It’s surreal reading Sarah Zhang’s article on CoVid from 3 months ago – you can feel the frustration and angst in her tone , which is a reflection of how most Americans were feeling at the time. As we approach November, ushering us into the ninth month of the ongoing pandemic, there’s much less hope despite the prospect of a vaccine. The CDC is absent. Federal and state administrations are persistently inept – the upcoming election only exacerbates this fact. There’s just an overarching sense of somber acceptance that to outlast the pandemic, we must accept ethical compromises and I doubt vaccine distribution will be the exception to these sentiments.

Much like the approval of early faulty Covid testing material (resulting in a significant amount of false negatives and thus continued spread of the virus), rushing the process of medical equipment like a vaccine through the Trail 3 phase has a high chance of bringing as much harm as good, our best-case scenario is to have the vaccine be effective in merely 50% of those it is given to, but we as a country have made the ethical compromise to prioritize immediate chance over gradual certainty.

In prioritizing chance we have decided we need tens of thousands of research volunteers to create this vaccine. This presents one of the most challenging ethical dilemmas of all: selecting individuals who are likely to be exposed to and heavily affected by the virus. Many of these individuals are essential workers that work lower-wage jobs (delivery persons, grocery clerks, teachers, restaurant servers) who have continued to work through the pandemic as a means to stay financially afloat and individuals who are at high risks such as elderly people and those with pre-existing conditions. To even obtain a vaccine, we are essentially asking the most vulnerable populations to “take one for the team” and risk their lives for the betterment of the majority healthy and financially stable population. It’s especially heinous that many studies are targeting lower-income areas with the incentive of financial compensation, creating the equivalent of an economic Covid research draft.

And so we find ourselves at the most recent prompt of ethical compromise: who gets the vaccine and when? Since these communities are the ones being targeted, do they not deserve first priority when a vaccine is approved as reparation for their continued sacrifices throughout the pandemic? Were these not the citizens that helped the US function while the rest of us patiently waited safely inside our homes – how can they be “at-risk” enough to be guinea pigs but not “at risk” enough to be taken care of?

Zhang points out that providing vaccines to these communities has been an idea spread amongst professionals but that confusion of authority has delayed any sort of substantial distribution plans. I have to agree with her that the “vaccination program is likely to take place against a backdrop of partisanship and misinformation” and that’s a prediction from months ago. Resources are finite and its well known that the vaccine distribution will receive critique from every angle but in my opinion, and perhaps because I am partial towards the ethics of care and considering how this virus has disproportionately effected various communities, we should be prioritizing those that have been caring for us for the past nine months. We may not fully know who will get it right at the beginning but its very clear who should be recieving it last: all of us sitting at home waiting for a solution.

“A COVID-19 Vaccine Reality Check,” is an article recently published in The Atlantic by Sarah Zhang. In this article, Zhang looks at the current COVID-19 vaccine development that is taking place as well as the distribution plans to the public that are currently being assessed. Elements that most of the public is not involved in or that does not cross their minds. Zhang makes it evident that just because there is a high requirement for the vaccine due to the casualties, it does not change the fact that the vaccine needs to be rigorously tested before it can be mass-produced to try and save the lives of thousands. Despite the media giving regular updates claiming that the vaccine could be here as early as next month, Zhang believes it is going to be much longer. As well as this, Zhang creates a large ethical issue relating to the distribution of the vaccine, which is; who is given the vaccine first? When produced, it is still going to take time for the vaccine to be produced in numbers large enough that everyone is going to be able to receive it. Personally, when I think about this issue, I would look to a more logical and utilitarian method for distribution.

Taking this logical and utilitarian view on this issue, the best method would be to save the most lives possible and give to those that have the highest risk of contracting the virus. This would be the best possible scenario. In this case, those working on the frontlines as medical workers would be prioritized first. They are currently in the most danger by working with those who have COVID-19 every day, and because of their bravery and hard work, they should receive the safety of a vaccine first. This fits the utilitarian viewpoint as the person at higher risk has been saved first, and so the risk of life loss has decreased. This seems to be the most logical idea. Alongside this, the medical worker group fighting on the frontlines is not a large group of people meaning that the likelihood of being able to vaccinate all is high and even the possibility of still having vaccines left is also high. It seems simple for now.

Still keeping this utilitarian viewpoint, the next stage of distribution would be to give the vaccine to the group of people who are the most vulnerable of the rest. This would include those with underlying health conditions as well as the very young and old members of our society. Through research, it has proved that those groups have the highest percentage fatality rates from COVID-19; therefore, it is those whom we must protect next. From a purely utilitarian viewpoint, this argues stands, however, some arguments can arise when it comes to vaccinating the older generations. Due to the limited supply of vaccine, we must use them wisely – some research has been published that indicates that many of those older people dying of COVID-19 already had a high chance of dying through other causes by the end of 2020. Because of this research, some have argued that it is not worth vaccinating these people as they still have a high chance of dying soon after administration and so the vaccine could have been put to good elsewhere. This is extremely difficult to decide, though, as it based primarily on statistics.

