Ethical Considerations and Challenges Duringthe COVID-19 Vaccine Deployment: Experiences from an Indian Perspective

Introduction: There is a continued quest towards developing protective vaccines to halt and end the global pandemic of COVID-19 with the research predominantly driven by the developed world. Induction of herd immunity requires mass vaccination, and any avoidable delays would cause enormous health and economic losses. However, developing countries will experience extensive vaccine allocation challenges due to limited indigenous manufacturing and cold chain facilities. Methods: Literature searches were conducted on MEDLINE (accessed by PubMed).The reference list of the selected articles was also screened to find other relevant articles with an emphasis on ethical consideration in COVID-19 vaccine deployment and distribution. Results: Most developing countries are likely to face shortage and consequent uncertainty over timely COVID-19 vaccine availability. Developing countries are also at risk of significant pre-existing vaccine hesitancy and also compromising justice because of the socioeconomic divide, enabling the rich to access retail vaccines before the poor. Finally, the recommended measures for implementing a mandatory vaccination policy are mostly devoid of feasibility in the global south. We identified ethical challenges and their feasibility of resolution by establishing ethically valid mechanisms for allocation and distribution of COVID-19 vaccine as a scarce resource in these resource-constrained settings. Ethical frameworks for assessing government measures towards vaccinating their respective populations are limited in their scope due to scientific uncertainty with regards to the timeliness of vaccine availability and the unpredictable frequency and severity of vaccine-related adverse effects. Conclusion: governments may escape moral culpability despite failing to ensure adequacy and timeliness of vaccination coverage in the absence of specific and measurable ethical benchmarks developed as part of a robust ethical framework.