Rationing vaccine in a pandemic: Political support in the US for vaccine donations

Currently, access to vaccines during a pandemic is dependent on nations' ability to pay for doses. This raises a social justice issue in which populations in poorer nations may have similar risk as populations in richer nations, but have no access to the vaccine. During the 2009 H1N1 pandemic, the US and some other countries placed orders taking into account that two doses could be required to provide immunity. By late January, 147 million doses had been allocated in the US, and the public was being encouraged to get vaccinated. However, poorer nations, including at-risk populations, remain dependent on donations by countries and vaccine manufacturers, organized through the World Health Organization (WHO). Shipments from the WHO are contingent on countries having a national vaccine deployment plan. Would public attitudes in richer nations facilitate or present a barrier to equitable access to vaccines for people at equal risk around the world? To gauge support for donation of vaccines by the US to poorer countries, we conducted a national survey (n=2078) in which we asked respondents if the US should donate vaccine, and if yes, whether donations should occur 1) after those at-risk in the US have received vaccine, or 2) after those who want vaccine in the US have got it, or 3) coincident with access for at-risk groups in the country. The severity of the pandemic will inevitably play a role in attitudes. However, our results enable a discussion of political support for social justice principles in rationing vaccines.