Introduction
The extent of severe illness from Covid-19 has overwhelmed the health care infrastructure in several countries. Shortages of diagnostic tests, personal protective equipment, hospital beds, mechanical ventilators, and some treatments have forced health care systems to make difficult allocation decisions. The first safe and effective vaccines are now authorized for use in many countries, but their supply is limited within and across countries.
A number of countries and international organizations have published guidelines and protocols for priority setting during the pandemic. Below we list them by region.
World Health Organization (WHO) Guidelines
Coronavirus disease (COVID-19): Vaccine access and allocation, 28 October 2020
Ethics and COVID-19: resource allocation and priority-setting, 2020
Managing Ethical Issues in Infectious Disease Outbreaks, 2016.
Ethical Considerations in Developing a Public Health Response to Pandemic Influenza, 2007.
AFRICA
ALGERIA
BENIN
- Public Health Guidelines and protocols provided by the Health Ministry (available in French only)
BOTSWANA
Treatment
- Ministry of Health and Wellness, Botswana COVID-19 Guideline 4: Interim clinical guidance for the management of patients with Coronavirus disease 2019 (COVID-19) in Botswana, May 2020.
Public Health Guidelines
- Republic of Botswana, COVID 19 Task Force, Guidelines: Document Library.
- Ministry of Health and Wellness, Botswana COVID-19 Guideline 6: Contact Tracing, May 2020.
- Ministry of Health and Wellness, Botswana COVID-19 Guideline 5: Quarantine and Isolation, May 2020.
CAPE VERDE
- Overview of COVID-19 related documents (available in Portugese only)
UNION OF COMOROS
- Overview of COVID-19 related information (available in French only)
COTE D’IVOIRE (IVORY COAST)
- Ministère de la Santé, de l’Hygiène Publique et de la Couverte Maladie Universelle, Overview of COVID-19 related documents (available in French only)
REPUBLIC OF DJIBOUTI
- Ministère de la Santé Djibouti, Overview of COVID-19 related information (available in French only)
ETHIOPIA
Public Health Guidelines
- National Public Health Emergency Operating Center COVID-19 Emergency Preparedness and Response, Minimum standards for quarantine, isolation and treatment centers in Ethopia, Last accessed: 19.03.2021.
- Federal Ministry of Health (FMOH), National Comprehensive COVID19 Management Handbook, April 2020.
REPUBLIC OF SOUTH AFRICA
Treatment
- Critical Care Society of Southern Africa (CCSSA), Allocation of Scarce Critical Care Resources During the COVID-19 Public Health Emergency in South Africa, April 2nd, 2020.
Vaccines
- Department of Health, COVID-19 Vaccination Messaging Guidelines, March 2021, Last accessed: 19.03.2021.
- South African Government, COVID-19 Coronavirus vaccine strategy, Last accessed: 19.03.2021.
Public Health Guidelines
- The South African Medical Association (SAMA), SARS-CoV-2 (COVID-19) Guidance for Managing Ethical Issues, April 7, 2020.
AMERICAS
- Pan American Health Organization (PAHO), Ethics guidance on issues raised by the novel coronavirus disease (COVID-19) pandemic, March 18, 2020.
BRAZIL
Public Health Guidelines
- Plano Nacional de Operacionalização da Vacina contra a Covid-19, Ministério da Saúde, Brasil, 21 January 2021 (in Portuguese)
CANADA
Treatment
- Ontaria Health, Clinical Triage Protocol for Major Surge in COVID Pandemic, March 2020, Last accessed: 19.03.2021.
- Canadian Critical Care Society, Clinical Managament of Patients with COVID-19 – 2nd Interim Guidance, August 17 2020, Last accessed: 19.03.2021.
Vaccines
- Guidance on the prioritization of initial doses of COVID-19 vaccine(s), National Advisory Committee on Immunization, 18 December, 2020.
Public Health Guidelines
- Government of Canada, Public health ethics framework: A guide for use in response to the COVID-19 pandemic in Canada, Last accessed: 19.03.2021.
- British Columbia, British Columbia’s Pandemic Influenza Response Plan, 2012.
