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Illustration: Annelise Capossela/Axios

All lives are equally valuable. That's the strong consensus emerging from the many different countries and organizations that have struggled with the question of who should get first access to the COVID-19 vaccine.

Why it matters: The current scarcity of the vaccine looks like an economics problem — too much demand, and not enough supply. But no one is seriously proposing a market-based solution, where the vaccine goes first to those willing and able to pay to jump to the front of the line.

The big picture: The National Academies of Sciences, Engineering and Medicine have constructed an ethical framework based on three considerations.

  • Maximum Benefit means that the vaccine rollout should be designed to save the most lives, care first for those most in need, and prevent new infections. It does not include any economic considerations.
  • Equal Concern is the principle that "every person has equal dignity, worth, and value." This principle makes it impossible to look at economic concepts like "life-years," which, as the American College of Physicians points out, are "inherently biased against the elderly and the disabled."
  • Mitigation of Health Inequities means that populations experiencing the greatest burden from the disease should receive priority.

Details: No vaccination program will manage to abide perfectly by these ethical standards. If individual states receive vaccine allocations according to their overall population, for instance, that would violate the third principle. Maine's population is much older than Utah's, and Montana's population is much whiter than Mississippi's. But age and race are highly correlated with vulnerability to COVID-19.

  • There is universal agreement, however, that health workers and people in nursing homes should get the vaccine first, and that there should be no formal mechanism whereby individuals can buy early access to the vaccine.

What to watch: Rich people will get early access to the vaccine, just as they are currently getting access to antibody therapies. By the time the World Economic Forum holds its annual meeting in Singapore in May, it's a safe bet that many delegates will have managed to get themselves vaccinated somehow. (Which will surely come as a relief to Singapore's public-health agencies.)

  • Such vaccinations will probably be accompanied by sheepishness, however, since they will clearly be unfair.

Between the lines: Ethical considerations seemingly stop at national borders. Vaccine allocation according to ability to pay is shameful within countries — but has already largely determined vaccine distribution between countries.

  • Of note: The opportunity cost — measured in dollars — of taking the ethical path is impossible to calculate with specificity, but is certainly enormous. A GDP-maximizing algorithm would give large early allocations to healthy high-earners and would place little comparative value on the lives of the elderly.

The bottom line: We've finally reached a point at which there is an unambiguous tradeoff between economic activity and public health. To our credit, we've chosen the latter.

Go deeper

Jan 29, 2021 - World

EU grants conditional approval of AstraZeneca vaccine

Photo: Sunil Ghosh/Hindustan Times via Getty Images

The European Commission on Friday granted conditional approval of the Oxford-AstraZeneca coronavirus vaccine for people 18 years and older.

Why it matters: This is the third vaccine to receive approval from the commission, coming hours after the Emergency Medicines Agency recommended its authorization.

Jan 29, 2021 - Health

WHO says most pregnant women can now receive coronavirus vaccine

A doctor administering Moderna's coronavirus vaccine at a university hospital in Essen, Germany, on Jan. 18. Photo: Lukas Schulze/Getty Images

The World Health Organization has altered its guidance for pregnant women who wish to receive the coronavirus vaccine, saying now that those at high risk of exposure to the COVID-19 or who have comorbidities that increase their risk of severe disease, may be vaccinated.

Why it matters: The WHO drew backlash for its previous guidance that did not recommend pregnant women be inoculated with vaccines made by Pfizer-BioNTech or Moderna, even though data indicated that pregnancy increased the risk of developing severe illness from the virus.

Updated 7 hours ago - Politics & Policy

Omicron dashboard

Illustration: Shoshana Gordon/Axios

  1. Health: CDC director says number of U.S. Omicron cases "likely to rise" — Two years of COVID-19 — Prior coronavirus infections may not protect well against Omicron.
  2. Vaccines: Data demonstrates most-vaccinated counties less vulnerable to worst of COVID — Omicron adds urgency to vaccinating world — Omicron fuels the case for COVID boosters.
  3. Politics: Nevada to impose insurance surcharge on unvaccinated state workers — New Jersey GOP lawmakers defy statehouse COVID policy — Oklahoma sues Biden administration over Pentagon vaccine mandate.
  4. World: Vaccine mandates lose steam in the U.S. while Europe doubles downWHO: Delta health measures help fight Omicron — COVID cases surge in South Africa in sign Omicron wave is coming.
  5. Variant tracker: Where different strains are spreading.