This post is a part of our Bioethics in the News series
By Parker Crutchfield, PhD
As the COVID-19 pandemic continues to maim and kill thousands and devastate countless others, many are pinning their hopes of returning to a life resembling normal upon the development of a vaccine. The Centers for Disease Control and Prevention has even advised states and cities to be prepared to allocate up to 800 million doses of a vaccine in late October or early November. But it is highly unlikely that a vaccine will do much to stop the pandemic and related significant harm. For a vaccine to get us out of the pandemic, it needs to be developed, distributed, and received. Regardless of its development and distribution, if people don’t take it, then it won’t do any good. And there isn’t much reason to think that many people will take it, at least initially.
Allocation Models
Recently, a team of scholars advocated for a scheme to allocate the eventual vaccine, the Fair Priority Model. This model, like most models of allocation, assumes that the vaccine will initially be scarce. On this assumption, the allocation then proceeds in phases, the first preventing the most significant harms such as death, the second preventing other serious harms and concomitant economic devastation, and the third addressing community transmission. Other models may set different priorities by, for example, putting health care workers or racial and ethnic minorities first in line.
Developing allocation models is important. But they all rest on a questionable assumption: that the people to whom the vaccine is allocated actually want it, or are at least willing to take it. Scarcity is just as much a matter of demand as it is a matter of supply.
Demand for a Vaccine
Recent evidence suggests that, generally, people won’t take the vaccine initially, even if offered. Almost 80% of people said they wouldn’t get it, if available, at least until others have done so, according to a recent CBS News poll. A return to something resembling normal life requires around 70-80% of the population to be immune.
Mistrust of the politicization of vaccine development or of the scientific practices involved may be responsible for much of the population’s apparent hesitation. But reasonable people may also simply not want to be first in line for a new immunity enhancer. Thus, whatever criteria are used, the allocation scheme must incorporate consideration of demand, not simply supply.
For example, the first allocation according to the Fair Priority Model should go to those people whose being vaccinated would most likely prevent death and who want the vaccine. If the vaccine is allocated to health care workers, the allocation must be to people who are health care workers and who want the vaccine. That is, demand for a vaccine should be just as much a component of allocation models as any other consideration.
Voluntary or Compulsory?
Allocation models must consider the population’s demand for a vaccine in order for such models to provide useful guidance on distribution. Given the apparent lack of demand, giving people the choice of whether to take the vaccine is unlikely to stop the pandemic any time soon. But demand only matters if people have an option. One way to avoid having to consider the population’s willingness to take the vaccine, and to dramatically decrease the time it takes to boost 70-80% of the population’s immunity, is to take that willingness out of the equation and make it compulsory.
Already some vaccinations are compulsory, depending on a person’s circumstances. Some have argued that the COVID-19 vaccine should be mandatory. One common principle in philosophy is that ought implies can. This means that what one’s moral obligations are hinges on what one can do. Even if one can justify compulsory COVID-19 vaccination, it’s unlikely that this is something that can be achieved. Compulsory vaccination is not something we can do, which means it’s not something we should do.
Consider, for example, the widespread reluctance to wear a mask and the flouting of social distancing guidelines. Wearing masks and social distancing are very minor burdens to bear for others’ well-being. While it is true that mask and social distancing mandates push against unrestrained permission to do what you want when you want to do it, others be damned, these intrusions are arguably minor (though are admittedly disruptive). Requiring 70-80% of the population to go someplace and get poked by a needle on multiple occasions or sprayed in the nose are much greater liberty intrusions. It is a pipe dream to think that a vaccine mandate would be accepted by the very same population who refuses to bear the more minor burdens of mask wearing and social distancing, which amounts to at least 29% of the population, enough to undermine our ability to stop the pandemic.
Different Baskets for Our Eggs
If administration of the COVID-19 vaccine is voluntary, not enough people will volunteer to get it. If administration is mandatory, still not enough people will get it. The vaccine’s allocation can only be either voluntary or mandatory. Either way, not enough people will get it, at least at first. The only conclusion to draw is that a vaccine is not going to stop the pandemic, at least any time soon. If ought implies can, we ought not pin our hopes upon a vaccine, because we cannot hope for it to work to stop the pandemic. There is no light at the end of the tunnel.
