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Multivalue ethical framework for fair global allocation of a COVID-19 vaccine
  1. Yangzi Liu1,
  2. Sanjana Salwi1,
  3. Brian C Drolet2
  1. 1 School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
  2. 2 Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Ms Yangzi Liu, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; yangzi.liu{at}


The urgent drive for vaccine development in the midst of the current COVID-19 pandemic has prompted public and private organisations to invest heavily in research and development of a COVID-19 vaccine. Organisations globally have affirmed the commitment of fair global access, but the means by which a successful vaccine can be mass produced and equitably distributed remains notably unanswered. Barriers for low-income countries include the inability to afford vaccines as well as inadequate resources to vaccinate, barriers that are exacerbated during a pandemic. Fair distribution of a pandemic vaccine is unlikely without a solid ethical framework for allocation. This piece analyses four allocation paradigms: ability to develop or purchase; reciprocity; ability to implement; and distributive justice, and synthesises their ethical considerations to develop an allocation model to fit the COVID-19 pandemic.

  • distributive justice
  • clinical ethics

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  • Correction notice This paper has been updated since first published to amend name of

    'Brian C. Drolet'.

  • Contributors YL and SS contributed to research, analysis and writing of the manuscript. BD contributed to analysis, writing and critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.