Sarah Zhang’s article “A Vaccine Reality Check” discusses the ongoing efforts throughout the world to develop a vaccine for COVID-19. Many hope that a vaccine will allow life to quickly return to as it was before. Zhang warns against this, pointing to the difficulties that will still occur even if a vaccine is successfully developed such as a limited number of available resources needed for mass production and the difficulties that will be faced in distributing a vaccine. However, even if all the difficulties of developing, producing, and distributing a vaccine could be overcome, there is still a glaring concern. Zhang states that “20 percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult.” The question of how to resolve the issue touches on multiple ethical and moral questions. 

The ethical question that seems most relevant to me is whether paternalism is justified in this context. There is a particular brand of liberalism rising within the United States that has been exemplified throughout quarantine. Many have insisted that requirements to wear a mask or adhere to social distancing guidelines are infringements to their autonomy and freedom. The same argument would most likely be raised if any mandates were imposed requiring vaccinations to return to the workplace, school, or university campus. Similar requirements are already in place for many other vaccines, particularly in school environments, and there has been much debate over the topic. However, such a mandate may be needed if the United States is going to reach levels of immunization necessary for herd immunity. A rebuttal I would raise to the argument against mandatory vaccination is a concept that is fairly common in medicine: paternalism is acceptable if restricting a person’s autonomy is necessary to protect others from harm. Refusing to get a vaccination not only puts yourself at continued risk for exposure to coronavirus but could also put others who are unable to receive the vaccine due to economic or health reasons at undue risk. 

One question this debate leaves me with is why American society is much more sensitive to paternalism in this case than in the many other daily occurrences where paternalism occurs. The requirement that we all drive on a certain side of the road, laws prohibiting stealing, and many other aspects of daily life can all be seen as the government engaging in paternalism because they believe it is in the best interest of their citizens. People rarely argue that such requirements infringe on their autonomy. What can such resistance to paternalism surrounding vaccines be attributed to? Does it result from a rising culture of medical and scientific skepticism, a genuine concern for health, or something else?

Throughout the COVID-19 pandemic, a multitude of ethical issues about resource scarcity have arisen. Different questions about the fair distribution of tests, personal protective equipment, and life-saving medical technology seem to come about every day. As the pandemic has evolved, the necessity for a vaccine has become more obvious, as well. Though there seems to be a race to discover the vaccine, the question of how to do so in a fair and just manner seems to only be in the back of a few minds. Though the vaccine itself will need to be allocated, the glass vials, temperature-controlled storage units, and other basic supplies that are needed to create it will be just as crucial. With so many moving parts, America’s lack of infrastructure could potentially botch the vaccine’s rollout. If a vaccine is found and able to be widely produced, fair distribution of it must be at the forefront of the conversation. According to the equal opportunity approach, everyone should be entitled to the necessary resources that will allow them to achieve “normal functioning” and equally compete for opportunities in society. In an ideal world, I believe that viewing the vaccine as a part of the right to healthcare would ensure that citizens are able to reach this baseline of normal functioning. Realistically, though, the issue of resource scarcity far outweighs the issue of the right to equal opportunities and access to healthcare.

Guaranteeing absolute equality is not economically feasible, so finding ways to prioritize who should get the vaccine first is critical. During the H1N1 pandemic, government organizations were able to efficiently and effectively distribute the vaccine to the highest priority group, showing that prioritizing has been successful in the past. Because healthcare professionals are risking their wellbeing to help others, getting first priority of the vaccine could help them get closer to achieving normal functioning. The vaccine would provide them with at least a small amount of protection and reduce the severity of symptoms if they were to get COVID-19. This would give the healthcare professionals a better chance of recovery, allowing them to equally compete for opportunities more quickly. Apart from healthcare professionals, I believe that we must give second priority to individuals with pre-existing conditions. Getting the vaccine would give them at least some protection, easing their anxieties and allowing them to equally participate in society again. It is a fact that certain people will be treated differently during vaccine distribution, but it is up to us to ensure that it is in the most fair way possible. 

Though prioritizing seems to be a good way to provide some baseline amount of equal distribution of the vaccine, would the lack of infrastructure stop this process before it even begins? Would having a general, national distribution of the vaccine be more realistic due to the weak infrastructure, or would that completely eliminate the fairness of the vaccine distribution?