However, incentives and disincentives can change a person’s mind. Other than the incentive intrinsic to getting the vaccine—the preservation of human life and well-being—are there others that might make people more willing to get it, such as money or tax breaks? Or are there disincentives to vaccine refusal that might convince someone it is better to get it than it is to refuse? Carrots or sticks?
If neither, then we’re in for the long haul.
Parker Crutchfield, PhD, is Associate Professor in the Program in Medical Ethics, Humanities, and Law at the Western Michigan University Homer Stryker M.D. School of Medicine, where he teaches medical ethics and provides ethics consultation. His research interests in bioethics include the epistemology of bioethics and the ethics of enhancement, gene editing, and research.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, October 8, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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More Bioethics in the News from Dr. Crutchfield: Trust and Transparency in Quarantine; Public Health Crisis Warrants Liberty Restrictions; We Should Tolerate and Regulate Clinical Use of Human Germline Editing
References
- Marshall M. The Lasting Misery of Coronavirus Long-Haulers. Nature. September 14, 2020. https://www.nature.com/articles/d41586-020-02598-6.
- Centers for Disease Control and Prevention. Provisional Death Counts for Coronavirus Disease 2019 (COVID-19). U.S. Department of Health & Human Services. https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm. [Accessed 16 September 2020]
- Bauer L. The COVID-19 crisis has already left too many children hungry in America. Brookings. May 6, 2020. https://www.brookings.edu/blog/up-front/2020/05/06/the-covid-19-crisis-has-already-left-too-many-children-hungry-in-america/.
- Kaplan S, Wu KJ, Thomas K. C.D.C. Tells States How to Prepare for Covid-19 Vaccine by Early November. New York Times. September 2, 2020. https://nyti.ms/3hVlXNr.
- Emanuel EJ, Persad G, Kern A, Buchanan A, Fabre C, Halliday D, Heath J, et al. An ethical framework for global vaccine allocation Science 11 Sep 2020. 369(6509):1309-1312. DOI: 10.1126/science.abe2803. https://science.sciencemag.org/content/369/6509/1309.
- De Pinto J. Voters skeptical about potential COVID-19 vaccine and say that one this year would be rushed – CBS News poll. CBS News. September 6, 2020. https://www.cbsnews.com/news/voters-covid-19-vaccine-opinion-poll/.
- Lederman M., Mehlman MJ, Youngner S. Defeat COVID-19 by requiring vaccination for all. It’s not un-American, it’s patriotic. USA Today. August 6, 2020. https://www.usatoday.com/story/opinion/2020/08/06/stop-coronavirus-compulsory-universal-vaccination-column/3289948001/.
- Wu KJ. You’d Rather Get a Coronavirus Vaccine Through Your Nose. New York Times. July 14, 2020. https://nyti.ms/2OnHfpT.
- Brenan M. Americans’ Face Mask Usage Varies Greatly by Demographics. Gallup. July 13, 2020. https://news.gallup.com/poll/315590/americans-face-mask-usage-varies-greatly-demographics.aspx.
MSU Bioethics 
One of the things that needs to be emphasized is that the 50-80% of the population that has told pollsters they would not accept a COVID vaccine at this time are not anti-vaxxers. They are reasonable people who are very concerned that Trump is trying to rush through some vaccine without adequate attention to safety or efficacy. They do not wish to be Trump’s political guinea pigs. Ironically, this seems to be as true for Trump’s supports as his critics. Many of Trump’s supporters will say they are willing to take a bullet for him, but they will not take a shot in the arm. There is another issue that the Trump Administration is not calling attention to, namely, that in order to have a vaccine approved before the election the FDA would have to issue an Emergency Use Authorization. If such an order were issued, as was pointed out in the Wall Street Journal this week, then Medicare has said it would not pay for the vaccine (I think that would be because the vaccine would be regarded as experimental.) As a consequence, older individuals who are most vulnerable to COVID would have to bear those costs themselves, which would become an economic obstacle for the part of the Medicare population in the lower 50% of the economic spectrum. Caveat emptor.
Thanks for this comment! Even taking the politics out of it, a reasonable person might simply not want to be among the first to receive a newly developed intervention, whether that intervention is a vaccine, a new drug, surgical technique, etc. With new interventions, the evidence indicating safety just might not have had the time to meet the individual’s threshold of risk they find acceptable. So, yes, there are certainly political reasons that might cause hesitancy, but also epistemic ones.
