Ava Fasciano / Sun Graphic Designer

Policymakers must use ethics when deciding who gets to stand at the head of the vaccine line.

February 15, 2021

The Medical Ethics Behind the COVID-19 Vaccine Rollout

Print More

With a limited supply of COVID-19 vaccines and a long list of Americans waiting to receive one, federal and state governments are figuring out the vaccine line — weighing how to equitably distribute vaccines while maximizing benefit to society.

To demystify the decisions behind vaccine distribution plans, medical professional and ethicist Dr. Kim Overby, science and technology studies, offered insight into the ethical challenges that complicate the country’s vaccine rollout.

Epidemiologists currently estimate that 70 to 90 percent of the population needs resistance to COVID-19 to achieve herd immunity. However, only 4.2 percent of Americans have received both doses of the COVID-19 vaccine, meaning federal and state policymakers must ration available doses and decide who gets to stand at the head of the vaccine line.

According to Overby, policymakers should use ethics — how the public thinks about what makes something right or wrong and what actions are worthy of praise or blame — to determine the order in which groups of people are vaccinated. A core principle in this field is justice, which can be both procedural and distributive. 

“[Ethical and moral concerns] center on how we think about distributive justice, which refers to the fair and equitable distribution of shared resources and, because we may not all agree, also the concept of procedural justice, which requires that there be a fair and transparent process for identifying and applying allocation criteria and appealing disputed decisions,” Overby said.

These ethical considerations include prioritizing those who have a high risk of contracting or having severe consequences from COVID-19, as well as those who have essential roles in society, Overby said.

Overby explained that four key ethical principles are guiding policymakers who are deciding the vaccine line — societal benefit, equity, social usefulness and social vulnerability. 

Societal benefit means minimizing the effects of the virus by prioritizing vaccinating those most at risk of infection, of developing serious illness and those most at risk of spreading the virus. Prioritizing social usefulness means prioritizing those directly involved with limiting the spread and effects of the COVID-19 pandemic, such as healthcare workers and other essential workers who keep society functioning. 

Social vulnerability refers to the moral obligation to consider existing inequities in healthcare that result from structural racism and social determinants of health — societal factors outside of the healthcare system that affect one’s health. 

These social determinants of health include factors such as housing, transportation and education — which play a critical role in the ethics of vaccine distribution. Communities of color and Indigenous people are facing higher rates of COVID-19 infections, hospitalizations and deaths — a consequence of centuries of structural inequities and underlying health disparities.

“Plans for allocating COVID-19 vaccines are attempting to take [social determinants] into consideration in various ways, but we will have to see how this actually plays out in the coming months,” Overby said. 

The goal of these considerations is equity, which in the context of vaccine distribution, means ensuring that existing disparities are taken into account to mitigate the effects of the pandemic on the most marginalized groups.  

Some health departments, like Washington, D.C., are trying to mitigate vaccine distribution disparities caused by social determinants by narrowing vaccine sign-ups to less affluent ZIP codes hardest hit by the pandemic. Although promising, these plans have yet to show how equitable they are in practice, Overby said.

Healthcare workers and other essential employees have priority for the vaccine because they are at high risk of exposure and are critical for decreasing disease and death. Vaccinating healthcare workers has the benefit of protecting the worker themself, in addition to mitigating the effects of disease in others because they can safely treat patients — a phenomenon known as the multiplier effect. 

Although Overby said the benefits of the multiplier effect made it clear who would be in the first phase of vaccine rollout, there’s much more gray area for the following rollout phases, as policymakers weigh underlying social inequities and pre-existing health conditions. 

While states use the same overarching principles to guide the vaccine rollout, how these allocation critera are interpreted and prioritized varies in each state and its individual communities, according to Overby. 

The result is a patchwork of vaccine policies, as states are strewn across different rollout phases, each with varying vaccine eligibility criteria based on the risk of virus exposure, age and health conditions.

As for whether college students are a high priority group to receive the COVID-19 vaccine, Overby said it depends on students’ individual circumstances. 

Some Cornellians — such as grocery workers and emergency medical services providers — have already received the vaccine due to their high risk of exposure to the virus, while others must wait.

“There will be college students who have health conditions, jobs or other circumstances that warrant vaccination at different times,” Overby said, “so it is not a situation where all college students will necessarily be treated as one big group and receive the vaccine at the same time.” 

Overby added that one way to eventually increase vaccinations for the general population is for employers to mandate vaccination for their employees. However, this policy can be ethically complicated, due to persisting vaccine hesitancy and safety concerns in the general public.

“Evidence suggests that the available vaccines are quite safe and effective, but we are still in kind of an uncertain period,” Overby said. “This gets back to the issue of making sure that it’s not just the benefits, but also the burdens that are being equally shared.”

Even though individuals are eager to receive the vaccine to protect their own health, Overby said a collective mindset and strong sense of community are crucial to overcome the COVID-19 pandemic.

“We tend to be a very individualistic society, but the pandemic has made it clear that we are very much interconnected,” Overby said. “We need the will and the mechanisms to work together to address challenging situations, like how we ought to allocate scarce resources, [when] we all have an interest as both individuals and as members of a larger community.”

Editor’s note: This post initially included inaccurate paraphrases attributed to Prof. Kim Overby. It has since been updated with statements that better reflect the information provided by Overby. The Sun regrets this error.