The eventual arrival of a vaccine will bring with it a stark reality: there will be between 1.5 and 2 billion doses available for the nearly 8 billion people in the world. How to allocate the scarce and precious gift of prevention is the next issue lying in wait for the pharmaceutical industry and governments after a vaccine is developed.

The World Health Organization (WHO) has mandated an even distribution across the globe, with emphasis on those most at risk of death from Covid-19. Beyond that guidance, it is still a matter of balancing ethics, politics and the functioning of society. I listened to Ezekiel Emanuel, MD, PhD and ethicist from University of Pennsylvania today, then spoke with my friend Dr. David Nabarro, World Health Organization Special Envoy for Covid-19 and former top United Nations official responsible for Ebola and Avian Flu. Here is the direction that health authorities are giving:

  1. Put Vaccines Where They Will Do the Most Good — Countries with higher incidence of Covid-19 will get a disproportionate percentage of the vaccines.
  2. Health Workers and First Responders Will Be Prioritized — Those on the front lines should have it first – including cleaners and those who transport sick patients.
  3. Prioritize Those with Pre-Existing Conditions — Those with cancer, heart disease, obesity, diabetes and blood illness (sickle cell anemia) will be given vaccines first.
  4. Those Over 65 May Not Be First in Line — The theory is that the disadvantaged and poor are worse off than the middle- and upper-class elderly. There is concern about massive political backlash as if older people are expendable.
  5. Poverty Reduction as Criterion — This is a matter of fairness and respect. Where can we cut poverty rates, get children back to school to improve educational outcomes.
  6. Distribution Across Countries, Then Distribution Within Countries — The overall allocation comes on the basis of hot spots, then the political class and public health experts will have to decide on distribution.
  7. There Is Evolving Epidemiology — Today’s hot spots may not be equally hot tomorrow; the quiet places could erupt. Allocation will be changed based on disease spread.

This issue must be addressed in a public fashion in short order. I would bet that every person over 65 in the U.S. and other developed nations is expecting to get a vaccine. If this is not to be the case on the basis that the disadvantaged are at even more risk, then experts need to explain their decision process. The eventual success of a vaccine will hinge on the public’s trust in government. Our recent Edelman Trust Barometer Special Report: Workplace Trust and the Coronavirus, revealed that only two-thirds of people would take a government approved, no cost vaccine when available. India (83 percent) and South Korea (73 percent) are most receptive to a government approved vaccination while the U.S. (57 percent) and France (51 percent) would be the most hesitant.

PR folks should be aggressive within pharmaceutical companies and health care delivery entities to make the case for communicating now and through the spring. Yesterday, The New York Times reported that Pfizer and Moderna had broken their long-standing policy of secrecy surrounding clinical trials and released their “comprehensive road maps of how they are evaluating their vaccines.” Choices will be made, and voices need to be heard in the process.

Richard Edelman is CEO.