PT  - JOURNAL ARTICLE
AU  - Siddhanth Sharma
AU  - Nisrine Kawa
AU  - Apoorva Gomber
TI  - WHO’s allocation framework for COVAX: is it fair?
AID  - 10.1136/medethics-2020-107152
DP  - 2021 Apr 09
TA  - Journal of Medical Ethics
PG  - medethics-2020-107152
4099  - http://jme.bmj.com/content/early/2021/04/08/medethics-2020-107152.short
4100  - http://jme.bmj.com/content/early/2021/04/08/medethics-2020-107152.full
AB  - The COVID-19 Vaccines Global Access Facility (COVAX) represents an unprecedented global collaboration facilitating the development and distribution of vaccines for COVID-19. COVAX pools and channels funds from state and non-state actors to promising vaccine candidates, and has started to distribute successful candidates to participating states. The WHO, one of the leaders of COVAX, recognised vaccine doses would initially be scarce, and therefore, prepared a two-staged allocation mechanism they considered fair. In the first stage, vaccine doses are distributed equally among participating countries, while in the second stage vaccine doses will be allocated according to a country’s need. Ethicists have questioned whether this is the fairest distribution—they argue a country’s need should be taken into account from the start and correspondingly, have proposed a framework that treats individuals with equal moral concern, aims to minimise harm and gives priority to the worst-off. In this paper, we seek to explore these concerns by comparing COVAX’s allocation mechanism to a targeted allocation based on need. We consider which distribution would more likely maximise well-being and align with principles of equity. We conclude that although in theory, a targeted distribution in proportion to a country’s need would be more morally justifiable, when political realities are taken into account, an equal distribution seems more likely to avert a greater number of deaths and reduce disparities.Data are available in a public, open access respository.