An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US

As researchers and drug manufacturers work tirelessly to find effective treatments for coronavirus disease 2019 (COVID-19), the media and the public await any report of a promising therapy. The antiviral drug remdesivir recently received Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA) for treatment of COVID-19. Many other new or existing therapies are under investigation, and the FDA has committed to expedited approval of proven new therapies. With patients and clinicians desperate for effective treatments, each new therapy will be in high demand. The need is projected to exceed the available supply, even as manufacturers strive to increase production,1 and shortages may be exacerbated by distribution problems and new waves of disease in the pandemic. When there is not enough of a new therapy available, frontline clinicians will need to rapidly identify which patients should receive it. Recommendations have been published for the equitable allocation of COVID-19 therapeutics and vaccines around the globe, as well as the rationing of ventilators if necessary, but little information is available about rationing of new therapies.2-4 This Viewpoint