Priority-setting for early access to COVID-19 vaccines in Islamic Republic of Iran

Background: Priority-setting for early access to vaccines during a pandemic optimizes the impact of vaccine rollout, however, low-and middle-income countries (LMICs) have little experience in policymaking on this. In the Islamic Republic of Iran, the national clinical ethics committee developed a policy for early access to COVID-19 vaccines with support from the national committee on COVID-19 vaccine. Aims: This paper reports the process and results of a national COVID-19 vaccine priority-setting in the Islamic Republic of Iran and discusses its ethical and cultural aspects. Methods: A multidisciplinary team of experts planned and developed a national guideline following an extensive literature review and face-to-face consultations. Results: We present the list of priority groups and subgroups, tiered through a 4-phase process, as well as the ethical values and sociocultural issues underpinning COVID-19 vaccine prioritization in the Islamic Republic of Iran. Conclusions: Our experience shows that a transparent and well-reasoned policymaking process can inform fair priority-setting for pandemic vaccines, especially in LMICs.