Why You Shouldn’t Feel Guilty about Getting Vaccinated ahead of Others
Our society thinks your life should be saved first. Here’s why you shouldn’t feel bad about that.
After more than a year since the World Health Organization declared the coronavirus pandemic, vaccination campaigns are finally underway all over the world. The overall goal is to achieve what scientists refer to as herd immunity, or the state in which a significant portion (around 60 to 70 percent) of the population has been inoculated in order to stop the transmission of the virus. But as we have seen, not all countries are on equal footing.
While developed countries such as the United States, United Kingdom, and territories in the European Union have been vaccinating hundreds of thousands daily, many developing countries are still struggling to meet daily vaccination goals and are still seeing an uptick in COVID-19 cases and deaths. Even worse, the vaccines other countries are receiving are not enough for them to cover the needed percentage of people to safely return to normal — making the goal of achieving herd immunity a distant dream. There is also the problem of vaccine hesitancy, with millions of people eligible for vaccination turning down the shots, as well as other sociopolitical barriers such as vaccine diplomacy.
In the Philippines, vaccination has been slow and allocations scarce, so far covering only around 3 percent of the country’s 110 million population. Some estimates say that at the rate we’re going, it will take two to three years to achieve herd immunity. Large urban cities in Metro Manila also get the lion’s share and allocations are yet to reach the general public because of a tiered approach on the vaccine priority list. Workers in other essential industries such as in food delivery, transportation, hospitality, and public utilities are at a lower tier — regardless of the degree of exposure they have to the virus.
This leads us to wonder: Is the government’s prioritization list a good approach? Is it ethical? And on a personal level, is it ethically acceptable for a person to take a scarce public health resource such as the COVID-19 vaccine ahead of others who might need it more?
The Ethics of Vaccine Priority
Ethicists believe that any approach to vaccination priority falls under ethics and not science, though it is not often talked about that way. This is because more than the nature of the virus, judgments on who to save first are based on how one is valued in society. For example, in France, younger workers with contact to the general public are on the higher end of the priority list. This is distinct from the United Kingdom’s approach, which is largely based on age. The only commonality many countries share is that most agree that vaccines must first go to health care workers. Aside from considering the role they have been playing in the pandemic, the move is also a way to support public health systems.
The difference in values among the world and the goals each country has in mind vis-à-vis their vaccination program make people’s questions about the ethics of vaccine priority difficult to answer. Before arriving at a solid justification, there are other ethical questions that must be satisfied first. What does a country hold to be the most valuable end point? Should as many lives be saved as possible or should certain lives be held in higher regard? Should the people deemed to have the best quality of life if saved be prioritized, or should the most vulnerable be given immunity first considering their age and underlying health risks?
In a paper published in Bioethics, bioethicists and academics Alberto Giutilini, Julian Savulescu, and Dominic Wilkinson wrote: “Science can tell us how to achieve whatever we want to achieve with a vaccination policy. But what we want to achieve depends on which values we think matter the most.”
These values can be intrinsic — such as number of lives saved, years of life saved, quality of life saved, age, or quality-adjusted life years — or instrumental, like the stability of a country’s health care system or broad societal interests such as key worker status or having young dependents. Whatever values a society holds dearest are reflected on whose lives will be prioritized and which ones are tiered at a lower scale. The challenge, they said, is to find the right balance between these values.
Got the shot? Don’t feel guilty.
As one’s health and age are not the only coefficients that should be taken into account to assess vulnerabilities, it simply cannot be assumed that the best strategy is prioritizing the most vulnerable through these criteria.
But if the specific situation in the Philippines, where vaccines are scarce, is taken into account, the government’s prioritization list seems to be a good approach. For one, the benefit of vaccinating by age and comorbidities is that as many lives as possible can be saved. At the same time, doing so would reduce the burden on an already weak public health system which could further erode if those who would require hospitalization and life-saving treatments will be infected. This strategy, following Giutillini and peers’ assertion, hits both intrinsic and instrumental values.
On a personal level, is it then ethically acceptable for an individual to take the vaccine even if their comorbidities are relatively minor? The answer is yes, says Fr. Nicanor Austriaco, OP, a molecular biologist, theologian, and bioethicist currently in residency at the University of Santo Tomas. Fr. Austriaco is also the bioethics consultant of the Catholic Bishops Conference of the Philippines.
“The priority list, the A1, A2, and A3, is specified by our society through our national government,” says Fr. Austriaco. “If a person finds that they are on the list, there should be no guilt in moving forward in receiving the vaccination.”
Focusing first on distributing the majority of the vaccine allocations in Metro Manila cities, the country’s center of commerce, is also the most efficient strategy. There is no question regarding the ethical acceptability of such a move either, because of its larger societal benefit.
“The surge in cases in the provinces is a direct result of the surge in Metro Manila,” says Austriaco. “Two months after every surge in Metro Manila, we see a surge in the provinces. Which is why the government’s approach in suffocating the pandemic in Metro Manila will actually benefit the entire country.”
What seems to be the only unethical way of getting vaccinated is cutting the vaccine line, such as when the Presidential Security Group and some government officials went ahead even of health care workers who need it the most. Other than that, if you are slated to receive the vaccine because of your occupation, age, or underlying health conditions, you should have no moral or ethical qualms. In the end, society decided to prioritize your life not necessarily because you’re more important than others but based on a variety of criteria that would lessen the burden on our society as a whole.
