Abstract
Prospective planning of COVID-19 vaccines allocation will be essential to maximize public health and societal benefits while preserving equity. Decisions about how to allocate limited supplies of vaccines need to be clear about the criteria used in setting priorities, with a specific commitment to transparency and communication. The aim of our study was to think through these competing demands, focusing on the opinion of healthcare workers (HCWs). The primary endpoint of the study was to assess the opinion of all the HCWs in a University based Italian Hospital about the fairest priority order to COVID 19 vaccines and to understand on which criteria the prioritization preferences of HCWs are implicitly based. The secondary endpoints were to assess whether HCWs approach differs from national guidelines and to assess the attitude of HCWs towards mandatory vaccination. An online survey accounting with multiple choice single answer questions and ranking questions was administered to all the HCWs of the University Hospital P. Giaccone of Palermo (Italy) and completed by a total of 465 participants. Almost all respondents confirmed the need for prioritization in COVID-19 vaccination for HCWs (n = 444; 95.5%), essential services and law enforcement (both n = 428; 92%). Clinically vulnerable individuals, HCWs and population over 65 years have been considered the first three groups to be involved in getting vaccination, being indicated as first position group by 26.5%, 32.5% and 21.9% of respondents, respectively. A large majority of respondents (85%) asked for a consistent, transparent and detailed order of priority at a national level. After adjusting for potential confounding due to sex and age, physicians have been found to be statistically significantly associated with the choice of mandatory vaccination (odds ratio (OR): 10.2; 95% confidence interval (CI) = 2.7–39.1) or with other strategies different from voluntary (OR = 7.2; 95% CI = 1.9–27.3). The broad consensus expressed by respondents towards mandatory vaccination for HCWs is extremely relevant at a time when vaccination hesitation is one of the biggest obstacles to achieving herd immunity. Data show a mismatch in the position attributed to long-term care residents compared to the position of absolute priority assigned by most of national distribution plans, impelling us to reflect on the issue of maximizing benefit from limited healthcare resources. Our findings clearly indicate a preference for COVID-19 frontline health professionals as the first tier of recipients, since they better meet all the criteria (higher risk, immediate system stability). As the guidelines are likely to directly affect a considerable number of citizens, our results call for policy interventions to inform people on the ethical rationale behind vaccine distribution decisions, to avoid resentment and feelings of unfairness.
Highlights
IntroductionDespite the worldwide effort to develop safe and effective COVID-19 vaccines and to ramp up production capacity, as effective vaccines become available demand is outstripping early supply.Prospective planning of vaccine allocation and of adequate logistics are essential to maximize public health and societal benefits while preserving equity.Most of the Western countries, including Italy, have already developed plans of distribution and have identified priority target groups for COVID-19 vaccines at different stages of supply availability [1,2,3,4].Decisions about how to allocate and prioritize limited supplies of vaccines must be guided by the best available evidences about the epidemiology of the virus, the clinical severity of COVID-19, the efficacy and safety of available vaccines and the administration procedures
Almost all respondents confirmed the need for prioritization in COVID-19 vaccination for healthcare workers (HCWs) (n = 444; 95.5%), essential services and law enforcement
Resource allocation is not a new topic emerging as a consequence of the recent COVID-19 pandemic
Summary
Despite the worldwide effort to develop safe and effective COVID-19 vaccines and to ramp up production capacity, as effective vaccines become available demand is outstripping early supply.Prospective planning of vaccine allocation and of adequate logistics are essential to maximize public health and societal benefits while preserving equity.Most of the Western countries, including Italy, have already developed plans of distribution and have identified priority target groups for COVID-19 vaccines at different stages of supply availability [1,2,3,4].Decisions about how to allocate and prioritize limited supplies of vaccines must be guided by the best available evidences about the epidemiology of the virus, the clinical severity of COVID-19, the efficacy and safety of available vaccines and the administration procedures. Despite the worldwide effort to develop safe and effective COVID-19 vaccines and to ramp up production capacity, as effective vaccines become available demand is outstripping early supply. Most of the Western countries, including Italy, have already developed plans of distribution and have identified priority target groups for COVID-19 vaccines at different stages of supply availability [1,2,3,4]. At the same time these decisions need to be clear about the criteria used in setting priorities, which means defining openly the objectives to pursue in vaccination strategies and which principles lay behind. The most commonly mentioned in the plans of distribution of COVID-19 vaccines of different countries and in ethical guidelines are the risk criterion, the utility criterion and the desert criterion [5,6,7,8]
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