- Ontario Health Plan for an Influenza Pandemic Working Group, Critical Care During a Pandemic, April 2006.
USA
Treatment
- Society of Critical Care Medicine, Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19), March 28, 2020.
- U.S. Centers for Disease Control and Prevention, Ethical Considerations for Decision Making Regarding Allocation of Mechanical Ventilators during a Severe Influenza Pandemic or Other Public Health Emergency, July 1, 2011.
- Washington State Department of Health, Scarce Resource Management and Crisis Standards of Care, 2020.
Vaccines
- U.S. Centers for Disease Control and Prevention, The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020, November 23, 2020.
Public Health Guidelines
- American Medical Association, AMA Code of Medical Ethics: Guidance in a Pandemic
- American Nursing Association, Adapting Standards of Care Under Extreme Conditions, March 2008.
- HHS Office for Civil Rights in Action, Bulletin: Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19), March 28, 2020.
- U.S. Centers for Disease Control and Prevention: Ethical Guidelines in Pandemic Influenza, February 15, 2007.
- Veteran’s Health Administration, Meeting the Challenge of Pandemic Influenza: Ethical Guidelines for Leaders and Health Care Professionals in the Veterans Health Administration, July 2010.
- Berlinger et al., Ethical Framework for Health Care Institutions and Guidelines for Institutional Ethics Services Responding to the Novel Coronavirus Pandemic, The Hastings Center, March 16 2020.
State guidelines
- California Department of Public Health, California SARS-CoV-2 Pandemic: Health Care Surge Crisis Care Guidelines – Concept of Operations, April 2020.
- New York State Task Force on Life and the Law, Ventilator Allocation Guidelines, November 2015.
- Indiana State Department of Health, Crisis Standards of Patient Care Guidelines with an Emphasis on Pandemic Influenza: Triage and Ventilator Allocation Guidelines, April 2014.
- Indiana University Center for Bioethics, Pandemic Flu Preparedness: Ethical Issues and Recommendations to the Indiana State Department of Health, August 2007.
- Florida Department of Health, Pandemic Influenza: Triage and Scarce Resource Allocation Guidelines, April 5, 2011.
- Minnesota: Dorothy E. Vawter et al, For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic, 2010.
- South Carolina Pandemic Influenza Ethics Task Force, South Carolina Prepares for Pandemic Influenza, September 2009.
- Utah Hospitals and Health Systems Association, Utah Pandemic Influenza Hospital and ICU Triage Guidelines, August 11, 2009.
- North Carolina Institute of Medicine, Stockpiling Solutions: North Carolina’s Ethical Guidelines for an Influenza Pandemic, April 1, 2007.
Hospital guidelines and protocols
- University of Pittsburgh, Department of Critical Care Medicine, Allocation of Critical Care Resources During a Public Health Emergency, March 23, 2020.
- Nancy Berlinger et al, Ethical Framework for Health Care Institutions and Guidelines for Institutional Ethics Services Responding to the Novel Coronavirus Pandemic, The Hastings Center, March 16, 2020.
- John L. Hick et al., Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2, National Academy of Medicine, March 5, 2020.
ASIA
SAUDI ARABIA
Treatment
- The Saudi Critical Care Society, Clinical Practice Guidelines on the Management of COVID-19 Patients in the Intensive Care Unit, November 2020, Last accessed: 11.04.2021.
Vaccines
- Ministry of Health, Priority Groups for COVID-19 Vaccination, December 2020, Last acccessed: 11.04.2021.
Public Health Guidelines
- Ministroy of Health, COVID-19 Guidelines (several guidelines available, which are updated on a continuous basis), Last accessed: 11.04.2021.
SINGAPORE
Treatment
Vaccines
Public Health Guidelines
- Recommendations of the Expert Committee on COVID-19 Vaccination, Ministry of Health, Singapore, 27 December 2020
AUSTRALASIA
Treatment
Vaccines
- Australian Technical Advisory Group on Immunisation (ATAGI), Preliminary advice on general principles to guide the prioritisation of target populations in a COVID-19 vaccination program in Australia, Last accessed: 11.04.2021
Public Health Guidelines
- New South Wales, Health Influenza Pandemic Plan, May 26, 2016.
