COMMENTARY

COVID Vaccine: Keep It for the US or Share With Other Countries?

Arthur L. Caplan, PhD

Disclosures

December 15, 2020

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This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the New York University School of Medicine.

We've all been hearing some good news about vaccines. It looks like some vaccines made by Pfizer and Moderna may be out for early approval. Hopefully, we will face a very important moral question: Who should get them first?

Remember that when a vaccine comes out with early approval, it means the data for safety and efficacy are incomplete, but it's looking good enough for the FDA to decide that there should be an emergency use permission for vaccines.

You still have incomplete information that is a little bit risky in that something could still show up. It might be that the vaccine's duration of efficacy, even though we've heard numbers like 90%, isn't that good and doesn't last more than a couple of months. It's unlikely, but there could be a safety issue that pops up after more than 2 months of monitoring the subjects.

In any event, there's certainly a lot of thought that many people are not going to take this vaccine with incomplete information or they're worrying about safety being incomplete. We hear that at least 40% of doctors and nurses saying they're not sure about a vaccine. I think if it comes out with 90% effectiveness, it's going to be something that many people are going to want.

There are really two ways to think about this. First, are we going to use most of the vaccine in the US that is approved early and subsequently gets licensed, or will it be shared internationally? Many people argue that it should be shared internationally because it makes sense both from a humanitarian and infection point of view. If you have big outbreaks in Europe, you don't want them spreading back here, so you may need to share with countries that are having flare-ups or outbreaks.

Unfortunately, the data upon which the vaccines are getting approved are not about infectivity but about whether the virus will harm or kill you. We're getting data demonstrating that if you're vaccinated, it looks like you don't get sick, but it doesn't mean you don't shed virus. If that's true, I think the case for sharing with other countries is weaker.

Morally, I think we have to protect first our own people at high risk for death, disability, and hospitalization. We have to try to protect the hospital system from getting overrun, given huge outbreaks. I think we're going to be using it domestically and I think that's morally justified.

Who goes first, then, if we're using it in the US? High-risk people. Because this is a vaccine that protects against death and disability, you want to take the people most likely to get harmed by the virus, including frontline healthcare workers, ICU and ER staff, doctors and nurses, people who clean rooms, and people who work in the hospital with high exposure for various reasons. They're going to have to go first, partly to protect the integrity of the healthcare system.

Then we're going to see other high-risk groups follow, including first responders, police, people with high exposure, people who are working in the food industry handling food — they've had heavy outbreaks — poor people, and minority people in some neighborhoods that seem to be especially ravaged by the virus.

Interestingly enough, there's a lot of consensus on who should go first. Exposure and risk seem to drive who it is. I don't think the general population is going to see this vaccine until next year, probably late in the spring or the summer. I do think we can agree on who it is: a high-risk healthcare worker; a high-risk first responder; or high-risk institutionalized, elderly, or disabled. They're the ones who are most likely to die. They're the ones who need protection.

What I would argue is that we're going to focus on our own in the US and we're going to focus on the high-risk folks in the short run.

Here's hoping that the vaccine pans out. The early reports are good, but let's hope that they stick. Let's hope that we really do have a tool that we can use to work our way out of this pandemic.

I'm Art Caplan at the New York University Division of Medical Ethics. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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