Table 5 Ethical considerations related to specific groups

HCWs

1- Prioritizing front-line HCWs due to their higher odds of contagion exposure [28, 30, 41, 43].

• Giving priority to HCWs due to constant exposure

• Respecting the right to have a safe work environment

• The importance of the ability to care for and protect patients

• Maintaining the stability and resilience of the health care system in emergencies

2- Conflict of ethical principles of autonomy and beneficence with compulsory vaccination among HCWs [16, 21, 42].

• Consideration of the conflict between the ethical principles of beneficence and autonomy with compulsory vaccination of health care workers

3- Concerns of HCWs about the safety and effectiveness of vaccines [21].

• HCWs doubt the safety and effectiveness of vaccines

• HCWs worry about the severity of the disease

• HCWs have concerns about Covid-19 and vaccination like other people in society

4- The unwillingness of HCWs to be vaccinated despite their responsibility to implement the vaccination strategy and reassure the community [27, 42].

• Responsibility of HCWs as the main element in implementing public vaccination strategies

• HCWs’ responsibility to reassure the community

• The reluctance of HCWs due to uncertainty about the safety of vaccines

• The effect of race on vaccine hesitancy and primarily unequal access among HCWs

5- Prioritizing vaccination based on balancing profit and loss/ benefits and risks (balance of principles of beneficence and non-maleficence) [27, 42].

• Consideration of maximizing vaccination benefits and minimizing risks to prioritize HCWs

• Vaccination is more useful for HCWs because of the greater risk of infection

• High risk of infection in HCWs due to their constant exposure

Children and adolescents

1- Acquiring informed consent tailored to children and adolescents [9, 31].

• Considering the ethical considerations of autonomy, informed consent, confidentiality, and protection of individuals for vaccination of children like other groups

• Acquiring informed consent from children for vaccination like any other medical procedure

2- Evaluation and acceleration of vaccine immunization trials vaccine in children and adolescents [20].

• Accelerating immunogenicity trials of Covid-19 vaccine in children and adolescents due to lack of reliable, evidence-based information on their long-term effects

3- Consideration of the expected beneficence for the community and the child during the children and adolescents vaccination process [29].

• Consideration of the expected beneficence for the community and the child during the children and adolescents vaccination process

• Implementation of compulsory vaccination policies for children can be justified when it has the expected positive benefits for both society and children and adolescents.

4- Considering the ethical principles of autonomy, non-maleficence, and trust in the vaccination of children as well as adolescents [9, 31].

• Impossibility of acquiring informed consent from the children without the parent’s permission

• The negative impact of parental pressure to vaccinate children and adolescents on their autonomy and informed consent

5- Lack of ethical justification for the vaccination of children as a requirement to attend school [43].

• Lack of evidence-based information on the safety and efficacy of Covid-19 vaccines for children

• Vaccination requirement for children to attend school is not ethical

Elderly

1- Giving priority to the elderly [4, 20].

• Giving priority to the elderly for injecting emergency licensed vaccines

• Giving priority to the elderly with comorbidities

Ethnic and racial minorities

1- Identifying the conditions and social harms of racial and ethnic minority communities to remove barriers to vaccination [24, 38].

• Limited access of ethnic and racial minorities to health care and services due to social factors

• Identifying the conditions and social harms of ethnic and racial minorities

2- Considering institutional and structural discrimination as a factor leading to vaccine hesitancy among ethnic and racial groups [22, 24, 37, 38].

• Suspicion, fear, and hesitancy about the pressure to be vaccinated among minorities

• Racial injustices in vaccine development and trial

• Minorities’ religious and moral concerns

• Hesitancy about the legitimacy and restrictions on access to vaccine information

• The rampancy of distrust and uncertainty among minorities due to previous institutional and structural discrimination

3- The necessity of reducing health inequalities in the distribution of vaccines [38].

• Opportunity-oriented approach to the distribution of the Covid-19 vaccine as an opportunity to address the health inequalities of ethnic and racial minorities

• The effect of the socio-economic status of ethnic and racial minorities on the fair distribution of vaccines

• Coping with the unfair distribution of vaccines among minorities (removing barriers to equal distribution of vaccines among ethnic and racial minorities)