The Fair Priority Model we propose is for the international allocation of vaccines. I would counsel strongly against using one poll that asked Americans– who live in a country where the federal COVID-19 response to date has stood out for its poor quality and has beeen systematically influenced by political considerations–whether they would get a vaccine during calendar year 2020, to conclude that people around the world would refuse COVID-19 vaccines. We know that support for childhood vaccination differs globally, with many poorer countries (such as India and Bangladesh) showing much less hesitancy than certain rich countries like France and Russia: https://ourworldindata.org/grapher/share-agrees-vaccines-are-important-wellcome . Furthermore, many countries, including both the USA and poorer countries, have achieved over 80%–and close to 100%–immunization rates for common diseases: https://ourworldindata.org/grapher/perception-of-the-safety-of-vaccines-vs-vaccine-coverage?time=2020 . It is important to avoid parochialism in our bioethical analyses, yet the poll makes very sweeping statements based on data about only Americans, in a very particular political context.
Points well made, Govind. For many countries, a vaccine may indeed be something like a light at the end of the tunnel. And certainly the responses of Americans are not representative of citizens of other countries. For them, there may be hope. For those of us in the U.S., there isn’t, at least none that the development of a vaccine can provide.
Saying that “For those of us in the U.S., there isn’t [hope], at least none that the development of a vaccine can provide,” is an overstatement that I, respectfully, worry borders on irresponsible. First, an effective vaccine would directly protect people who receive it, and prevent them from spreading Covid-19 to their loved ones. That would be a huge improvement. Second, constant social distancing can be much more burdensome than a one-time or two-time vaccine. Before claiming that those who resist social distancing won’t ever get a vaccine, I would like survey data on, for instance, how many university or high school students would be happy to be vaccinated if it allowed them to safely congregate in groups with friends, or adults would do it if it allowed schools to reopen for their kids. I would also want to know whether people would accept compulsory vaccination in specific high-risk settings and jobs before claiming that it is categorically impossible. Third, if people in specific geographic areas are more willing to be vaccinated, this will help in slowing or stopping Covid-19 there, even while the pandemic proceeds elsewhere. In the Northeast, the Gallup poll you cite say only 8% “never” wear a mask (and overall the “never” are 14%, not 29%–it’s misleading to say that 29% of people refuse mask wearing, when that includes 11% who “sometimes” do outside their homes). We have seen substantial differences across states, perhaps reflecting differences in state policies and uptake of interventions like masking; I would expect the same with a vaccine, especially if the politicization of the approval process reduces or changes. Fourth, if infection produces some degree of immunity, the proportion of people who have immunity from infection will eventually–combined with those who are vaccinated–be sufficient to stop pandemic spread, albeit more slowly and with unnecessary loss of life compared to the outcome if vaccine uptake were higher. That is, even though a vaccine may not stop the pandemic on its own, it will combine with other measures that will together stop the pandemic. While it is important to acknowledge information about people’s willingness to be vaccinated, what we know does not support the view that Americans cannot garner benefit or hope from a vaccine or that a vaccine won’t help to stop the Covid-19 pandemic. I appreciate your response and engagement.
Thanks for the reply, Govind.
I’m not claiming that an individual can’t hope to benefit from a vaccine. Those who want to take it can certainly hope to derive great benefit from it, and that benefit will promote a network of benefits for others, both for those who receive the vaccine as well as those that don’t (benefits which include immunity, but also those associated with “normal” life). My point is simply that that network, however far it extends, will be insufficient to get us back to anything resembling a normal life in the near future. Policies will rightly vary locally and state to state–hopefully those states that create a far-reaching network of benefit can be models for states or regions that do a poor job. To return to normal soon, thought, we need to solve a problem of collective action to achieve a common good. Of course, we can and will return to normal at some point, and a vaccine will be partially to thank for that. And to return to normal it’s not even necessary to cooperate. But for normality to return “soon,” something else must intervene, other than simply the development of a vaccine. We, at the level of the nation and state, don’t have the chops to do it together. Is there a single example from that last fifty years of people in the U.S. or even any of the states to come together to avert a comparable threat? I can’t think of one, but maybe my memory is failing me.
