The COVID-19 Vaccine Is Here. What Ethics Should Guide Its Rollout?

Today, the U.S. began administering its first doses of the Pfizer COVID-19 vaccine. Sandra Lindsay, a critical care nurse at Long Island Jewish Medical Center in Queens, New York, was the first known person to be vaccinated for COVID-19 in the United States.

The vaccine was approved last week by the U.S. Food and Drug Administration; shipments of the vaccine are expected to arrive in all 50 states today. This news comes as the virus continues to spread rapidly nationwide and the total number of deaths in the U.S. reached 300,000; the head of the Center for Disease Control warned Americans of “more deaths per day than we had at 9/11” over the next several months.

Initially, the available doses of the vaccine are limited; experts estimate that it could be months before the vaccine is available to most Americans. And for the incoming administration as well as public health experts, this raises a number of ethical questions, most importantly: Who should be the first to receive the vaccine?

The front of the line

President-elect Joe Biden has promised to invest “$25 billion in a vaccine manufacturing and distribution plan” and create a new task force that will “provide recommendations and oversight on disparities in the public health and economic response.”

Officials for the incoming administration have stated they will prioritize at-risk communities for initial vaccine access, including the elderly, those with chronic health conditions, and communities of color. Elder-care homes have been COVID-19 hotspots since the beginning of the pandemic, and those with chronic illnesses are often immunocompromised, making them more vulnerable to the effects of the virus. Given the legacy of medical racism in America, communities of color — especially Black Americans, Latinos, and Native Americans — often suffer from comorbidities that make them especially susceptible to the virus’s effects, including hypertension and diabetes, or from lack of access to health care.

According to Dr. Nancy Berlinger, the lead author of the Hasting Center’s ethics guide for health care institutions responding to COVID-19, the ethics of vaccination focuses on protecting the community as a whole.

“In a public health crisis, ethics always has a dimension toward other people. It's not just, ‘Well, what's the right thing I should do for myself?’ It's, ‘What are my responsibilities concerning how we live together in society?’” Berlinger told Sojourners. When you get vaccinated, you not only protect yourself, Berlinger explained, you contribute to “community immunity,” especially for infants, people who have a compromised immune system, and other people who cannot be vaccinated.

But even prioritizing those most at risk raises ethical questions. “Among those groups is where it starts to get a little bit more contentious,” Dr. Céline Gounder, part of Biden’s COVID-19 task force, told CNN. “How do you prioritize between the 85-year-old woman in a nursing home, versus the 65-year-old African American — especially when that 65-year-old may be just as high-risk of significant disease?”

For Dr. Ki Joo Choi, a theological ethicist at Seton Hall University, those who are poor always “ought to receive a particular moral priority or concern.” Choi agrees that elderly people, those in nursing homes, and healthcare workers should be a priority for vaccination. But even within those communities, Choi believes that those who are most at risk should be first in line. “If health care workers and seniors are to receive this and there's a limited supply, should we be [following] up deeper in terms of asking, ‘Can we identify health care workers and and seniors and those who are vulnerable, immunocompromised?’ Even look at those populations more deeply and asking, ‘How would that pan out if we think about it, in terms of their economic situations?’”

Building public trust

Dr. Jozef Zalot, a staff ethicist at The National Catholic Bioethics Center, agreed that the elderly, those with comorbidities, and health care workers are the obvious first choice for the vaccine. But for Zalot, there’s another ethical question at stake when it comes to faith and vaccines. “I think the biggest ethical issue is really, what is the link with the cell lines derived from the aborted children, in terms of the development of the vaccines?” Zalot told Sojourners.

In mid-November, a few bishops told their parishes not to be vaccinated because of the possible association with aborted fetuses; on Nov. 23 the U.S. Conference of Catholic Bishops responded by assuring bishops that at least two of the possible vaccines were “ethically sound,” and reminded clergy that Catholic teaching permits the use of vaccines from “ethically unsound origins” if there are no other potential treatments available.

“Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development or production," said the USCCB memo. “They are not completely free from any connection to abortion, however, as both Pfizer and Moderna made use of a tainted cell line for one of the confirmatory lab tests of their products. There is thus a connection, but it is relatively remote. Some are asserting that if a vaccine is connected in any way with tainted cell lines, then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching."

But stem cells aren't the only barrier to the vaccine's acceptance. As Washington Post global opinions editor Karen Attiah recently wrote, the legacy of medical racism in the U.S. is contributing to some Black Americans’ distrust of the vaccine. To combat this suspicion, several public figures have called for President-elect Biden and Vice President-elect Harris to be vaccinated on live television to assuage concerns.

“The percentage of African Americans who are being very cautious about taking the vaccine is understandable, given our history with racism, our current wranglings over racism and how black communities have been subject to really just horrific kinds of medical experimentation,” Choi said. “I think the fact that we have been developing this vaccine, and then we have been thinking about distributing this vaccine in a way that hasn't addressed the concern of so many communities with respect to justice, only breeds further suspicion about it.”

Berlinger of the Hasting Center noted that “Vaccine hesitancy tends to flourish when there is low trust in authority.” The challenge, she explained, is when communities that distrust the medical establishment are the same communities to receive the vaccine.

To overcome this challenge, Berlinger suggests that healthcare workers should be the first to receive the vaccine — something that will promote important public narratives for those who need it most. “[Starting] with health care workers seems to be a way around that, because it's a big workforce, it's a workforce directly encountering risk, it's a population that's used to being vaccinated,” Berlinger said. “If you are at a community health center, it's very important that the healthcare worker sitting across from you be able to talk with you about the vaccine, and if they've already been vaccinated, that really helps that story.”

In the meantime, public health officials are imploring Americans to continue wearing masks and taking preventative measures to avoid further spread. While the vaccine rollout begins, social distancing and quarantining continue to be the best protections against COVID-19 infection.

But Choi cautioned that the vaccine should not be seen as a cure-all for those worried about the moral questions raised by the coronavirus pandemic. “One of my worries is that, if this vaccine is effective, and it's widely distributed, that we will forget all of the lessons that we reportedly have learned this year about the importance of community solidarity, to use Pope Francis's words, fraternity and community,” Choi said. “I think this year has revealed that what was normal prior to March 2020, wasn't necessarily all that just.”