Table 1

Four schemes of vaccine allocation

Global models	Bioethics models
COVAX fair allocation mechanism This mechanism relates to the distribution of COVID-19 vaccines to countries on the basis of vulnerability according to three criteria: The number of front-line health workers. The proportion of people over the age of 65. The number of comorbidities in the country.	Nuffield Council on Bioethics This proposal offers an ‘ethical compass’ of three broadly shared values in determining allocation of scarce resources during the pandemic: Ensuring equal respect, dignity and human rights. Helping to reduce suffering of those who are sick or otherwise in need. Maintaining fairness through both non-discriminatory treatment of others and equitable distribution of benefits and burdens.
WHO/SAGE values framework The overarching goal of this framework is ‘for COVID-19 vaccines to contribute significantly to the equitable protection and promotion of human well-being among all people of the world’, and human rights are recognised as key guiding principles.	Fair Priority Model5 This model is underscored by three fundamental values: Benefiting people and limiting harm. Prioritising the disadvantaged. Equal moral concern. It focuses on three types of harms: Harm to individual health. The increased strain on healthcare systems, and the impact it has on particular health conditions. Global socioeconomic harm. Vaccines should be allocated in three phases, prioritising the prevention of more urgent harms in earlier phases.

Global models

Bioethics models

COVAX fair allocation mechanism
This mechanism relates to the distribution of COVID-19 vaccines to countries on the basis of vulnerability according to three criteria:

The number of front-line health workers.
The proportion of people over the age of 65.
The number of comorbidities in the country.

Nuffield Council on Bioethics
This proposal offers an ‘ethical compass’ of three broadly shared values in determining allocation of scarce resources during the pandemic:

Ensuring equal respect, dignity and human rights.
Helping to reduce suffering of those who are sick or otherwise in need.
Maintaining fairness through both non-discriminatory treatment of others and equitable distribution of benefits and burdens.

WHO/SAGE values framework
The overarching goal of this framework is ‘for COVID-19 vaccines to contribute significantly to the equitable protection and promotion of human well-being among all people of the world’, and human rights are recognised as key guiding principles.

Fair Priority Model5
This model is underscored by three fundamental values:

Benefiting people and limiting harm.
Prioritising the disadvantaged.
Equal moral concern.

It focuses on three types of harms:

Harm to individual health.
The increased strain on healthcare systems, and the impact it has on particular health conditions.
Global socioeconomic harm.

Vaccines should be allocated in three phases, prioritising the prevention of more urgent harms in earlier phases.