It’s been a long and tiring journey – from panic buying to quarantine, COVID-19 has put humanity to the test again and again. However, with Pfizer and BioNTech’s announcement last November that the development of a COVID-19 vaccine had been successful, it seems like there is finally light at the end of the tunnel.
Although vaccination will greatly reduce transmission, there has been the question of who will be vaccinated first. Each country has created its own vaccine rollout strategy to divide and distribute doses, co-ordinating different phases that prioritise certain demographics. As each country allocates scarce resources uniquely, their strategies can sometimes seem quite controversial.
So, what makes an effective vaccine rollout strategy?
World Health Organisation (WHO) states that the overarching goal of COVID-19 vaccines is “to contribute significantly to the equitable protection and promotion of human wellbeing among all people of the world.” Although this aim is quite broad, it can be evaluated both practically and ethically against WHO’s six key principles: Human Wellbeing, Equal Respect, Reciprocity, National Equity, Global Equity and Legitimacy.
In terms of practicality, WHO states that vaccines should promote Human Wellbeing in two main ways. First, from a health perspective, vaccines should reduce deaths, contain transmission and increase immunity. Second, vaccines should reduce societal and economic disruption by protecting essential workers so that necessary services can continue to function.
Meanwhile, the ethical aspect of vaccines is addressed under the principles of Equal Respectand Reciprocity. That is, all individuals and groups are given equal consideration when deciding how to allocate vaccines. Moreover, countries have an obligation to protect the most vulnerable in society during this time. These criteria prevent groups – such as essential workers or those with pre-existing health conditions – from being underrepresented or neglected during the vaccination process.
The principles of National and Global Equityelaborate on how to take everyone’s interests into account. Specifically, WHO states that each country should ensure that vaccine prioritisation considers the societal, geographic and biomedical positions of different groups to best address their vulnerabilities and needs. Countries should do this by developing systems and infrastructure that ensure vaccines are equally accessible to priority groups and disadvantaged populations. Furthermore, as COVID-19 is a global pandemic, all countries are also responsible for considering the needs of people in low/middle income nations and committing to ensuring those people can be vaccinated.
This leads to the question of how do we know that each country’s rollout strategy is effective? WHO’s last principle, Legitimacy, states that the process for creating and implementing the strategy should be transparent. That is, each country should employ scientific evidence and expertise, as well as unbiased processes, when prioritising vaccine rollout. This principle is important because the public’s trust in vaccination and prioritisation relies on the country being accountable and clear on their values.
The UK Model for Vaccine Rollout:
For all the mishaps made by the UK Government throughout the course of the COVID-19 pandemic, so far, its vaccine rollout has been a rare success. According to Britain’s National Health Service, by the week ending 14th March, a total of 45.4% of the population aged 16 or older will have received at least one dose of a COVID-19 vaccine, and a further million people will have received a second dose – which is far above the world average of just over 5%.
Yet of those who have received a dose of the vaccine, a considerable 60% have gone to those aged 60 or older. This shouldn’t be surprising to readers, who have become accustomed to the idea that the elderly, and those more at risk of suffering severe symptoms, should receive the vaccine first. And why shouldn’t they? Logically speaking, this should minimise deaths, as those that are most at risk are protected. Early adoption and faster inoculation have also proved to be advantageous, bringing the UK population closer to herd immunity and eventually, an end to the pandemic.
A point of comparison, the Indonesian Model:
In sharp contrast to many other nations, Indonesia has adopted a policy targeting working aged citizens aged between 18 and 59, with even the Vice-President, Ma’ruf Amin, not receiving a vaccine due to his age (77). The decision to prioritise the inoculation of younger adults has in part been driven by the lack of research into the safety of the Chinese Sinovac vaccine for those over 60. A further rational for this policy is that citizens of working age are more likely to spread the virus. In theory, prioritising the inoculation of the working age population over the elderly can decrease overall transmission.
Another intriguing aspect of Indonesia’s vaccination rollout is their decision to allow private companies to offer vaccines to their staff. On one hand, it may be argued that allowing the private sector into the vaccine rollout process is not all too different from individuals having private health insurance and hence accessing sometimes preferential and improved health care in exchange for payment. This appears to be in stark contrast to the WHO guidance around ensuring that vaccines against COVID-19 are treated as a “global public good”. However, from a purely numerical standpoint, allowing private sector involvement may speed up the inoculation process leading to herd immunity, which would benefit the entire Indonesian population.
Country demographics play a key role in decision making
The primary role vaccines play can be argued to be the protection of the most vulnerable in society, and thus to prevent as many deaths as possible. Directly vaccinating the elderly population, and others at risk, is a simple and straightforward way to achieve this. An indirect route to minimising deaths is to vaccinate the young working age population and if enough are vaccinated herd immunity may be achieved. In Indonesia’s case this might just work.
With less than 5% of their entire population consisting of those aged older than 65, and a whopping 80% of their cases amongst the young working age population, it is no surprise that more people under the age of 60 have died of COVID compared to those older than 60. Given the booming developing economy of Indonesia is extremely hard to fully shutdown, it makes logical sense for the country to target the ‘super-spreaders’, those such as taxi drivers, police or hospitality workers, to prevent the rapid spread of COVID. Therefore, for Indonesia, this not only makes economic sense but more importantly, will help save lives and the livelihoods of their citizens.
Alongside a global health emergency leading to the upheaval of lives all over the world, the COVID-19 pandemic has also proven to be a challenge for experts in a multitude of fields. Among them, economists have been one of many parties involved in discussing and debating the allocation of vaccines and other health products, such as PPE. While the vaccine rollouts of the UK and Indonesia differ in many aspects, both have merits. On one hand, the UK has chosen to vaccinate the vulnerable first and has so far been able to distribute a much larger number of doses of the vaccine per capita. In contrast, Indonesia has begun the rollout with the young and allowed private companies to participate in the vaccination process. Ultimately, the complexity of rolling out a vaccine implies that any judgement will be partially values-based and demographic dependent, depending on what is most important to and what is possible for a government at a given point in time.
The CAINZ Digest is published by CAINZ, a student society affiliated with the Faculty of Business at the University of Melbourne. Opinions published are not necessarily those of the publishers, printers or editors. CAINZ and the University of Melbourne do not accept any responsibility for the accuracy of information contained in the publication.
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