Fair Allocation of Vaccines, Ventilators and Antiviral Treatments: Leaving No Ethical Value Behind in Healthcare Rationing

Abstract

A priority system has traditionally been the protocol of choice for the allocation of scarce life-saving resources during public health emergencies. COVID-19 revealed the limitations of this allocation rule. Many argue that priority systems abandon ethical values, such as equity, by discriminating against disadvantaged communities. We show that a restrictive feature of the traditional priority system largely drives these limitations. Following minimalist market design, an institution design paradigm that integrates research and policy efforts, we formulate pandemic allocation of scarce life-saving resources as a new application of market design. Interfering only with the restrictive feature of the priority system to address its shortcomings, we formulate a reserve system as an alternative allocation rule. Our theoretical analysis develops a general theory of reserve design. We relate our analysis to debates during COVID-19 and describe the impact of our paper on policy and practice. This paper was accepted by Axel Ockenfels, behavioral economics and decision analysis.