I also want to push back on the idea that it is irresponsible to point this out. It’s troubling to hear people say things like, “Once there’s a vaccine this will all be over.” I hear it all the time and you probably do, too. But it’s incorrect. It’s not gonna be all over once there’s a vaccine. The pandemic is going to continue to disrupt even after a vaccine is developed. It’s not irresponsible to point this out.
You bring up a really good point about the disruption of vaccine versus social distancing. I wanted to put this in the article, but was limited by space. A vaccine is more invasive than social distancing because it goes directly into the body, but social distancing is probably more disruptive to one’s life. When it comes to which is more intrusive to one’s liberty, how do we balance these? It at least depends on the person intruded upon and how they want to use their bodies and liberty to move. I don’t think there is a good way of saying one way or the other that vaccine are more or less intrusive.
Dear Dr. Crutchfield,
I couldn’t agree with you more, especially after witnessing the MSU undergraduates at mini-superspreader events spread covid-19, threatening the entire mid-Michigan communities and many others, far and wide.
Herd immunity only works when a large enough percentage of the entire population is vaccinated.
The African-American population won’t even volunteer for vaccine trials, given their mistrust of current government and the historical fiasco of the Tuskegee syphilis EXPERIMENT without any consent.
I’m afraid you’re correct that a considerable segment of our diverse population will refuse to be immunized, whether it’s voluntary, OR MANDATORY!
The two incentives for me is as follows:
1). Protect my family, and myself, so that
2). I can return safely to the job I love, i.e.,
teaching medical clerks, residents and fellows, and serve as a consultant to faculty, as I did for 35 years at MSU, and many years at Hurley Medical Center and KCMS, later WMU.
This pandemic is affecting in many ways the detailed education of our future physicians and “first responders”. Some of even this cadre refuses to wear masks and social distance to protect themselves AND OTHERS, and will probably reject covid immunization!
Hello Dr. Netzloff,
Firstly, thank you for your comment and interpretation of this post. I think it is a bold, yet warranted, point that you made about the African-American community and their cautious attitude towards immunizations given the Tuskegee experiments. However, I do think that being cautious toward the vaccine can be relevant for many other populations because of the roller-coaster that has been COVID up until now. There have many situations in which we believed that one form of treatment would work, where it later proved to hinder one’s long term health; i.e. physicians moving away from ventilator treatments in June. Though there are other extraneous factors to account for, I think regardless of the population, there should be meticulous research and consideration whether taking, or refusing, the vaccine (if and when it comes). I think we all want some semblance of normalcy back, but given where we are now, it seems like there is no resolution in near sight.
We are all being affected by this pandemic in some way, but what we can do is make ourselves, and others, feel safe.
Thanks for the comment, Michael. I like your point about your own incentives. How should we respond to problems of collective action when we see that our own contributions are not likely to be reciprocated? For those of us whose cooperation is conditional (I’m not saying yours is–maybe your contributions are unconditional), we are likely to fall back on serving our own interests first and foremost, at least those we know enough to serve.
You also bring up a great point about the effects of the pandemic on medical education. Obviously it’s hugely disruptive, but I wonder what the long-term effects will be. Hopefully years from now some good social scientists will tell us, and hopefully they’ll tell us that it had a positive effect.
Dear Dr. Crutchfield,
I do not see how the “dumbing down” of medical education, and thus future medical care can have I positive effect. I certainly had observed poorer (uninformed) medical care in our mid-Michigan community over the last 10 – 20 years: e.g., how can one practice MODERN MEDICINE without adequate medical genetic consultation (available DNA testing is changing every day, making gold standard clinical diagnosis completely, in most instances, dependent on knowing the correct genetic test
to order; this will only get more interdependent in the future!
And don’t even get me started on the gobsmacked and distrustful response of the AVERAGE citizen to our completely dysfunctional current national government!
They do not feel our leaders can be trusted, especially with regard to a covid vaccine.
Our advanced age and attendant risk factors make my family and me willing guinea pigs for a CDC-approved immunization!
Mike Netzloff, M.D.
One thought is that maybe the experience in medical school will make future physicians highly adept at virtual medicine, or that the experience will confer upon them some other psychological trait that makes them better physicians.
