COVID-19 vaccines are scarce. Many people who want the sights cannot get them yet, either because they are not yet eligible, according to priorities set by their state or county, or because there are no jobs available.
In a world of excellence, vaccines would be universally available now, says Faith E. Fletcher, “so that individuals are not placed where they encounter moral dilemmas regarding should I accept this vaccine or not? ” Fletcher is a biologist at the University of Alabama in Birmingham and a senior advisor on the Hastings Center, the leading U.S. research institute in bioethics.
As it is, the U.S. is in the midst of a COVID-19 vaccine rollout where eligibility rules vary from state to state, county to county and even sometimes across city lines. CDC guidelines on fair distribution have been revised by states, as pressure has been placed on regulators to distribute what remains a scarce resource to accelerate. Whether you are eligible for a vaccine may depend not only on your age or occupation, but also on where you live, what company you work for, and who you know.
It can look very unfair. If you think the system is not working, is it ever fair to cut into it?
NPR spoke with three biologists – Fletcher, along with Ruth Faden, founder of the Johns Hopkins Berman Institute of Biology, and Gabriel Lázaro-Muñoz of Baylor College of Medicine, to find out what’s right.
If I hear at a grocery store that has extra things that are going to go away, is it fair for me to get one, even if it is not my own opportunity?
The panel was unanimous. “100% yes,” said Lázaro-Muñoz. If a dose is in danger of going to waste, and you are there and you want it, you should take it. Ethics still called for calls.
Doses from open, open vaccine valves must be used or discarded within six hours. So if your local pharmacy has a few extra doses as a result of a shutdown, or if the freezer has failed to melt unexpectedly, it is ethical to accept a vaccine that would otherwise go wrong. into the trash, even if you are a healthy young person who would not deserve another.
“If you take it, you are contributing to reducing the risk of getting COVID yourself, and the potential risk of others interacting with you,” says Lázaro- Muñoz adds.
But even if the move is ethically accepted, there could be other things you could try that would be ethically better, Faden says. For example, “If you have a colleague or a neighbor’s family member who is already in a priority group, and you can get the call and help there, that’s better,” she says. Or if you have a friend who is at higher risk than you, say with real comorbidity, it would be better for them to match the “extra” dose, even if they are not yet officially eligible for vaccination.
Faden says the pharmacy could help the situation by offering them first to the elderly, who are thought to be at greater risk of becoming ill from the virus if they catch it. “One thing the pharmacy could do is go on the PA system and she said, ‘is there anyone over 60 who needs a vaccine? ‘”She says.
“But sometimes it doesn’t work that way. And the worst result, for a vial of Pfizer or Moderna vaccine, is throwing away even a single dose,” Faden says.
If I don’t fit in my county, but I could if I lived in the county next to mine, should I drive over to get them?
In this case, the answer is “100% no,” says Lázaro-Muñoz.
Here, he says, you are not preventing a dose of vaccine from going to waste; instead, you take an expected slot for your neighbor.
“Distribution is very limited at the moment. Any county that receives these vaccines is having a hard time getting them, and they are getting them to some extent based on consideration of their population, and what is their people, “Lázaro-Muñoz says.
People involved in active line-cutting – strategically positioning themselves to receive unexpected vaccinations – may be working with “vaccine entitlement,” says Fletcher: “Some there are people who feel reasonable in getting and jumping on the line and going to a county or state because they are so used to getting a chance, and they believe that they are entitled to facilities that others would not. “
For example, in cases where people from richer neighborhoods go to poorer neighborhoods that have been prioritized for COVID-19 vaccinations, the outsiders get the benefit, Fletcher says. “They have access to transportation. They have access to information, to the internet.” This is a move that undermines efforts to reduce health inequalities.
“The system relies on people presenting themselves correctly,” Faden says, “If there’s a theme through this, it’s that people have to follow the rules of the game, even when the rules aren’t necessary to ethics are the best rules possible. ”If the county next door serves as the main vaccination center for your area, for example, it would make sense for you to make an appointment when you deserve it. But if these positions are not yet intended for you, you should not break the rules to get one.
Some places have been slower to provide views than others, and this has caused great frustration, Faden admits. But states are learning lessons from their first weeks of vaccine administration, and working to get vaccines out in a more efficient and equitable way. At this point, she says, “I would persuade people [resist the temptation to seek vaccines across borders] and the hope that their states will soon self-correct and do a better job. “
And if the situation seems unfair, Faden says you should organize, complain, or send a call or email to elected officials to help improve the system. Instead of deceiving, she says, “the emphasis should be on changing the rules.”
Why should smokers take precedence over speakers?
For some people, cigarette smoking is voluntary behavior. In others, it is slavery they could not stop. However, being a regular smoker or a previous smoker is at risk of becoming seriously ill if they receive COVID-19.
The CDC vaccine advisory committee, which issued its priority advice in the manner of a start-up last fall, believes that smoking is a high-risk medical condition and recommends that smokers, in addition to those with a number of other basic conditions, a priority for vaccines ahead of the general population of healthy young people.
That ranking is not exactly the same as the way many Americans judge smokers – like having enslaved themselves. But the ethical goals of the U.S. government’s COVID-19 vaccine guidelines, says Lázaro-Muñoz, are to save as many lives as possible.
“We’re not focusing on which of those lives we think would be most valuable to society,” he says. “Our priority is just to save lives, time. “
“Single smokers are a slippery slope out there that does not deserve priority for vaccination, when they are at higher risk of COVID-19 infection,” Fletcher says. “People could argue the same thing, for example, with Type 2 diabetes and the risk of COVID-19. Some might argue, well, Type 2 diabetes is strongly linked. obesity, and why do these people have access to vaccines? “
She says a ban on vaccines from high-risk people with worsening health conditions would lead to health inequalities. Smoking is more common among poor people and those living in stressful environments. “We should focus on how we can give a fair distribution of vaccines to everyone, especially the most vulnerable, no matter how the vulnerability has manifested,” she says.
“If we could, we might treat cigarette smoking for some people differently than cigarette smoking for others,” says Faden. For example, whether a person could quit but not try, or whether a person picked up smoking when they should have known better. “But we can’t separate it from each other, and of course we can’t do it at the service level,” such as when someone applies for a COVID-19 vaccine.
And the protection of smokers – along with anyone at high risk from COVID-19 – will help reduce the burden on hospitals in this pandemic. “It’s definitely in our best interests if smokers are protected,” said Faden. “This is one smaller group that will add to the hospital burden from the disease.”
Couldn’t a nonsmoker easily lie down and cut the line? Even now, while some states require large paperwork from those who turn up for vaccination meetings, others are more lofty, based on the respect system.
“I’m sure there will be people who will say what they can to get to the vaccines,” says Lázaro-Muñoz, but he points out that this behavior will be the exception, limited to “a few immoral neighbors, “instead of a big gap that many try to take advantage of.
There is a downside to forcing people to jump through too many circles to get: Asking for documents about someone’s smoking use, or medical records to diagnose comorbidities, would put in place obstacles that could could be the result of a “worse outcome,” in which fewer people would be at high risk of being vaccinated, says Lázaro-Muñoz.
“I think it’s better to stay with him [the probability that a small number of people will cheat] than imposing more requirements to access the vaccine, “he says,” if we start asking people for evidence, we are going to make it more difficult for us, as a society, to get those vaccines. get out and get to the herdsman. immunity. ”