- COVID-19 Vaccine and Treatment Strategy, Department of Health, Australia
- COVID-19 Vaccine Strategy, Ministry of Business, Innovation & Employment, New Zealand
EUROPE
Treatment
Vaccines
- European Centre for Disease Prevention and Control, COVID-19 vaccination and prioritisation strategies in the EU/EEA, 22 December 2020
- European Commission, Preparedness for COVID-19 vaccination strategies and vaccine deployment, 15 October 2020
Public Health Guidelines
- European Medicines Agency (EMA), Public-health advice during COVID-19 pandemic, Last accessed: 19.03.2021.
AUSTRIA
Treatment
- Allokation intensivmedizinischer Ressourcen aus Anlass der Covid-19 Pandemie (German only), ARGE Ethik ÖGARI, March 17 2020.
Vaccines
Public Health Guidelines
BELGIUM
Treatment
- Ethical principles concerning proportionality of critical care during the 2020 COVID-19 pandemic in Belgium, Belgian Society of Intensive Care Medicine, March 18 2020.
Vaccines
Public Health Guidelines
FRANCE
Treatment
Vaccines
Public Health Guidelines
- Stratégie de vaccination contre le Sars-Cov-2, Haute Autorité de Santé, 30 November 2020
- Une Strategie de Vaccination, CARE – Comité scientifique COVID-19 – Comité Vaccin COVID-19, 9 July 2020
GERMANY
Treatment
- Clinical and ethical recommendations of DIVI, DGINA, DGIIN, DGNI, DGP, and AEM, Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic, December 2020, Last accessed: 19.03.2021.
Vaccines
- How should access to a COVID-19 vaccine be regulated?, Position Paper of the joint working group of Members of the Standing Committee on Vaccination, The German Ethics Council, and the National Academy of Sciences Leopoldina, November 9 2020.
Public Health Guidelines
HUNGARY
Treatment
Vaccines
- Priority List of Hungary’s Vaccination Plan Revealed, Hungary Today 4 January 2021
Public Health Guidelines
- A COVID-19 Védőoltásra Jelentkezési Hely Az Egészségügyi És Egészségügyben Dolgozók Számára, 25 January 2021 (in Hungarian)
ITALY
Treatment
Vaccines
Public Health Guidelines
- Raccomandazioni di etica clinica per l’ammissione a trattamenti intensivi e per la loro sospensione – In condizioni ecezionali di squilibrio tra necessita e risorse disponibili (Italian only), The Italian Society for Anesthesia, Analgesia, Resuscitation and Intensive Care Medicine (SIAARTI), March 16 2020
NORWAY
Treatment
Vaccines
Public Health Guidelines
- Prioritering av helsehjelp i Norge under covid-19 pandemien (in Norwegian), Helsedirektoratet, March 25 2020
- Råd om prioriterte grupper for koronavaksinasjon i Norge (in Norwegian; English translation), Ekspertgruppe i etikk og prioritering, November 15 2020.
SWEDEN
Treatment
- New Swedish Guidelines for ICU Priority Setting in Exceptional Circumstances, Short Summary by Christian Munthe
Vaccines
- Nationell plan för vaccination mot covid-19, Folkhälsomyndigheten, 4 Feburary 2021 (in Swedish)
Public Health Guidelines
- Nationella principer för prioritering inom intensivvård under extraordinära förhållanden, Socialstyrelsen, March 2020 (in Swedish)
SWITZERLAND
Treatment
- Covid-19 pandemic: triage for intensive-care treatment under resource scarcity (available in French, German, English, Italian), SAMS, March 24 2020
Vaccines
Public Health Guidelines
UNITED KINGDOM
Treatment
- COVID-19 rapid guideline: critical care in adults, NICE guideline, March 20 2020
Vaccines
- Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination, 30 December 2020, Updated 6 January 2021
Public Health Guidelines
- COVID-19 ethical issues. A guidance note, British Medical Association, April 1st, 2020