Priority Setting during the COVID-19 Pandemic: Going Beyond Vaccines

Successful vaccination against the SARS-CoV-2 virus is a decisive development in the international response to the pandemic. It also has substantial implications for how governments and international bodies deploy their resources, as major decisions will need to be made in a fast-moving and uncertain environment. Current trends in vaccine development have stimulated much commentary on how vaccines deemed to be the safest and most effective should be allocated, both at the global level (to ensure access for low-income countries) and within countries (to prioritise critical personnel and the most vulnerable population groups). We recognise the importance of mass vaccination as a public health measure, and the crucial need to promote equity and solidarity across countries. We also recognise that prioritisation is required within countries so that resources are directed to best protect life, reduce inequities and increase public confidence. However, based on analysis of the COVID-19 response so far, we would argue that at least three additional forms of prioritisation are required: between vaccines; between vaccines and other elements of the pandemic response; and between COVID-19 and other areas of health provision. In each case, decision makers should concentrate as much on infrastructure and implementation as on principles of resource allocation.