Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States

Publication Date

August 19, 2020

Page Number

Link to Report




The COVID-19 pandemic will continue for the foreseeable future, but widespread vaccination could hasten its end.  “At least 165 candidate vaccines…are in development worldwide,” and there is hope that one or more will soon be shown to be sufficiently safe and effective to achieve emergency use authorization.  When it is authorize, it will initially be in limited supply.  A plan is needed for how to allocate and distribute this limited supply.  This report offers an ethics framework for decisions, considering medical risk, public health, equity, economic impact, and logistics.

The framework emphasizes the common good, recognizing contributions of essential workers, treating individuals fairly, and promoting social equity.  The Top Allocation Tier should include those most essential in sustaining the COVID-19 response, those at greatest risk of severe illness or death and their caregivers, and those most essential in maintaining core society functions.  The Second Tier should include those involved in broader health provision, those who face barriers to care if they become seriously ill, those contributing to maintaining core societal functions, and those with living or working conditions giving them elevated risk of infection.  Initial vaccine supply will likely be insufficient for everyone in Tier 1 and Tier 2, and priorities will likely have to be made within tiers.

The time between when the vaccine is authorized and when widely available will likely vary around the world: in wealthy countries like the US it may be a matter of months.  “In low- and middle-income countries, this period could last much longer despite aggressive global efforts to have 2 billion doses available by the end of 2021.”

Note:  Although the report is aimed at the US, this framework could apply to any country.  Also see “What if the First Coronavirus Vaccines Aren’t the Best?”  (New York Times, 1 Sept 2020, D8), on different approaches to vaccine development, and the possibility that even with cheap and effective vaccines against COVID-19, “with an abundance of other coronaviruses lurking in wild animals, another COVID-like pandemic may not be far off.”   Some “universal” coronavirus vaccines under development, however, might protect people from an array of the viruses.