Dr. Crutchfield, thank you for your insight into the world of vaccines. When dealing with something so new, especially Covid-19 many of us have to think of all the testing that has gone into previous vaccinations. The vaccination for Polio wasn’t developed, tested, and implemented within a 6 month time frame, Jonas Salk worked for a few years to get it developed. This is possibly why people are so uncertain about the vaccination for Covid. There are many people who don’t vaccinate their children due to their lack of belief in the science of these often times life saving vaccines. With no studies being done for the Covid-19 vaccination, there’s also no knowledge of long term effects that this vaccine may have. That uncertainty wouldn’t make anyone want to receive that vaccine. The vaccine won’t stop the pandemic, nor will it stop another outbreak of the virus, especially if no one volunteers to get it. Making it mandatory will also may not be the best idea, as there is guaranteed to be some form of opposition, how they will oppose is a mystery as well. All we can do currently is hope that science is on our side and that the vaccine will be prove to be effective and the effectiveness will encourage many to vaccinate for the desired goal.
Thanks for the comment, Cassandra.
You are right that the uncertainty, especially initially, has been problematic. One such principle that people have been appealing to is the Precautionary Principle, which says that when the effects of an intervention or action are uncertain, it is better to not act or intervene in that way. Whether such a principle is a justifiable guide to action is one matter–it might not be–but it does seem true that people act according to it. This principle wouldn’t apply to other interventions, such as other vaccines, because to the extent that the effects of anything are known, the effects of vaccines are known. But the novelty of the COVID-19 vaccine, assuming one is developed, might trigger for some the Precautionary Principle.
Dr. Crutchfield,
Thank you for the thoughtful post. Undoubtedly, the pandemic has been a particularly complicated time for our country (and world). I would argue that a good portion of the complicated nature has been due to the vast unknowns surrounding the virus. Who will get sick? How do we protect ourselves? What about schools, businesses, mental health? How can we make an informed decision? Am I/my family at risk? Navigating these uncharted waters has impacted nearly every fabric of society. When the wellbeing of an entire society is in question, yet we are largely unable to discern beneficial steps due to lack of research/information, it sends even the most intelligent minds spinning.
I had many thoughts and questions while reading your post, regarding: 1) mandatory vaccinations for healthcare workers, as I work in the field and would likely be a part of this; 2) the ethics of incentives or disincentives for vaccination; and 3) potential financial barriers due to Medicare’s decision to not cover the vaccine.
1) I think it is warranted to bring attention to the fact that healthcare workers mandated to receive the COVID vaccination may share similar fears as the general population (as noted by the poll you cited), regarding reasonable concerns on essentially being guinea pigs in the initial phase of vaccinations. Do you think vaccinating healthcare workers would be an essential first step? Are they that disproportionately at risk for COVID compared to other first-responders such as police officers, firemen/women, and grocery store workers that would warrant them being the first line to receive the vaccination?
2) It interested me that you brought up incentives vs disincentives for receiving the vaccination as a means to ensure compliance. It’s tricky because without any form of incentive, as the poll showed, the majority of Americans will be hesitant to vaccinate. However, Cassandra is correct in saying that the loss of liberty associated with a mandatory vaccination will likely lead to opposition. I also worry that there may be an ethical dilemma in enforcing incentives/disincentives. By the same token, our government enforces other safety precautions (i.e., seatbelts), so what will it take for the enforcement of vaccinations as well?
3) With Medicare not covering the vaccine, I am concerned that many individuals with preexisting vulnerabilities (such as those in poverty, POC, additional health conditions/complications, etc) will not receive the vaccine due to financial barriers. If those that need the vaccine most are unable to get it, what are we accomplishing?
Your insights to this current issue given your background and experience are appreciated. Thank you!
These are great points, Kerri.
1) As far as priority allocation goes, the Fair Priority model authored by Dr. Persad (commenting above) and others is, I think, spot on. According to this model, the priority is to first avert the greatest harm. Such priority setting doesn’t necessarily include health care workers, because, as far as I know, they are not especially likely to die from COVID. In other words, simply being a health care worker doesn’t put someone at the front of the line for the vaccine, because health care workers aren’t especially at risk of the greatest harms.
