Fair Allocation of Scarce Therapies for Coronavirus Disease 2019 (COVID-19)

Area of Science:

• Public Health
• Medical Ethics
• Infectious Disease Management

Background:

• The US FDA issued emergency use authorizations for COVID-19 therapies, including monoclonal antibodies and oral antivirals.
• Increased demand due to variants led to federal control and rationing of these critical treatments.
• Future variants may necessitate continued or intensified rationing of scarce medical resources.

Purpose of the Study:

• To identify ethical principles for allocating scarce COVID-19 therapies.
• To propose priority groups for accessing these treatments.
• To advocate for an improved allocation strategy over current methods.

Main Methods:

• Identification of relevant ethical principles: benefiting people, preventing harm, equal concern, and mitigating health inequities.
• Integration of population health and medical factors to define priority groups.
• Analysis of current allocation strategies based on vaccination, immunocompromise, age, or clinical risk factors.

Main Results:

• Proposed priority groups include healthcare workers and disadvantaged communities disproportionately affected by COVID-19.
• An integrated approach to population health and medical factors offers a framework for allocation.
• The proposed strategy aims to operationalize ethical values in resource allocation.

Conclusions:

• Prioritizing access to scarce COVID-19 therapies based on ethical principles and integrated factors is essential.
• This approach is superior to current methods relying on categorical exclusion/inclusion or ad hoc risk assessment.
• Effective allocation strategies are vital for mitigating health inequities during pandemics.