Dr. Ezekiel Emanuel
(Photo: Neilson Barnard / Getty)

Dr. Ezekiel Emanuel, who was named to Joe Biden’s coronavirus advisory team on Monday, published a paper in September arguing that any coronavirus vaccine should be distributed globally according to something called the “Fair Priority Model.”

Emanuel, the lead author on a paper in Science called “An ethical framework for global vaccine allocation,” argued that there should be a “fair international distribution of vaccine,” rather than what he and his co-authors call “vaccine nationalism.”

“Reasonable national partiality does not permit retaining more vaccine than the amount needed to keep the rate of transmission (Rt) below 1, when that vaccine could instead mitigate substantial COVID-19–related harms in other countries that have been unable to keep Rt below 1 through ongoing public-health efforts,” Emanuel and his co-authors write.

He and his co-authors reject a proposal by the World Health Organization (WHO) to distribute vaccines proportionally, with “with 3% of each country’s population receiving vaccines” and allocation up to 20% of the population in every country.

They also reject a proposal to prevent the highest number of deaths by giving vaccines to countries based on “the number of frontline health care workers, the proportion of population over 65, and the number of people with comorbidities.”

The problem with that approach, Emanuel argues, is that death is not the only form of harm, and prioritizing older people would mean sending a disproportionate share of vaccines to rich countries, where average life expectancies are longer.

The Fair Priority Model, Emanuel and his co-authors argue, focuses on preventing premature death; on preventing the harms caused by school and business closures; and on reducing community transmission of the virus in the population in general.

They introduce a complicated formula, acknowledging that it “will require approximations as well as judgments,” such as estimates of the precise effect of each dose of vaccine on the “poverty gap” in each country. The authors claim that countries will not “exaggerate” the severity of the pandemic to receive more vaccines, because that would hurt economic activity.

Pfizer announced Monday that a vaccine it was developing with German drugmaker BioNTech was 90% effective.

The company claimed, incorrectly, that it had not participated in President Donald Trump’s “Operation Warp Speed” (it boasted of its involvement in July). It has a $2 billion contract with the U.S. government to deliver 100 million doses — with an option to deliver 500 million more. Americans will receive the vaccine for free, thanks to the administration’s policy.


Dr. Ezekiel Emanuel, who once wrote that he did not hope to live past the age of 75.

Emanuel, the brother of President Barack Obama’s chief of staff, Rahm Emanuel, is known for his role in designing Obamacare. Once mocked as “Dr. Death” in debates over the rationing of end-of-life care, Emanuel wrote in 2014 that “living too long” was a state to be avoided.

As Breitbart News noted in April:

Emanuel has had a longtime and controversial fascination with healthcare rationing, writing scores of papers over the years on the ethics of allocating medical resources to a population. He is also a hyper-partisan champion of progressive policies that have sought to fundamentally transform the U.S. economy and healthcare system.

He once wrote a piece titled, “Why I Hope to Die at 75.” In the 2014 Atlantic article, Emanuel made clear that he was serious about his wish to die at 75 and even argued that “living too long is also a loss.”

Emanuel wrote:

I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Emanuel posited that “for many reasons, 75 is a pretty good age to aim to stop.”

Biden will be 78 if he is inaugurated in January.