2) If incentives or disincentives are put in place, they could be just like any other incentive that the state gives people to behave in certain ways. For example, maybe the best way to get people to get the vaccine will be to give them a tax break, and to certify it you have to submit your immunization record. Or maybe social distancing orders won’t apply to people who can certify that they’ve been vaccinated. A plan such as these wouldn’t interact with liberties in a way much different from other incentives.
3) It’s a great question about getting it to the people who need it most. There is certainly a strong moral justification for funding the vaccine for those that can’t afford it, or, indeed, for every single person. Leaving the vaccine only for comparatively affluent people would be morally reprehensible, for several reasons, not the least of which is that it would exacerbate many of the conditions that make COVID-19 such a threat to people who are already impacted by limited financial means.
Dear Dr. Crutchfield,
I enjoyed reading your post on your thoughts about a Covid-19 vaccine. Several details stood out from your post. First, I agree that the vaccine should be made available to specific populations who need it most and also those who want the vaccine. Once a vaccine is created and available, I think it needs to be made available to every person who wants it so that the effects can be reported. However, I think that vulnerable populations should be given an opportunity to get the vaccine after it has been proven safe. Some of these individuals who are more vulnerable due to health reasons or those who have a high rate of exposure to Covid-19 positive individuals may not respond well to a new vaccine; therefore, these populations should be given a chance to learn about some of the side effects first. Next, I do not agree with making the vaccine mandatory because I feel that if they were to try and make the Covid-19 vaccine mandatory then more people would be reluctant to get it. Making the vaccine mandatory may raise concerns about why people are being required to get it. Keeping the vaccine voluntary will also help if problems arise if a person was forced to get the vaccine and it ended up negatively impacting them. Lastly, I agree that an incentive would help people to volunteer getting the vaccine. Incentives could range from money, gifts, or other monetary forms. In the end, the pandemic is impacting every person in a different way and even once a vaccine is created the pandemic will still not end if society as a whole cannot start being responsible.
Thanks for the comment, Hannah.
You are right to point out that making the vaccine mandatory is likely to invite greater public scrutiny of not only the policy, but also the science. Given the dismal state of scientific literacy these days, it’s hard to see how it would go well.
Dear Dr. Crutchfield,
I very much so appreciated your thoughts and insights in this post. This is a topic that has been racking my brain for some time as well. Even as I consider the vaccine for myself, I do not believe that I would want to receive the vaccine until there had been further proof from others that it had been successful. That being said, I know that I am not the only one who has thought this way, just as you have spoken about in this post. On the other side of the situation, the thought of a mandatory vaccine is slightly alarming to me. It would be very concerning for me to have this kind of situation arise. Thinking to a time when the vaccine is available, I become concerned for those who are part of vulnerable populations. There is a good chance that they are most likely to volunteer, in the event that there are incentives provided, and how those populations would respond is another concern that could arise. I wonder what your thoughts are around aspect, that being, if an incentive was created, do you believe that there is a good chance of vulnerable populations being the first to volunteer?
Thanks, Kalli.
Your question is a good one. I think it depends on the vulnerability, as to whether the population will need incentives. For people whose vulnerability is medical and that vulnerability is a product of their social location, I speculate that the incentive would have to be greater than it would be for others.
Dear Dr. Crutchfield,
I want to thank you for writing this blog post and shedding light on an alternative thought to the ethics of a COVID-19 vaccine. Throughout the course of the pandemic, I have found myself and others under the context of that a vaccine will allow for our world to get back to it’s normalcy state. Our governor has mentioned that until there is a vaccine, she will “not soften the COVID response.” Your writing presented an alternative thought that even with a vaccine, we still will not be able to return to the state it was prior to the pandemic, due to the barriers of individuals unwilling to receive the vaccine. Previous to reading your post, I had been concerned of the ethics of distributing the limited resource of the vaccine, similar to how we distributed tests and ventilators at the start of COVID-19. However, your information presented theorizes that this may not be as highly sought after. Do you believe that, if the vaccine is proven safe over time, that we may experience a high volume seeking of the vaccine that would result in having to utilize the fair allocation model? Or is it your belief that we will continue to see people refuse the vaccine, not matter how effective and safe?
Thank you for your thoughtful post!
