Russia and China have begun COVID-19 vaccinations outside of clinical trials. This move has been met with widespread criticism because the safety profiles of these candidate COVID-19 vaccines remain uncertain without data from phase 3 trials.1,2 Emergency use authorisations—a regulatory mechanism that enables the public to gain access to promising investigational medical products when those products have not yet received regulatory approval and licensure3—have previously been used for unlicensed vaccines in public health emergencies and can be ethically justified provided that certain conditions are met.