Ethical Issues For Vaccination

Thursday, April 14, 2022 3:35:40 PM

Ethical Issues For Vaccination



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Vaccines for Children?

Or what is really so weird about quantum mechanics? Well, you should listen to Why This Universe? Part of the University of Chicago podcast network. Paul Rand: When you think about an ethical framework for distribution of the COVID vaccine, what do you think that ethical framework is? You can see, especially since the new administration has taken over, the careful attention that people have spent on this issue.

And the fact that the case fatality rate is different based on age is a significant part of how we have to think about the justice system. Laurie Zoloth: In the same way that if it was a pediatric disease, we would have to favor the children. People over 65 are just in that category. And that should center our attention on giving the vaccine to people in that age category. So normally, we would think about the poor. We would think about the vulnerable. We would always foreground them first, but in this particular case, with this particular disease, an age based distribution system has worked most effectively and has brought the death rate down. We see this in Israel and in the UAE and in England, where they have done that strategy, the most straightforward strategy.

And you can begin to see it changing the death rate in those countries. Laurie Zoloth: Now, in addition to that things that potentiate the disease and make you more likely to die, have to do with your social economic status, like all diseases. Paul Rand: Okay. Most of the healthcare workers have been offered the vaccine, and more and more people in nursing homes have been offered the vaccine. And we have to spend some time thinking about that, about the ethical implications of that for people who have no other choice but to be in prisons or in nursing homes. How are we going to do this? How much can you get per week? Should they take it, or should they pass it on to somebody else who may be perceived as more vulnerable? Clearly this is something people about.

So clearly people have wondered about this. And we wonder about it now. This, we were not unique in this. Pretty much every medical center had struggled with that same problem of giving a vaccine to their own, and not really thinking that through. Laurie Zoloth: And also because people did not see another person standing next to them, whose life they could save by not taking the vaccine. And my poor 24 year old graduate student, who heard me go on and on about this, in her case, I felt that it was actually legitimate licit for her to take the vaccine, given the severity of the disease as a deadly disease.

But then you have to create a movement to fight against that injustice. Laurie Zoloth: And we have an example of this because of the Vietnam war, as white middle-class men in great numbers, my husband was able to get out of the draft because he knew a doctor who could say this and that about him. That happened all the time. People found ways to get out of the draft. They joined graduate school, they joined the revenant, they joined the clergy, they did other things. And every time you took an out, somebody else went to Vietnam. A poor person went to Vietnam, a person of color went to Vietnam. It was a very, very similar, and it was a life and death decision. Your not being there meant that some poorer person would be there. And the only way that that kind of choice is legitimate is to create a mass movement against the war in Vietnam that eventually brought everybody home and stopped the draft cold in its tracks.

So people are spending a lot of time. And I know, our family, we went through the same exact story with all of us who were 65 and older in our family, what were we going to do? How are we going to work it out? What sort of system would be fair? Could we sign up? Paul Rand: So far, the issues raised around vaccine distributions have been due to scarcity, but some think they have a way to speed up vaccine trials to get more vaccine in this system. The idea is that in some cases where you need to know the answer quickly, you can take a certain population and challenge and give them your intervention, and give them the disease and see if your intervention prevents them from getting sick.

Paul Rand: This approach, giving patients a vaccine of unknown efficacy, then infecting them with COVID, is obviously hugely controversial, and most bioethicists are against it. And would it have been ethical? You would just want to know, does this prevent infection or not? Oh, and if you had a fail-safe system. In this case, if someone got sick, the implications of that were terrible, and we were not willing. It was unethical to subject people to such an unknown disease, such an unknown story. It was much too risky. And that level of risk was seen as unethical. Now, when there is vaccine and there is treatments, somewhat effective treatments, it makes the calculus a little bit different.

And you might engage in a challenge trial to test a certain vaccine against another vaccine. Is this vaccine better than that vaccine? How would you do that? And you might want to think about that. Now the trouble is, is that the epidemic is so fierce and raging so intensely. There was no need to do a challenge trial because you got your results really quickly anyway. And challenge trials are typically used in places where the rate of infection is very, very, very slow and would take years to show any effect. And so many people got sick.

It was very easy to test any disease you want, any intervention you wanted against a disease that was that common. When it becomes unethical is when the risk is unacceptable, right? Asking people to take a risk to test an intervention is a very common part of practice. Paul Rand: In the UK, health officials have decided that the risk of challenge trials are acceptable.

The country will be launching trials this month that expose healthy volunteers to the virus to try and answer a key question. How much virus does it take to cause an infection? Eventually, the UK trials challenge will also test new vaccines to see which are most effective. The supply issue will be dealt with. There is an answer to the supply issue. And what do we do about that? And what do we do to get people through to understanding how critical it is for everyone? There was a history of other bad action and centuries of distrust. And those three are a very powerful mix of resistance. Now, what do we do? We have plenty of vaccine. Paul Rand: Which now raises the question of whether it would be ethical to force people to get the vaccine.

Is it ethical to demand that people get the vaccine to participate in certain actions? Much of the private action will be self-protective, right? And that, I think, is completely permissible. Laurie Zoloth: Now, these are emergency use authorizations. So all of those people need us to surround them with protection. And that was done with smallpox. And that certainly was done with polio. People had to be vaccinated. You had to not have smallpox. Laurie Zoloth: And in some states, it will come to that. In the United States, I think it will be the power.

We thought it with smoking. People can choose to smoke, but they have to do it in very constrained areas. Governments and institutional policymakers should use arguments to encourage voluntary vaccination against COVID before contemplating mandatory vaccination, says Smith. A number of ethical considerations and caveats should be explicitly discussed and addressed through ethical analysis when considering whether mandatory COVID vaccination is an ethically justifiable policy option.

Several childhood vaccinations have been made mandatory as a condition of attending school, including in Ontario, and other vaccinations are required as a condition of employment in health care settings," said Smith. The policy brief, titled COVID and mandatory vaccination: ethical considerations and caveats, identifies six ethical considerations that should guide decisions about whether to make COVID vaccinations mandatory, including:.

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