Vaccines will be in short supply when developed. Here’s a way to prioritize who gets one

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A weighted lottery would determine who gets a COVID-19 vaccine first. Credit: Frederic J. Brown/AFP/Getty Images

A preliminary plan devised by the Centers for Disease Control and Prevention this spring gives priority to health care workers, then to people with underlying medical conditions and older people. The C.D.C. has not yet decided whether the next in line should be Blacks and Latinos, groups disproportionately affected by the coronavirus.

But let’s suppose that health care workers and people with underlying medical conditions use up the first doses of the available vaccine. Should some be held in reserve for Black and Latino people? What about bus drivers and train conductors?

One solution that is starting to attract the attention of public health experts is a so-called weighted lottery, which gives everyone a chance at access, although some get a better shot than others.

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Doctors and ethicists rank patients, deciding which groups should be given preference and how much. First-responders, for example, may be weighted more heavily than, say, very sick patients who are unlikely to recover.

The goal is to prevent haphazard or inequitable distribution of a treatment or vaccine when there isn’t enough to go around.

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Weighted lotteries can allow researchers to find out, in a rigorous way, which subgroups of patients do best with a new drug or vaccine. That is because allocation within a group is random. The distribution is, in effect, a randomized, controlled clinical trial.

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