Who goes first? The ethics of distributing a Covid-19 vaccine.

A nurse prepares a shot as a study of a possible Covid-19 vaccine, developed by the National Institutes of Health and Moderna Inc., on July 27 in Binghamton, N.Y. (AP Photo/Hans Pennink)A nurse prepares a shot as a study of a possible Covid-19 vaccine, developed by the National Institutes of Health and Moderna Inc., on July 27 in Binghamton, N.Y. (AP Photo/Hans Pennink)

We are in the midst of a global health crisis that already has inflicted a significant humanitarian and economic toll on the United States. For now, we must try to contain the spread of Covid-19 through physical distancing and face-covering. But we will reach another turning point when a vaccine to prevent the disease has been developed. As the Catholic Health Association of the United States said in a July 27 statement, “it is essential to thoughtfully consider how to ethically develop and equitably distribute” a vaccine. (See a list of the C.H.A.’s guidelines below.)

A persistent anti-vaccination minority in the United States, along with many people’s unwillingness to adopt simple measures to prevent spreading the virus, underscores the challenges ahead. A vaccine program is concerned with the health of the community, and that should be important for any Christian.

Americans often focus on individual health, but vaccines are essential for our health, for the good for the community.

Humans are essentially social animals, whose well-being is dependent upon a vibrant and healthy community. We see evidence of this in the anxiety and depression affecting so many during the stay-at-home orders enacted to fight the pandemic. Americans often focus on individual health, but vaccines are essential for our health, for the good for the community.

So once a vaccine is developed, how should we distribute it? The obvious answer is that everyone should receive it. But given the delays and long lines for Covid-19 testing, we can imagine the potential for chaos once a vaccine becomes available. We will need a strategy.

We use a market approach to distribute most goods in our society, which means that those able and willing to pay more for a product can get it first. But medicine, because it is a basic good that we endeavor to make available to everyone, is not really distributed that way.

Until we have enough for general distribution, prioritizing who receives a vaccine dose will require a concerted effort among government and health officials. The Centers for Disease Control and Prevention and an advisory panel have developed a preliminary plan for distributing the vaccine. There must also be procedures for ensuring compliance by manufacturers and by state and local health agencies.

It is important to begin vaccine distribution with the first responders and those on the front lines of health care, since they are both most at risk and are doing a great service for others.

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In line with the C.D.C. recommendations, it is important to begin vaccine distribution with the first responders and those on the front lines of health care, since they are both most at risk and are doing a great service for others. To restart the economy, we should then think about workers who cannot work remotely, like factory or warehouse employees, but who provide essential services. After that, we should prioritize workers who are in close proximity to large numbers of people (like teachers). Then the vaccine should be targeted to those who are vulnerable to Covid-19 because of pre-existing conditions and the elderly. A more controversial option would be to expedite distribution of the vaccine in populations, like Blacks and Hispanics, who have had higher rates of Covid-19 infection.

After these priorities are met, we can move toward procedures for universal distribution.

Of course, particularly in the United States, there will be those who will not want to be vaccinated, just as there are those who refuse to wear face coverings in public and argue for “the right to be left alone.” But we should remember that public health cannot be solely concerned with the rights of the individual. You need not be sick to be a spreader of Covid to others, and we do not know how long one can spread the disease.

We can respect free choice, but choices have consequences. Those who refuse to take precautions against Covid-19, from wearing a mask to getting a vaccination when it becomes available, not only put themselves at risk but also risk the health of others. Health care does not fall neatly into the spheres of public and private behavior.

Furthermore, we do not have an unlimited supply of medical supplies like hospital beds and ventilators, and the cost of treatment is borne by others either in the community or in an insurance pool. And those who are being given priority access to the vaccine have a special obligation; essential workers should be required to get the vaccine or risk losing their jobs.

Though a Covid-19 vaccine should not be compulsory for everyone, we need to hold responsible those who refuse to take medically necessary precautions, and specifically who refuse a vaccine. For example, it would be appropriate to deny them beds or ventilators should they get sick as a consequence of knowingly engaging in risky behavior.

The Covid-19 outbreak is a reminder to Americans that health care cannot be understood completely as a private good and that in solidarity with others, each of us has a responsibility to work for a common purpose. This is a public health crisis, and we need to understand a potential vaccine as an obligation for oneself and for society.


The Catholic Health Association’s guidelines for “vaccine equity”

The C.H.A. listed the following guidelines for distributing a Covid-19 vaccine:

1. Vaccines should be demonstrably safe and ethically tested. Also, the burden of testing should not fall primarily on the poor, or those in developing countries.

2. Vaccines should be demonstrated to be scientifically effective. They should not be adopted too quickly for political or economic reasons.

3. Vaccine development must respect human dignity and protect the sanctity of human life at all stages.

4. Vaccines should be equitably distributed with priority to those at most risk for suffering negative health outcomes from Covid-19.

5. Efforts to develop and distribute effective vaccines should emphasize the principle of solidarity—working together, domestically and internationally, to achieve a common purpose.

6. Consistent with the principle of subsidiarity, the distribution of effective vaccines should involve local communities, including local governments, health care providers, nonprofit organizations and religious leaders.

Source: “Vaccine Equity and Catholic Principles for the Common Good,” Catholic Health Association of the United States.

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