**As the COVID-19 pandemic evolves, this document may be revised as necessary **

Vaccines are critical to the control and prevention of infectious disease transmission. The following principles are key factors for nurses and other health care professionals to examine in consideration of immunization.

Access
It is a considerable challenge to reach a critical mass of people around the world to ensure that COVID- 19 vaccines reach all recommended communities and countries. It will be important to establish and manage reliable supply chains for innovative approaches to effective vaccination. Decisions regarding distribution of the vaccine should follow public health principles to control the spread of disease globally irrespective of the ability to purchase the vaccine.

Transparency
Transparency in regard to all COVID-19 vaccines must include public access to information related to production, manufacturing practices, composition, origin, distribution, allocation, efficacy, safety including data, side effects, cautions, warnings, and additional vaccine options. This must be provided in clear, simple detail in various languages by open web content, printed material and mass media public service announcements.

Equity
It is critical to establish and sustain an infrastructure to support global equitable distribution of COVID- 19 vaccines. High income countries must not monopolize the global supply of vaccines. Considerations for essential workers and vulnerable populations must be prioritized while taking into consideration of public health strategies designed to stop the spread of disease.

Efficacy
Understanding vaccine efficacy and effectiveness is pertinent for a sustained reduction in the spread of COVID-19. Vaccine efficacy is measured by how the vaccine ideally performs in regimented protocols and relatively normal hosts; whereas, vaccine effectiveness is retrospective with measuring real world benefits of the vaccine. These concepts are critical measures that impact resources, public trust, the public’s willingness for uptake and health outcomes given the virus’ high transmissibility and mortality index. Both concepts strike at the heart of risk benefit ratios from a public health perspective – not only for healthcare workers and institutions but for the communities they serve.

Safety
The balance of safety and efficacy and the perception of personal risk versus overall benefit are at the core of acceptability of immunization practices. The known and potential benefits of a COVID-19 vaccine must outweigh the known and potential risks. ANA strongly recommends that registered nurses be vaccinated against COVID-19. However, we recognize that without a well-established safety profile, the risk benefit analysis could be such that nurses choose not to be vaccinated. We do not believe nurses should be retaliated against if they do not choose to be vaccinated.

As approved by the ANA Board of Directors September 2020 www.NursingWorld.org/COVID19Vaccines/