When a COVID-19 vaccine is available, experts say there won't be enough to administer to everyone right away. So, who should get the COVID vaccine first? That is the question scientists and leaders are trying to answer.

“It depends on the particular pandemic. In the past, groups have been designated according to their risk factor. Sometimes because they’re older or have certain chronic conditions," says Nicole Hassoun, Professor of Philosophy at Binghamton University and a bioethicist, "It depends on whose guidelines we’re going to follow how we’ll ration this time around. The National Academies of Sciences has recently proposed some allocation criteria for the United States I guess at the request of the Center for Disease Control, so I think it is very likely that we’ll be allocating according to their guidelines.”

The National Academies of Sciences, Engineering, and Medicine put out their draft report on the vaccine allocation in early September. The rationing plan they've laid out is in four phases. 

"So, the first group that would get the vaccine are critical care workers, people who have multiple co-morbid conditions that increase their risk a lot and older adults who live in care facilities," says Hassoun. 

Phase two would include teachers and school staff, prisons and homeless shelters along with older adults who may not have gotten it the first time around. The third phase will open up availability to children and young adults working in essential jobs. The fourth phase is when the rest of the population would be eligible. All of this will be done prioritizing those with lower incomes or in more vulnerable areas. 

Hassoun says there are a few issues she has with the proposal. 

“The elderly who are not poor and who are not living in care homes, but are high risk of death from the virus wouldn’t get the vaccine in phase one and the proposal also gives more priority to young adults and children rather than those of us working and supporting families because they pose a heightened risk of transmission," says Hassoun. 

Hassoun says that's just one concern many bioethicists have, but in addition to allocation, she says she's most concerned about the production of the vaccine itself. Hassoun says because of the issue of patents in the pharmaceutical industry, there are companies that could help make more of the vaccine, but won't be allowed to. 

"Which means we’re not using 80% of our manufacturing capacity, which I just find outlandish and one of the biggest ethical issues for me is how can we not expand access to the vaccine by utilizing our full manufacturing capacity," says Hassoun. 

There are a variety of vaccine rationing plans internationally as well. Hassoun says those plans have to deal with divvying up the vaccine among the countries.