Great questions, Alexandra!
This is very speculative, but I think that we will see a high enough volume of those wanting the vaccine that some priority setting will be necessary. Of course, much of this depends also on how much of the vaccine is made available immediately, and how this supply increases over time. As things progress, I think more and more people are going to want it, but at the same time we might expect the supply to increase as well. So, yes, I think lots of people are going to want it, and that the number of people who want it will exceed the supply. What I am skeptical of is that this will be a sufficient number of people to put an end to the pandemic such that we can return to normal. In any case, no matter what the evidence of safety and efficacy is, we can expect that some large number of people will refuse it.
Dr. Crutchfield,
Thank you for sharing this information with us all as this has been such a hot topic these last 6 months. As a social worker and a grad student, I have had the opportunity to work with many diverse populations and communities during our times of COVID-19. I could not agree more with what you have presented in this discussion. I find myself thinking about what a vaccine would look like. I agree that if/when a vaccine comes out, especially in the beginning, there will be much confusion and reluctance at the idea of being mandatory or not. I worry about the incentives for our most vulnerable populations as incentives may become the only reason a person accepts getting a vaccine, not necessarily because they want it. We see this all the time with vulnerable populations living in poverty for example.
I also want to make note that your statement about who/when is getting a vaccine is the most important aspect of this discussion. If no one wants to or feels comfortable getting a vaccine, then what’s the point? I understand that I do not have much knowledge on this topic of vaccines, but I was wondering what effects herd immunity plays on this example?
After reading this article, it seems to be a cat and mouse game and I am truly unsure of what a call like this may look like in terms of bioethics. I can only hope that whatever this looks like for us, that we have a community that we can help and save…even if it’s sometimes down the road. I have the hardest time with thinking that we would accept a vaccine when 29% of us refuse to social distance or wear a mask.
Thank you so much for sharing and presenting an unbiased discussion. I am very appreciative of your work and knowledge around COVID.
Respectfully,
Ravyn A. Rooney
Thanks for the comments, Ravyn.
As far as herd immunity goes, I’m not qualified to say.
You are right that if incentives were offered, they would affect people differently. For example, suppose everyone who gets the vaccine gets a check for $100. That is a much greater incentive for a family of four struggling to put food on the table, than it is for a socially active couple with two high-paying incomes and no children. In this situation, the wealthy couple is given very little extra incentive than the poorer family, and may force the poorer family to bear a greater burden in protecting the rest of the community (in addition to themselves). So, whatever the incentives are, if there are any, they will have to carefully considered, in order to ensure that social inequalities are proportionately distributed. Careful consideration, however, is not a hallmark of those who typically devise such incentives.
To: Yesakov, Elizabeth Margaret
Dr. Crutchfield,
First and foremost, thank you for your analysis on the subject matter of vaccines and COVID-19. It has definitely been a pertinent topic for the majority of this hectic year. One of the biggest takeaways I found from your article was the fact that there is still 29% of the population that does not deem it necessary to wear masks, despite the numerous data suggesting its usefulness. That being said, I cannot imagine that group of individuals, or others who do not want to feel like “guinea pigs” for a vaccine, would be willing to get one as soon as it becomes available. It can truly be difficult to gauge, because at least for me, there has been a lot of back and forth on what to do in terms of COVID-19 and whether or not the vaccine would do more good than harm, especially the first kinds of it to be released. Whether it is someone who is against wearing masks/against the vaccine or others who are religious about wearing masks and keeping sanitary, both sides make the argument of “living their lives” and that is the ultimate goal here: to get back to normal. I do not believe that there will be a sense of normalcy even after a vaccine has been announced. Then there is the matter that at least 70-80% of individuals would need the vaccine in order to be part of herd immunity, and who’s to say that, if this is a yearly needed vaccine, people won’t be willing to take it after a certain amount of years because they don’t see the benefits to it. On top of that, there is also the matter of individuals with pre-existing conditions. How can they feel confident that things won’t go awry and they will be covered by their Medicare policies. It just seems like, at this very moment, there is a lot up in the air and hard to determine what is best and what would cause a relapse of what we saw in March.
It is truly difficult to gauge where we will all be moving forward, but I appreciate insight into this topic and am truly hopeful to see what the future holds.