The real issues, however, arises after these two groups have received the vaccine. Who should receive it next? It comes down to a decision between teenagers and the middle-aged—research proving that neither is at a very high risk of dying from COVID-19. As a 19-year-old, I feel confident in being able to fight the virus and opt for vaccinating the middle-aged first; however; some disagree with my viewpoint as they are less confident in their safety. On top of this should the vaccine be mandatory for all or are people allowed to choose whether they want it at all. This comes back to the anti-vax arguments. This distribution of the vaccine is a complicated matter from an ethical standpoint as to who gets it first due to the limited supply. It appears to be more subjective than objective. How safe do you feel without one? If given the opportunity to be vaccinated over someone at higher risk would you take it? What is your hierarchy of priority?

In Sarah Zhang’s article, “A COVID-19 Vaccine Reality Check” in The Atlantic, she addresses the false hopes that the coronavirus vaccine is providing for America. She argues her case by stating America’s H1N1 vaccine procedures and how the coronavirus differs immensely. For example, the dosage is a two-step process and the uncertainty revolving around the coronavirus has yet to slow down. However, there are key similarities that, with ethical modification, America should implement. It is crystal clear that distribution will be an extremely complicated, particular process. America, as a whole, failed to address resource scarcity in the early stages of the pandemic, running out of masks and ventilators within weeks. While our focus must now shift towards a vaccine, keeping Zhang’s article and resource scarcity in mind, questions of what ethical practices that are justifiable must be put into place. I believe that America should take a modified, general utilitarian approach to distribution and heavily consider mandating the vaccine to a certain extent.

By taking the utilitarian approach to distribution, the allocation of resources will be properly addressed while respecting ethical practice. Zhang mentions the prioritization of certain groups of people as a successful procedure used during the 2009 H1N1 virus. This could be swiftly and effectively replicated for the coronavirus vaccine. The first group of people to be vaccinated and have priority should be healthcare workers, researchers, and officials on the frontlines of this pandemic. By vaccinating this group of people, we are adhering to the utilitarian perspective: a maximization of benefit and “good” produced in our society. These healthcare warriors could then devote their time and effort to save patients with great health, which is proven to increase productivity by economist Robert Fogel, and not have the preconditioned danger of receiving the virus. Furthermore, this group is fairly small with humongous value. With this method, we are still keeping in mind the scarcity of the vaccine. 

To streamline the process of distribution along, the people most vulnerable to the virus should receive vaccinations after healthcare workers. This would mainly include those with underlying health conditions and older adults in America: those who can truly not function “normally” due to the virus in their lives. Once again, we are adhering to the utilitarian perspective by decreasing the danger and effectiveness of the virus by protecting those most vulnerable. Thus, producing the most good and benefit by decreasing the threat that the COVID-19 virus possesses in America. This is also fairly similar to the normal function philosopher Norman Daniels stated while addressing the right to healthcare. However, this method becomes problematic after the first two prioritized groups: as it is extremely difficult to determine whose lives have been affected the most by this virus. 

Alongside questioning distribution methods, paternalism through the law (mandating the vaccine) could be justifiable to a certain extent and must be discussed. For example, if a healthcare worker or person with underlying health issues were, to hypothetically, deny the vaccine, should they still be able to work? Should we respect their autonomous decision? A golden rule when referring to paternalism in medicine is that overriding and/or restricting one’s autonomy is just if it is necessary to protect others in society. Refusing the vaccine is not only putting yourself in danger but putting others at risk that may be tremendously vulnerable to the coronavirus. To protect some autonomy, vaccines should be mandated to return to education at schools, the workplace, and other essential places. What is deemed to be an “essential place” is yet another complication to the hundreds of other logistical practices that must be addressed to successfully deliver the vaccine to the people.

Sarah Zhang’s piece, “A COVID-19 Vaccine Reality Check” examines the intricacies of vaccine research, development and distribution that are often overlooked by the general public. Zhang notes that this vaccine, currently being developed at record speed, will still take many more months of trials and necessary regulatory hurdles before it is cleared for universal use on the general population. Once the vaccine is deemed safe, public health officials will have to determine who gets the vaccine as limited doses become available. This will certainly lead to a shortage of supplies as the population rushes to get vaccinated. The ethical challenges that accompany dissemination of the vaccine can be examined through a lens of Rawls’ theories of distributive justice.

Though Rawls’ theory is rooted mostly in the abstract, his Veil of Ignorance has a somewhat tangible application in the case of the current pandemic, and his principles of justice can serve as a model for the type of national collaboration needed to rebuild our health and economy. The COVID-19 virus itself acts as a Partial Veil of Ignorance. Individuals are often acutely aware of their privilege or lack thereof, and this privilege can act as a shield from COVID-19. However, as has been evident with a recent COVID outbreak in the White House, the virus does not function strictly along the same socioeconomic or racial hierarchies. Individuals must then consider themselves at equal risk to get the virus and make decisions about the virus with that possibility in mind. This acts much like the Original Position, forcing individuals to choose a path under the assumption that they do not know where they will fall in society.

