The World Health Organization (WHO) has released a preliminary framework for the global allocation of COVID-19 vaccines when they become available. The plan is intended to guide policymakers at the global, regional, and national level in their allocation and prioritization decisions about vaccines.
WHO’s “fair allocation mechanism” emphasizes equitable allocation of vaccines and lists groups of people that should have priority access. The plan proposes vaccine distribution in two phases. In the first phase, all countries would receive vaccine doses in proportion to their population size - initially enough quantities to immunize 3 percent of their population with priority given to frontline medical workers and then additional doses until 20 percent of a nation’s population is immunized. In the second phase, vaccines to cover additional populations would be distributed to countries based on the country’s “COVID threat and vulnerability.” The WHO framework developed by its Strategic Advisory Group of Experts on Immunization calls for higher income countries to ensure that lower income countries receive vaccines in the early days of allocation.
WHO announced on September 21 that countries representing nearly two-thirds of the world’s population have joined its plan to fairly allocate COVID-19 vaccines. High-income countries that have joined WHO’s list of partners in the COVID-19 Vaccines Global Access (COVAX) Facility includes Canada, Japan, New Zealand, and Peru. Notably, China and the United States have not signed on. Many questions still remain on how the distribution plan will be implemented and how other higher income countries would be persuaded to join.
The WHO guidance follows a similar draft plan released earlier this month by the National Academies of Sciences, Engineering and Medicine (NASEM) which not only identifies priority groups but also ranks them in order of who should get vaccinated first. The NASEM framework proposes a five-phase plan to allocate vaccines, recommending that health-care workers and first responders be the first to be vaccinated, followed by people with underlying conditions and older people in densely populated settings, then essential service workers - such as teachers, grocery-store, transit and postal workers - and people in homeless shelters and prisons, then young adults and children at increased risk of exposure, and finally all remaining residents.
The NASEM plan also addresses people from minority groups who are over-represented in essential service jobs and have disproportionately higher rates of infection. “We really are trying to make sure that people of color, who have been disproportionately impacted, will also have priority – but for the factors that put them at risk, not highlighting just their racial and ethnic makeup,” said Helene Gayle, Co-chair of the NASEM panel that authored the plan.
The NASEM committee is expected to release their final guidance, which was requested by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, in October. CDC will consider NASEM’s recommendations in developing its own vaccine-allocation plan. The WHO strategic advisory group will continue to update its plan, including assigning rankings to its priority groups and incorporating new data from vaccine trials.