The Ethics behind COVID-19 Vaccine Distribution

Posted on 2/5/2021 8:58:04 AM

As America is only weeks into distributing the COVID-19 vaccine, much talk has focused on who’s first in line to receive the the shot and why. Students in philosophy faculty member Leo Yan’s courses have examined related ethical issues. Yan recently shared his students’ reactions, as well as his insights into issues surrounding vaccine distribution.

Leo Yan

More about Leo Yan

  • PhD, Brown University, 2019
  • PMA, University of Missouri, 2011
  • PMSc, London School of Economics and Political Science, 2008
  • PBA, Boston University, 2003

Courses

  • PHIL 122 Contemporary Moral Issues
  • PHIL 130 Introduction to Biomedical Ethics
  • PHIL 270 Ethics and the Environment
  • PHIL 320 Ethical Theory
  • PHIL 450 Philosophy of Law

Your courses couldn’t be timelier. The ethics of vaccine distribution and who’s first in line to receive the shot are certainly relevant right now. How have students responded?

In my Contemporary Moral Issues and Introduction to Biomedical Ethics courses last semester, we discussed the more general question of how to allocate scarce medical resources, using ventilators, ICU beds, and vaccines as examples, and considering the arguments that could be made for and against prioritizing different groups. I initially had some worries that this topic might hit a little too close to home. After all, we were—and still are—living in a pandemic where these questions are no longer merely academic and how we answer these questions will have real-life consequences that affect all of us.

I was truly impressed with the level of interest, seriousness, and maturity our students demonstrated during class discussions. The experience showed me how enthusiastic IUP students are to engage with and wrestle over the really difficult ethical questions we face as a society. It has also left me eagerly anticipating the start of our new interdisciplinary Philosophy, Politics, and Economics major track this spring, which combines the expertise and perspectives of these disciplines to achieve a better understanding of the social institutions and arrangements that shape our world.

The CDC issued recommendations to help guide the distribution of the COVID-19 vaccine. Why did it recommend prioritizing certain groups?

The CDC’s recommendations are based on assessments made by the Advisory Committee on Immunization Practices, an independent panel of medical and public health experts whose job it is to review all available data and give recommendations on how different vaccines, not just the ones for COVID-19, should be administered to best control disease in the United States. In coming up with its recommendations for COVID-19 vaccines, ACIP considered not only the scientific data around COVID-19 but also explicitly identified four ethical principles used to guide its selection process:

  1. Maximize benefits and minimize harms
  2. Mitigate health inequities
  3. Promote justice
  4. Promote transparency

Can you give an example of how these principles relate to the prioritized groups?

For instance, in the case of medical personnel, [ACIP] reasoned that prioritizing vaccinations to this group would help maximize benefits and minimize harm, since doing so would benefit not only the health care workers but also the patients they could then continue to treat. Moreover, this strategy would help mitigate health inequities since racial and ethnic minority groups are disproportionately represented in low-wage health care professions. Finally, giving medical personnel priority vaccination would promote justice because it would help fairly offset their elevated occupational risk of contracting COVID-19. Similar arguments were made justifying the other priority groups in terms of these ethical principles.

Does this mean the CDC needs to appeal to philosophy to justify its recommendations?

Absolutely it does! The ethical principles that ACIP explicitly appeals to in justifying its recommendations are the same sorts of principles that moral philosophers spend their days analyzing and assessing. Even though those four principles may seem attractive, there are still many questions that need to be answered.

What are some of those questions?

One set of questions is about how exactly we should unpack and understand each of these principles. For example, consider the principle that tells us to maximize benefits and minimize harms. Is it the number of lives saved or the number of life years saved that matters? How we answer this question can affect whether we prioritize vaccinating the elderly, who generally have a higher risk of death from COVID-19 but fewer years of life to lose, or we prioritize vaccinating children, who generally have a lower risk of death from COVID-19 but have more years of life on the line.

There is much more to discuss here, but the upshot is that no justification of any vaccination strategy will be complete without a thorough and rigorous philosophical analysis. Scientific research helps us understand COVID-19, develop the tools to fight it, and predict the outcomes of different public health strategies, but no amount of empirical data alone will tell us what to do. Rather, science helps us understand what we can do, while moral philosophy helps us understand what we should do. Ultimately, we need both to identify the best policies to implement in situations like the current pandemic.