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COVID-19 vaccination status should not be used in triage tie-breaking
  1. Olivia Schuman,
  2. Joelle Robertson-Preidler,
  3. Trevor M Bibler
  1. Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Olivia Schuman, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA; olivia.schuman{at}


This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.

  • COVID-19
  • ethics- medical
  • resource allocation

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  • Contributors OS initiated the paper and wrote all drafts of the paper and is its guarantor. JR-P contributed to the theoretical framing, research and editing. TB contributed to the research, conceptual analysis and editing of the paper. All authors approved of the final version.

  • 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.

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

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