Rawls’ Difference principle provides a framework that could help with vaccine distribution and the greater challenge of ending the pandemic completely. The Difference principle, states that inequalities are acceptable as long as actions are taken to remedy these inequalities. As mentioned earlier, this virus may act indiscriminately, but people are put in positions based on inequalities that may change their chances of infection. In terms of vaccine distribution, an honest effort to remedy these inequalities would include getting the vaccine to groups who have been hit the hardest by the virus so that they have a better chance of fighting off the virus and limiting spread. “The committee, which is composed of outside experts, last met in late June, when they discussed prioritizing vaccines for health-care workers, the elderly, and those with underlying conditions. They also considered prioritizing vaccination by race, given the racial disparities in COVID-19 cases” (Zhang). This comparison to Rawls’ theory brings up questions of how these disadvantaged communities were put into this position in the first place, and brings up the other component to the Differences Principle, equal opportunity to office. In giving all individuals equal opportunity to office, would these social determinants of COVID have been alleviated or better identified? Can some of these structural inequalities be resolved so this country can battle future pandemics more equitably?

America is and has been ethically and structurally unprepared for the Coronavirus pandemic. Practical shortcomings became clearly evident in the early days of the pandemic, on issues such as mask production. But as we move into the ‘late’ stages of the pandemic and everything is allocated to the possibility of a vaccine, even more infrastructural concerns are arising. Some of these are identified clearly in Sarah Zang’s article A Covid-19 Vaccine Reality Check: the complications relating to the vaccine are even more threatening. The complicated nature of the disease and the potential two-step nature of the vaccine threaten to throw the US healthcare distribution process into complete disarray. I believe that to organize this incredibly important ethical healthcare issue, we can apply ideals we have studied in this class- mainly, a combination of general Utilitarianism and Norman Daniel’s Normal Function models.

The utilitarian distributive approach– Sarah Zhang identifies in her article the method of ‘prioritization’ of distribution, where healthcare officials meet to decide which groups are a priority and therefore should receive the vaccine first. Zhang says this has been used before- in the 2009 H1N1 pandemic, a prioritization system was put in place with considerable success. However, I believe that this system needs to be modified to fit with the Covid crisis, and Utilitarianism theory can help. Utilitarianism, as we know, advocates maximum well-being for the maximum amount of people. Under this theory, I would strongly advocate priority immunization of groups who are actively fighting the pandemic, such as healthcare workers and researchers. This would result in them being able to devote maximum effort and time to caring for the sick and researching a vaccine without the fear of the disease itself. Therefore, by increasing their productivity, they in turn would produce the most good for society as a whole. They may not be the most numerous group, but their professions and actions will undoubtedly have the largest possible positive repercussions for our society in this pandemic. After these high-priority, society-affecting groups have been immunized, the distributive approach undoubtedly needs to focus on providing vaccination to those at risk. Yet as Zhang argues, there is endless discourse and speculation about ‘at-risk’ populations and who truly deserves the vaccine. It is because of this situation that I propose the use of the Normal Function model.

The Normal Function approach– To provide a quick summary of the normal function approach: Health philosopher Norman Daniels advocates that healthcare should be provided first to those who are not able to function ‘normally’ and achieve their goals (operating in a ‘red’ rather than normal ‘green’ zone). This could be almost flawlessly applied to this Covid vaccine distribution crisis. After the healthcare workers/other groups I identified above was immunized, the distributive professionals should use this model to identify groups that are operating out of their normal function range because of Covid. An example would be someone with a compromised immune system who cannot attend work and achieve goals because of fear of catching and dying from Covid. This person is operating out of their ‘green’ zone, and therefore that group needs to be designated as a priority. Do not prioritize groups that are not being directly pushed out of their green zone by Covid-19. Rinse and repeat. We have extensive knowledge of how Covid and similar viral diseases affect patients with pre-existing conditions that we didn’t have in the past. We need to use that knowledge to designate priority groups with the normal function model; streamlining the distributive process.

Although I believe this process would work, I do leave some questions after writing it. I wonder how officials would agree on the defining value zones that are critical to the normal-function theory? I also (sadly) wonder how we could balance utilitarianism with the ever-present diaspora of financial and lobbyist influence in the US, especially in the healthcare industry. 

In conclusion, the Covid vaccine distribution process is undeniably technically and ethically complicated. The US administration was not adequately prepared for the structural difficulty of this complicated Covid crisis. However, in the lens of ethical distribution, I believe that by applying utilitarianism and the Normal function model to society, the distributive process would be immediately streamlined, allowing society to focus more on refining the technical aspects of the pandemic.

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?