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The Ethics Of Who Gets The COVID-19 Vaccine And When


We are devoting this entire hour to questions we're getting about the rollout of the COVID-19 vaccines, including the big question of how different groups of Americans are being prioritized. Now we want to get some perspective on the kind of thinking that goes into these decisions and other practical questions about who is next in line. And oh, by the way, who decides all that? For that, we're joined by Ruth Faden. She is a professor of biomedical ethics and the founder of the Berman Institute of Bioethics at Johns Hopkins University, and she's with us now. Welcome. Thank you for joining us.

RUTH FADEN: My pleasure.

MARTIN: First of all, as briefly as you can, would you just tell us what ethics means in this context? Is it as simple as doing the most good while doing the least harm? How should we think about it?

FADEN: It's that, but it's more. Basically what we are trying to do in thinking through the ethics of vaccine prioritization is to first identify the ethics values that matter the most, one of which is clearly that we want to get as much good in terms of the public's health as we can from the vaccines available. But others include questions of fairness, equity and also reciprocity, recognizing that some groups have really taken on more risks and more burdens or have had more burdens imposed on them so that the rest of us could live more normal lives or have a better chance of staying healthy. And so that's a consideration that comes into play in particular when we talk about health workers, but also when we think about other people who are functioning in essential jobs outside of their homes.

MARTIN: OK, great. So that's good to think about. All right, and so there's been a lot of talk about people who don't want to get the vaccine, but that obscures the fact that most people do want to get the vaccine. So then the question becomes, when can you get it? When should you get it? The CDC has come out with recommendations, but is there any official body that decides that? Is there some commonly understood framework that they use?

FADEN: Yes and no. There are ethics frameworks or values frameworks that have been proposed by the National Academies in the U.S., by the Advisory Committee on Immunization Practices in the U.S., and also by the CDC. These values frameworks are available to the states to rely upon but also to adapt or modify to their own circumstances. So at the state level, there will be tweaking. There will be a lot of tweaking or a little tweaking.

So let me give an example. If the category is essential workers, that's a very large group, so states are going to have to make some determinations about why we should prioritize one essential workforce component over another. For health systems, health care systems, they're being allocated vaccine now for their health workers but not in sufficient supply to vaccinate everybody all at once. So health system employers are making determinations from among their health workforce who should go first.

MARTIN: We asked listeners for questions, and we got this one about undocumented people and where they fall in line. The listener asks, please report on whether undocumented immigrants will get COVID-19 vaccinations. There are an estimated 12 million. And one, we cannot reach herd immunity if so many are not vaccinated. Two, many work in essential jobs. And three, they are humans. How would you respond? How should we think about this?

FADEN: Well, I would say your listener just made the ethics case. This is not a context in which citizenship or legal status in the country is morally relevant. What matters is whether you otherwise fit within a priority group, and that priority group itself is defended on ethics grounds. So, for example, if a person who was in this country is not documented but is working in one of those occupational roles that is considered at elevated risk of occupational exposure, it doesn't matter if that person is documented or not. They meet the sort of values criteria for being vaccinated.

MARTIN: We have another question along those lines, but not quite the same. Over the course of the pandemic, prisons have become hotspots of infection. But we've seen some state officials in some places saying that prisoners will not be a priority for, you know, reasons that anybody can imagine. How do you respond to that? Does your field offer clarity on this issue?

FADEN: Yes, it does. Again, what we're searching for is, what is the morally relevant reasons why some groups should be prioritized over other groups? If the morally relevant reason is that the group is at elevated risk of contracting the infection and is not positioned to be able to reduce their risk through their own actions - that is to say, they can't physically distance or isolate from other people - then that becomes the reason why a group should be prioritized. And certainly people who are incarcerated and the people who are essentially responsible for them, prison staff, meet that combination of criteria.

Now, it's a separate question where prisons should fit relative to other groups that also can be so described. So nursing home residents, for example, are similarly situated in the sense that there is elevated risk of contracting the infection, and you can't really change the way you live in a long-term care facility.

MARTIN: So before we let you go, it's going to be a while before most of us are vaccinated. I think it's fair to say. We spend a lot of time on this program - And people, really, frankly, in any public sphere - talking about personal sacrifices amid this pandemic and weighing that against a lot of other people's demand for more personal freedom. And as these vaccines have rolled out, as you can see, there are debates about one group getting it versus another group getting it, and people have opinions about that. Is there something that you would offer us as a general guideline as people wait their turn?

FADEN: Maybe it's a time to think about character and personal values and emphasize the importance now more than ever of the virtues of patience, of empathy, of recognizing that not everybody can protect themselves the way perhaps I might be positioned or you might be positioned to protect themselves from infection and disease, and of solidarity. It maybe is a little bit too trite to say that we're all in this together. Some of us are suffering far more than others of us, but we are all really suffering. And so if we can remember - right? - to be patient, to be empathetic and to be committed to making this world better than it was before, I think we can get through this.

MARTIN: Ruth Faden is a professor of biomedical ethics at Johns Hopkins University, where she founded the Berman Institute of Bioethics. Professor Faden, thank you so much for sharing your expertise with us.

FADEN: My pleasure, Michel. Transcript provided by NPR, Copyright NPR.