Table 3 Ethical considerations of the vaccine distribution process and vaccination

Justice

1- Ensuring fair access to vaccines for all countries and communities [13, 34, 46].

• Responsiveness of companies to vaccine fair pricing

• Obligating political leaders to provide the vaccine to everyone, especially for high-risk groups

• Ensuring global financial resources for vaccine production

• Allocating limited resources to the most possible wide range of people fairly (distributive justice)

• Prioritization of groups who are at high risk of severe disease and mortality

• Unequal allocation is not necessarily unfair

2- Sharing of benefits [12, 26].

• Considering vaccines as an essential and universal good.

• Giving priority to LMICs and other vulnerable countries

• Giving priority to minorities or groups who are at higher risk of disease due to social, geographical, or biomedical factors

3- Respect for cultural diversity and pluralism [12, 26, 40].

• Nationalism can lead to vaccine hoarding and unfair distribution Nationalism may lead to immoral decisions in access to vaccines

4- Non-discrimination and non-stigmatization [3, 12, 14].

• Setting priorities fairly based on logical parameters tailored to current needs

• Using a fair priority model based on limiting harms, priority and benefiting the deprived ones, and equality of people’s value

• Transparency in vaccine allocation policies based on rational reasons for decision making

5- Considering ethical imperatives for immunity passports [32, 35, 36].

• Ethical justification for the implementation of immunity passports,

• creating a safe setting for work and travel

• The impulsing public will for vaccination

• Forecasting mechanisms for issues such as immunity passports’ forgery and ensuring privacy

Beneficence

1- Benefit and harm [2, 9, 19].

• Issuance of emergency vaccination authorizations in accordance with WHO guidelines and national medical safety regulations

• Assessing the beneficence of vaccines based on evidence-based information

• The need to obtain strong evidence on the safety and efficacy of vaccines for compulsory vaccination

• Providing evidence-based information on the safety and efficacy of vaccines for vaccination policy

• Evaluating the validity of data on the effectiveness, side effects, and safety of vaccines by reputable organizations and specialized assemblies

2- Monitoring vaccine pricing [26].

• Monitoring the prices of pharmaceutical companies’ products according to government support and subsidies for their research and development

Non-maleficence

1- Providing emergency use licenses for vaccines that are proven to be safe and acceptable [8].

• Providing emergency authorization to the vaccines whose safety has been proven.

• Dealing with the misuse of issuance of emergency authorizations

2- Respect for human vulnerability and personal integrity [9].

• Adherence to the harm prevention principle as an ethical imperative for vaccination

• Harm prevention is an ethical principle in vaccine studies

• The ethical principle of harm prevention entails individual and collective responsibilities

• Consideration of harm prevention given the risks and side effects of vaccines

Autonomy

1- The conflict between individual autonomy and public benefits [27, 29, 30].

• The conflict between compulsory vaccination and the free will or individual autonomy concept

• Adherence to the three necessary criteria for the ethical justification of compulsory vaccination, including the threat to the disease for public health, the expected positive beneficence, and the proportionate coercion.

• Implementation of a mandatory vaccination policy only if it is possible to prevent significant risks of disease and mortality or significant and clear public health benefits.

2- Autonomy and individual responsibility [25].

• Considering the factors influencing decision-making processes to increase acceptability, accessibility, and justice

• Clarifying information about the safety and effectiveness of vaccines to address doubts about informed decision making

3- Human dignity and human rights [32, 35].

• Acknowledging the rights and interests of participants

• Identifying people who are immune to the disease

• Providing the requirements for immune individuals to return to work or/and to do their activities

• Adherence to ethical autonomy imperatives in immunity passports

• Protecting participants through a balance between potential risks and benefits