Who should get the next round of COVID-19 vaccines? - The Dallas Morning News

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Here in North Texas, we’ve been living in the new world of the coronavirus that has required us to ask old moral questions in new ways. When we asked businesses to shut down at the beginning of the first spike of infections, it raised questions about how to share burdens in a society.

When we faced the challenges of medical rationing, we questioned how to make moral decisions in tragic situations. When we asked schoolteachers to go back to work, we asked questions about the virtues necessary to sustain common life, virtues like courage, fortitude, and even that greatest of the virtues, charity.

These moral challenges are hardly behind us, but with the Emergency Use Authorization of vaccines, they are quickly being replaced by new challenges related to prioritizing distribution of the vaccine. We can think carefully about these issues by asking a few basic moral questions about them.

Define the goal

First, what is the goal? Thinkers as diverse as Aristotle, Jeremy Bentham, and the character Chidi Anagonye, the moral philosopher in the sitcom The Good Place, have posed this question. In the case of the vaccine, there are two obvious answers. On the one hand, the long-term goal, as with all vaccines, is to achieve herd immunity.

On the other hand, we have more proximate goals, like saving the lives of the most vulnerable. These are predominantly older people in long-term care facilities. But we also need to protect health care workers to care for those who already have COVID-19. The short-term goals, then, present a bit of a conflict. What do we most need to achieve in the next few days and weeks with a vaccine that is in incredibly short supply?

Every policy guideline that I have read gives roughly equal weight to older people in long-term care facilities and health care workers. There seems to be broad agreement that we want to save the lives of the most vulnerable and protect those who work in institutions that care for the sick.

This two-pronged approach makes good sense and fits well within the public health framework that has guided our decisions over the past months. It allows us to keep health care professionals in the clinic to care for those who are sick while promising to reduce the current spike of cases. The approach is a powerful new tool for flattening the curve.

This is one helpful way of thinking about the short-term goal of vaccination. By protecting those in health care and those most likely to need hospitalization, we can both save lives and help flatten the current curve.

The broad agreement about the long and short-term goals, and about how to distribute the first round of vaccinations dissolves very quickly when we consider the middle phase of vaccination.

After health care workers and the most vulnerable, but before there are enough doses of the vaccine for everyone in the world, how do we decide who gets vaccinated when?

Obligations of justice

This changes the moral question from asking about goals to asking about obligations, specifically obligations of justice. What do we owe to whom?

Should those in densely populated urban areas move ahead in the vaccine line of those in sparsely populated rural areas? What if those in the rural areas have multiple comorbidities? Should factors like class, race and gender play into these calculations?

My university students are largely younger and healthier than the general population, but they are also transient. Should they be prioritized above others who are at greater risk but are less likely to spread the virus?

Thinkers as diverse as Thomas Aquinas, Immanuel Kant, and, again, the character Chidi Anagonye have asked questions about obligations and justice. Even if we do our best to think as these authorities taught us to think, we still aren’t going to achieve any consensus about who exactly gets which place in line. Too many populations have plausible claims to priority status, and a society so addicted to the rhythms of polarization and discord cannot fully agree on an answer to this question. Already there are lobbyists trying to push their groups to the front of the line, and we aren’t even through the first round.

This lack of agreement on regulation, however, doesn’t leave us without direction. Somewhere between agreement on goals and disagreement on obligations lies a question of responsibility. Who makes these decisions? Who do we trust to make them? Can we trust those who have already started making them?

Whom should we trust?

This last question about public trust is a tricky one and probably the most important. We’re a cynical people, and we’re especially suspicious of anything that includes big government or big pharma. Developing COVID-19 vaccines required both big government and big pharma to work together. This certainly leaves a lot of people across the political spectrum suspicious, but the result of that partnership has been, as President Donald Trump says, “a miracle.”

At the same time, it isn’t big government or big pharma that would benefit disproportionately from the vaccines. It’s all of us.

This is evident in the way neither big government nor big pharma is making the difficult moral decisions about prioritization. Such decisions are being made by local hospital administrators, local officials and local teams of advisers. The guidelines for distribution come from federal agencies like the Centers for Disease Control and Prevention, but these are guidelines, not regulations or laws.

This approach to delegating decision-making responsibility to localized communities is what the Catholic tradition calls subsidiarity. It is exactly what is needed in a situation like ours, in which the challenges in rural hospitals in Wyoming differ from the challenges we’re facing in North Texas.

In this case, subsidiarity gives us good reason to trust the guidelines at every level of our society. These guidelines reflect the wisdom of experts who are embedded in real and local communities, not just those who reside in mythical ivory towers or inside the D.C. Beltway.

The Catholic tradition that gives us the principle of subsidiarity pairs it with another principle called solidarity, which roughly reminds us that we’re all in this together — and we need to act like it, instead of acting only in our own self-interest. If subsidiarity gives us good reason to trust the experts as they make decisions about the next phases of the vaccination process, solidarity suggests a set of responsibilities for those of us who aren’t tasked with making those decisions.

The first is to get the vaccine when it’s our turn in line. The second is to be patient about our place in that line. The third is to continue living well within the new realities that began last March — doing the tedious work of wearing masks and keeping six feet apart.

We may not be the ones making decisions about public health policy, but our actions are at least as important as the decisions being made. We are the public in public health policy, and if we want our old world back, we must continue to live well in this new world for just a little while longer.

Dallas Gingles is associate director of the Houston-Galveston Extension Program of Southern Methodist University’s Perkins School of Theology. He wrote this column for The Dallas Morning News.

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