Thank you
Thanks, Elizabeth. You are right–the evolving uncertainty makes it very difficult to understand what a person should do, and what they can do to prepare. It is very unsettling. Eventually things will get back to some sense of normal, but it might be a less secure life than it was for some people. It’s not clear how we should deal with that as individuals or as a community.
Dr. Crutchfield,
Thank you so much for your wonderful blog post. This has been a topic that has been on my mind often and I am sure it is on the minds of many others.
I agree with you that the COVID-19 vaccine should first be available to the most vulnerable populations and those who truly want the vaccine, but only once the vaccine is proven to be safe. I am aware that it usually takes many years to finalize a vaccine and to feel confident in its safety, so it is a worry of mine that we will push this vaccine on people too soon. From people I have talked to, many are open to getting a COVID-19 vaccine but are scared to get one this early on.
When it comes to making the vaccine voluntary or mandatory, I believe that making the vaccine voluntary is the best option. Requiring the entire U.S. population to visit a pharmacy or doctor’s office to get the vaccine (and potentially cough up money to get it) is unrealistic since we still have people who believe wearing a mask to protect others is a liberty intrusion. If people have a problem with wearing masks, they are going to have problems with getting a vaccine since that is even more intrusive.
I think another determiner to consider regarding whether people will decide to get the vaccine is whether people believe that COVID-19 is a real concern. There is a lot of speculation that there are people dying and their deaths are being counted as a COVID-19 death when there may be a different reason that they died. Some believe this idea and feel that this is being done in order to make COVID-19 look worse that it truly is. While I personally have not been able to come up with conclusive evidence to back up this idea, I do know people who tend to believe in this are also the ones that feel like they should not have to wear a mask in public places. Another interesting belief I have heard from others is that the government will use this vaccine as a way to inject people with trackers or microchips. This lack of trust in the government could also make citizens more hesitant to get the vaccine.
Thank you again for writing this blog post. I enjoyed reading your perspective on this issue!
-Kaitlin Schutz
Thanks for the comment, Kaitlin.
The people you identify as having false beliefs about the disease are a danger to society. The beliefs that COVID-19 is not real, not dangerous, not infectious, treatable with homeopathy, etc. are malignant beliefs, especially when those people spread these beliefs to others. They are unjustified beliefs and they get people killed. W.K. Clifford, a philosopher from the 19th century, argued that maintaining unjustified beliefs was a moral wrong. Most people think that he might have gone too far in this, but I can think of no better example of his point than the people who think COVID is a hoax and then spread that belief on social media.
Perhaps the more relevant issue is what we should do about all of the false beliefs regarding the pandemic. There’s pretty good evidence that giving this group of people more information will do nothing but cause them to further entrench themselves into their system of beliefs. One thing that might help is involving them in the decision-making process, but that requires allowing people who have demonstrably and dangerously false beliefs have a say in strategies to mitigate harm. I don’t know what ought to be done…though I am personally committed to staying away from this group of people so as to not endanger my family or myself.
I can think of several reasons why we (The People of the USA) should not put our hopes on a vaccine to solve the COVID problem but this one I think nails it, “It is a pipe dream to think that a vaccine mandate would be accepted by the very same population who refuses to bear the more minor burdens of mask wearing and social distancing, which amounts to at least 29% of the population, enough to undermine our ability to stop the pandemic.”. Thank you for writing this article, it is informative, logical and well argued.
Thanks, Larissa. I’m glad you found it informative!
Dr. Crutchfield,
Thank you for the insights and education you provided with this post. Some of the points made that resonated with me the most included that on allocation models and apprehension towards a vaccine. I imagine there is a pretty smart group of people behind the models who put a lot of time and thought into them – however, I wonder how one model would be chosen over another? That is a decision I can see becoming pretty politicized and polarized fairly easily. Regarding apprehension towards a vaccine, honestly, I get it. To grossly oversimplify the idea, you could compare it to how most people are more trusting of car models a year or two after they come out on market, so it doesn’t surprise me that there are similar feelings towards a vaccination. I imagine that in a perfect world without the politicalization of the vaccines, there would still be a great deal of hesitancy surrounding it.
I really enjoyed reading this post, and appreciate the time and thought you put into it!
-Mackenzie Mitchell