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Uncertain COVID-19 Vaccine Distribution Leaves Many Navigating Ethics Of Skipping The Line09:41
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Pfizer's COVID-19 vaccination is administered to a Tufts Medical Center employee on Dec. 15. (Jesse Costa/WBUR)
Pfizer's COVID-19 vaccination is administered to a Tufts Medical Center employee on Dec. 15. (Jesse Costa/WBUR)

From a medical ethics perspective, Arthur Caplan says the vaccine rollout in the U.S has been “somewhere between miserable, awful and what my grandmother would have called ‘fakata’ — meaning it's been bad, very, very bad.”

Despite the guidelines and frameworks for the distribution of the coronavirus vaccine, there has been a raft of reports of people accidentally or intentionally jumping the line. Caplan, the director of the Division of Medical Ethics at the NYU School of Medicine, has been exploring the morality of vaccination.

The Trump administration promised a surplus of vaccines, which the states then planned for. But when President Biden took office, all of the vaccines had been distributed and it’s still unknown how much the country has on hand, he says.

Not everyone who wants the vaccine can get it because of supply issues. This raises concern for communities who have been disproportionately hit by the pandemic, such as people of color.

Race correlates with the risk of getting and dying from COVID-19, but so do poverty and exposure, Caplan says. There’s no evidence that biology plays a role in putting any racial group in greater danger, so wealthy people of color living in suburbs might not face the same increased risk as bus drivers or cleaning workers, he says, for example.

Plus, people with diabetes, hypertension, asthma or other chronic health conditions as a result of receiving poor health care are also at risk, he says.

“While we tend to want to focus just on race, what we should be paying attention to is the horrible secret of American health care,” he says, “that if you're poor and a minority and have a job that exposes you to the virus more than most people, that's where the risk is.”

Incarcerated people should be the first in line for vaccines, he says. Some states such as New York don’t have any plans to vaccinate prisoners yet.

Other states are vaccinating only prison guards, but Caplan says this “dumb” strategy doesn’t account for visitors, administrators and food suppliers coming in and out of the facility. And in cramped jails, some people who couldn’t make bail are awaiting trial and haven’t even been convicted of a crime.

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“Prisons we know are incubators of COVID,” he says. “It's hard to socially distance. It's hard to stay safe there. They're not hygienic to begin with. You always have a roommate in nearly every prison.”

Many politicians have been vaccinated, arguing that they need to project confidence in the vaccine so that the public will trust it and protect the continuity of government. But Caplan says this is “the stupidest argument I've ever heard” considering the country’s lack of vaccine supply and trust of politicians.

“I don't see any change in vaccine confidence, in vaccine refusals as a result of this burst of politicians pushing up to the head of the line, so I think it was unethical to do that right now,” he says. “If you wanted to show support for vaccines, go to a nursing home and applaud while they vaccinate the residents.”

In places like Arizona, young people might go along in the car with an older relative to a drive-through vaccination center because the site will sometimes give out shots to anyone in the vehicle, regardless of age or health.

If someone offers you a shot, Caplan says to take it rather than let it go to waste.

“Wasting vaccine in the middle of a plague is not a good idea,” he says.

The worst thing people can do to get vaccinated is bribery, he says. A wealthy Canadian couple recently flew to the Yukon and took vaccine doses intended for Indigenous elders, The Washington Post reports.

Using one’s resources to cut the line and cheat the system is different from taking an extra dose while working in a nursing home or driving your grandmother to get vaccinated, for example, he says.

The lack of a cohesive national strategy for vaccine distribution is partly fueling these ethical dilemmas — but some blame falls on citizens, Caplan says. People didn’t demand that the Trump administration or local officials explain the logistics of the vaccine rollout, he says.

Across the country, the vaccine rollouts are failing to meet the needs of the most vulnerable groups, he says. Many states are booking vaccine appointments online, but the websites often crash or say there aren’t available slots, he says.

“The people who are trying to get in there are often 75 years old and older. Many of them are not savvy to that,” he says. “A state should be in charge of offering you appointment times, not putting the burden the other way.”

And many poor elderly people don’t have access to the internet at all, he says.

Rationing vaccines might seem like a new problem, but Caplan points to the fact that organ transplants are rationed every day. Without enough organs for everyone who needs them, a system decides who gets a transplant.

“It's not like we’ve never rationed anything in this country. But when it came to vaccines … President Trump didn't talk about COVID or vaccines for the last two or three months of his administration,” he says. “We weren't prepping. We were just talking about rigged elections.”


Alexander Tuerk produced and edited this interview for broadcast with Tinku RayAllison Hagan adapted it for the web.

This segment aired on January 28, 2021.

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