WATCH: WBUR Town Hall: Ethics And The Vaccine

Who should get the COVID-19 vaccine first? How do those in charge define the varying degrees of need in order to make this determination? What is needed to ensure a fair and equitable vaccination process is in place? These questions, both practical and ethical, loom large over the COVID-19 vaccine rollout.

In the third of a four-part virtual event series on the COVID-19 vaccine, senior correspondent and host, Deborah Becker, sat down with Dr. Akilah A. Jefferson Shah, bioethicist and assistant professor of allergy and immunology at University of Arkansas to address these questions and more. The event began with a look at ethical concerns around the role and responsibility of social media platforms in curtailing the spread of misinformation about vaccines from Endless Thread podcast host Ben Brock Johnson and producer Josh Swartz.

(You can hear more on investigations into vaccines by listening to their series, "Infectious: The Strange Past and Surprising Present of Vaccines — and Anti-Vaxxers.")

Highlights from this interview have been lightly edited for clarity.

On how the honor system can be taken advantage of in phased vaccination

Deborah Becker: Most states are using the honor system here when you're talking about comorbidities and other issues that would make someone eligible for the vaccine. And in Massachusetts, there was some controversy that you may have heard of where we had companion vaccines, where if someone took a senior to get a vaccination, they could be eligible for getting vaccinated. And of course, that prompted ads on Craigslist and folks offering to give people rides or do what they could to help so they could then get vaccinated if they helped a senior get a vaccination. So I guess I wonder, with the honor system involved here, if it works in this kind of situation where everyone is vying for something and there's just not enough right now. And is there a better way? Is there a better way to do it?

Dr. Akilah A. Jefferson Shah: I don't think it works. And we know that people who are not eligible via the criteria that's been given for each state are getting vaccinated and they're getting vaccinated because they say that they're a teacher or their health care worker or that they have diabetes or whatever it is to fit the criteria, and it's not true. So we know that it doesn't work. We know that there are people who are going to cheat the system in a certain way.

The other thing we know is that the honor system doesn't work for everyone, generally speaking. So it depends on how you look. So if you go to a place and someone doesn't like the way that you look, for whatever reason, whether it's the color of your skin or it's something else that has to do with you, they're going to ask you questions.

And so the honor system gets thrown out of the window in that situation versus if you are a more privileged person, you may not have to answer any of those questions at all. And you just kind of can get whatever it is that you asked for. So there are many ways in which the honor system is not going to be the best way to ensure an equitable vaccine distribution system or one that is that is even, you know, doing the best to not waste our resources or to be smart about our resources.

And so we have to come up with better ways to do it, whether it is literally that you have to have documentation stating your age, for instance, which is easy enough to do; your job, your occupation, your underlying health status or whatever it is where you live, whatever the criteria is. You know, we might have to do that because we know the honor system doesn't work for everyone.

On partnering with communities to carry out successful vaccination efforts

Dr. Jefferson Shah: I'll talk about my home state for a second. I'm from Louisiana, from New Orleans, Louisiana. And there was a vaccine clinic, a community clinic that was done back on Martin Luther King Day in the suburbs basically of New Orleans in a predominantly Black community. It was organized by predominantly Black folks, including the city council members and others. And what they did is they talked to those people who live there and made sure it was a place that people could easily get to. If you need to walk there, if you need to get a ride there. They advertised it so that people who needed to know, who may not be on Facebook or Twitter or whatever knew about it. They had phone calls going out. They had notifications at the church that this is going on, all this stuff to make sure the people that they were targeting for this particular clinic, which were highly vulnerable populations, knew about what was going on and they were hearing it from their peers. And so I think that that is a good way to do it. We can't just have random people come into communities and tell them what to do. We have to partner with communities, figure out what the need is there, what the barriers are there, and then really shape our policies, our approaches to vaccination based on that information.

And so that drive, that vaccine drive, I was so happy to hear about it because they got a thousand people vaccinated in a day back in January in a community that was very hard hit by COVID-19. And they did it by partnering with the people there.

On the role of social media in policing the spread of vaccine misinformation

Ben Brock Johnson: A few weeks back, a long time after these efforts to ban misinformation from search which were put into action, I logged on to Facebook and looked for information about vaccines with some pretty generic search terms like "vaccines", "vaccine information", things like that. And it took me less than two minutes to find this page. So it maybe looks innocuous enough at first blush, right? It's supposedly just making sure people log adverse reactions to COVID vaccines. But this kind of group and site again and again is proving to be kind of a gateway for much more aggressive anti-vaxx information and misinformation campaigns, I should say. And top posts on this group are people from the group trying to game or avoid the Facebook algorithms, interestingly, by misspelling words and putting URLs, onto the site, onto the page with spaces in between letters so that their "cause isn't silenced," as one user put it. This commenter says, another commenter says here, "I'm not taking this vax and I'm not letting my child have it." So once again, you sort of see this connection to the parenting aspect of anti-vaxx groups connected to the COVID vaccines.

Josh Swartz: Clearly, this challenge for Facebook is not over. Just last month, they took one of their biggest steps yet in curtailing the spread of this type of misinformation. Now, even if people are sharing those personal stories that Monika Bichert [head of global policy development at Facebook] was talking about, those posts meet the criteria for removal if they perpetuate unfounded conspiracy theories like "vaccines cause autism."

Johnson: So in 2021, when ... not taking a vaccine feels existential, and like a really big choice, not just for yourself or your bubble or your community, but your country and maybe even the world, this is a really big moment that we're talking around: taking a vaccine to stop the pandemic. It feels more and more like an ethical or moral issue.

You can register and find out more about the last event in the town hall series on the COVID-19 vaccine here.