Penn Bioethics Seminar Series (PBS): Brittany Johnson, BS, MD candidate

A Utilitarian COVID-19 Vaccine Allocation Strategy: Prioritizing Prevention of Transmission Over Prevention of High-Risk Infection 

Brittany Johnson, BS, MD candidate at the University of Alabama School of Medicine 

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Description: The number of COVID-19 vaccines initially produced will not be sufficient to achieve herd immunity or eliminate community viral spread in America. It is paramount to distribute vaccines quickly and broadly through an allocation process that maximizes the benefit of this scarce resource. Still, the vaccine rollout process has been fraught with logistical challenges, resulting in widespread frustration as Americans await vaccination. Allocation frameworks proposed by leading health authorities, including the Centers for Disease Control (CDC) and the National Academies of Sciences, Engineering, and Medicine (NASEM), prioritize the vaccination of medically high-risk individuals before those most likely to transmit infection. However, epidemiologic data show that the medically high-risk demographic plays a small role in viral transmission, suggesting that implementation of the proposed strategies will have minimal impact on viral spread and will likely prolong the pandemic. 

This paper presents an evidence-based argument for a utilitarian vaccine allocation framework that prioritizes prevention of COVID-19 transmission over prevention of high-risk infection. We argue that transmission-focused vaccine allocation not only maximizes utility, but also secondarily protects high-risk persons via lower community transmission rates. Our proposed framework ultimately achieves the stated aims of CDC and NASEM plans while additionally reducing overall infection rates and subsequent morbidity and mortality. We develop a point system to determine the vaccination priority of any individual based on an assessment of risk factors that predispose infected persons to transmit COVID-19. We argue that immediate distribution of COVID-19 vaccines to healthcare workers, residents and employees of nursing homes, homeless shelters, prisons, college dormitories, and certain essential workers is the fastest, most ethical way to reduce the burden of COVID-19 on the nation.

Bios: Brittany Johnson, BS, studied biology and English at the University of Alabama and graduated with a Bachelor of Science in 2018. She is currently a 3rd year MD candidate at the University of Alabama at Birmingham School of Medicine. Her past research includes work in oncology at Oxford University and high-risk obstetrics. She is interested in bioethics, women’s health, and the intersection of art and medicine. Following graduation in 2022, she plans to pursue a career as a clinician-scientist in the field of maternal-fetal medicine.

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