A Rawlsian Analysis of the COVID-19 Vaccine

In “A Vaccine Reality Check,” writer Sarah Zhang provides a thorough exegesis on the current stage of the Coronavirus Vaccine, while using a complex array of historical precedents and contemporary analyses to examine the effectiveness and distribution of the vaccine. To briefly lay out the major points within the article, she examines the definition of a vaccine in general, elaborates on their implementation with respiratory illness, speaks on the specific development of various COVID vaccines, and examines the political implications of these developments. While these points clearly provide valuable insight into this issue, especially with the election nearing, I found the ethical dilemmas and theories that dictate the narrative within the article to be vastly more fascinating. 

With regards to development specifically, the question of ownership begins to govern how society views medical innovation: is it proprietary or collective? Zhang describes how the Trump Administration is encouraging many vaccine makers to invest in infrastructure and manufacturing systems to already prepare for FDA approval of the vaccine; while this may decrease the lag time between approval and availability, it raises the question of power imbalance in ownership once the vaccine is created. The two struggles are constantly at odds: the dichotomy between serving the public good by making these vaccines extremely affordable and the profit incentives for these companies to continue investing in manufacturing and infrastructure. If the medicine becomes specifically proprietary, then that allows companies to prioritize profits over public safety, but if the incentive of profit is removed, it reduces the economic interest of companies to invest in the first place. This ties back heavily to not only the ethical concept of ownership, but also to the essential idea of value-ordering. This will dictate how companies will act. In my opinion, a nuanced solution to this issue is a bit more free-market based. Instead of mandating companies to act a certain way, which I believe will largely de-incentivize their involvement to begin with, I believe the government should provide more market incentives for companies that make the vaccine more affordable. This may involve certain subsidies, but it will be more conducive to creating an economic equilibrium that also expedites the production of the vaccine. I strongly believe ethical principles should apply to institutions as well, because institutions are, in essence, a collective of individuals. Therefore, in respecting the autonomy of these collectives, I believe even more stringent government mandates would be a breach in the moral sense as well. Viewing pharmaceutical companies this way allows society to humanize them, and from that point, extrapolate a more nuanced solution. 

In terms of distribution of the vaccine, I could largely extrapolate ethical subtexts of utility and societal responsibility. The question then revolves around who receives the vaccines first, or at all. Zhang specifically describes a tactic used in 2009, in which states and hospitals used a system of priority status to determine high-risk individuals such as health care workers to get the vaccine first, in order to save the most lives. I felt uncertain about prescribing priority to anyone during a public health crisis, but I also realized that people must be prioritized due to medical scarcity and developmental struggle. So the ethical question shifted: how do we decide who gets the vaccine first? This intrinsic dilemma draws back on two central ethical tools from our study of John Rawls. The first dictates action, and the second prescribes it. This dilemma can be examined through the difference principle, or alternative distributive justice. Essentially, Rawls prescribes that it is okay, and at times expedient, for communities to stray from strict equality, as long as the lower echelons of society are better off than they would be under strict equality. Using this perspective, it makes sense that healthcare workers and high risk individuals would receive the vaccines first, because if strict equality was imposed, the scarcity that ensued would induce a distribution that would not benefit the lowest echelons of society. Saving the lives of healthcare workers, specifically in minority and underprivileged communities, directly helps save more lives, so the lowest strata are lifted up as well with this system of priority status. The second Rawlsian tool that would be most helpful with distribution is the Veil of Ignorance. While improbable, encouraging interest groups and various identities to examine how they would want this vaccine distributed if they did not know their medical details (i.e. age, predisposition, compromised immunity) would allow societies to determine who should receive the vaccine first. 

The article also evoked certain personal dilemmas from me. Zhang mentions that this virus can be used politically and the vaccine is no different. She also mentions the ensuing storm of misinformation and politicking that will follow. So I pondered how I could be helpful in a situation like this, and the most immediate solution that came to mind was voting. In exercising my constitutional right, I am not only electing a leader for the country, but also a global physician in a way. The next president will determine how the virus and the vaccine is handled, and it is an extremely important choice. I also wondered how this issue would play into systemic inequalities in the modern American paradigm. Having just finished The Immortal Life, I wondered how historically marginalized groups, Black Americans in particular would be affected by an improper distribution strategy. These questions only led me back to my first realization: it is extremely important that the will of the people is pronounced on Tuesday. In a moment of historic proportions, democracy is all we can look to for answers. 

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