Ethical framework for COVID-19 vaccine distribution

Using the ethical principles outlined below to guide COVID-19covid 19 vaccine prioritization and distribution decisions and decision-making processes is critical for ethical and effective distribution and will help to promote consistency, stewardship, accountability, and public trust.

Appreciating that the application of the following principles will to an extent be context-dependent and that other values and principles may be relevant to decision-making, this framework should serve as a guide and be adapted where appropriate.

All levels of government have a legal obligation to take preventative steps to stop the spread of COVID-19covid 19 and treat people without discrimination. Vaccine distribution and prioritization decisions must comply with existing human rights protections and take additional steps necessary to prevent and treat COVID-19covid 19 among vulnerable groups. This Ethical Framework therefore should be read in conjunction with the Ontario Human Rights Commission’s Policy statement on a human rights-based approach to managing the COVID-19covid 19 pandemic.

Minimize harms and maximize benefits

• Reduce overall illness and death related to COVID-19covid 19
• Protect those at greatest risk of serious illness and death due to biological, social, geographical, and occupational factors
• Protect critical infrastructure
• Promote social and economic well-being

Equity

• Respect the equal moral status and human rights of all individuals
• Distribute vaccines without stigma, bias, or discriminationSee Ontario’s Human Rights Code and specifically Part 1 for Code-protected groups
• Do not create, and actively work to reduce, disparities in illness and death related to COVID-19covid 19, including disparities in the social determinants of health linked to risk of illness and death related to COVID-19covid 19Consider applying the Ministry of Health’s Health Equity Impact Assessment decision support tool to identify potential health equity impacts
• Ensure benefits for groups experiencing greater burdens from the COVID-19covid 19 pandemic

Fairness

• Ensure that every individual within an equally prioritized group (and for whom vaccines have been found safe and effective) has an equal opportunity to be vaccinated
• Ensure jurisdictional ambiguity does not interfere with vaccine distribution (e.g., Jordan’s Principle)See Jordan's Principle
• Ensure inclusive, consistent, and culturally safe and appropriate processes of decision-making, implementation, and communications

Transparency

• Ensure the underlying principles and rationale, decision-making processes, and plans for COVID19 vaccine prioritization and distribution are clear, understandable, and communicated publicly

Legitimacy

• Make decisions based on the best available scientific evidence, shared values, and input from affected parties, including those historically under-represented
• Account for feasibility and viability to better ensure decisions have intended impact
• To the extent possible given the urgency of vaccine distribution, facilitate the participation of affected parties in the creation and review of decisions and decision-making processes

Public Trust

• Ensure decisions and decision-making processes are informed by the above principles to advance relationships of social cohesion and enhance confidence and trust in Ontario’s COVID-19covid 19 immunization program