A: This vexing ethical dilemma has a few black and white answers, and a whole lot of gray.
tl;dr: Don’t lie about your status. Don’t take a dose clearly intended for others. If doses are truly going to waste and a vaccination provider is looking for arms, it’s ok to take the shot, but you might also try seeing if someone with higher priority could get that dose instead.
We’ve all heard — or perhaps been a central character in — the stories:
🕠 At 4:45pm, you get a text from a nurse friend who’s working a vaccine clinic. There are extra doses! Can you be there in 10 minutes? No, you’re not eligible yet in your area, but these doses might otherwise go to waste at the end of the day.
🚗You are not eligible in your own county currently, but you are eligible in the next county over because they have different rules. You hear that they are checking age requirements, but they aren’t checking residency when you show up for the appointment.
💻On a Saturday afternoon, you get an email forwarded by a friend who got it from her cousin whose boss forwarded it her: A link to sign up for an appointment! The link was supposed to only get emailed to eligible people but you can click through and easily make an appointment.
📋Your workplace has some doses to distribute and is trying to prioritize people based on exposure risk: who is most likely to encounter sick people in the line of work? You click through the questionnaire, and see one box to check that doesn’t *quite* apply to you, but it’s a fuzzy line. If you check the box, you’ll get a dose.
Variations on these stories abound, and will continue to do so as long as vaccine supply is scarce and demand is high. So what’s the right thing to do?
To answer these hard questions, we can turn to bioethicists, or scientists who examine what is the “right” thing to do when there are conflicting values and uncertainty about ethically justifiable decisions or actions. In a recent NPR story (link below) three bioethicists (Dr. Faith Fletcher, Dr. Ruth Faden, and Dr. Gabriel Lázaro-Muñoz) were presented with some scenarios like the ones above and weighed in with some general principles to help guide decisions about whether to “jump the line” for an offered vaccine:
🕠 The “doses are going to waste” scenario: All 3 bioethicists agreed that this was a thumbs up, but also encouraged people who get that kind of invite to ask if others higher on the priority list had also been invited, or could be. For example, a grocery store or pharmacy chain could get on the store PA system and ask if anyone over a certain age was in the store and needed to be vaccinated. For entities that are running mass vaccine clinics every day, an ongoing wait list system can be established that ensures those end-of-day “extra” doses are going to higher priority individuals.
🚗 The “across county lines” scenario: The bioethicists said this was a no-go for them. Those doses aren’t going to waste if you don’t get one — they are actually intended for people in a different county. Dr. Faden says that if that feel unfair, then the right action to is to organize, complain, and advocate for different guidelines in your county. A murkier situation is when a vaccination clinic intended for a disadvantaged community is accessed by wealthier, more advantaged, more technically-savvy individuals. See Stat News story link below for how this happened recently in Florida.
💻The “golden ticket link” scenario: This one was not addressed in the NPR story, but has been been an issue in Philadelphia and elsewhere (see link to a story below). If invite emails include forwardable links, people will likely try to use them! We are worried about scarce supply, the eligibility criteria aren’t always clear, and it’s easy to just keep clicking through to see what happens. Presto! You have an appointment. But, wait a minute — your spidey sense is telling you you’re not eligible yet, and you can confirm that with a quick click over to your local health department’s website. In this case, if it seems too good to be true, it probably is. Like crossing the county line, these are not leftover doses, but doses intended for others. Reconsider, and see if you can cancel the appointment.
📋The “well I’m sort of eligible?” scenario: Portals that screen for eligibility before letting you schedule an appointment rely on you giving accurate information. Are you really “instructional faculty”? Usually, but not this semester. Are you “customer-facing”? Sort of, but I only see customers online now. Are you working in a lab that handles “COVID patient blood samples”? Well, I work in a lab with blood samples, but we study Zika virus. This is another gray zone where you will have to draw on your best self to determine the right answer. Try asking yourself: “Would I run this scenario past a bioethicist for their input? Would I run it past my mom?” If the thought makes you feel a little morally queasy, follow that instinct. See link below to a tweet thread from Dr. Noel Brewer, a social scientist at UNC Gillings School of Public Health, who went public with a similar quandary.
However you end up with a vaccine dose, you might experience “vaccine guilt” — another novel mental health consequence of the pandemic. This is natural, and increasingly widespread. See two recent stories linked below about vaccine guilt and what you can do about it.
We get that this is a very challenging time. We all need to be amateur bioethicists as we confront scarce supply, different systems and rules in different locations, the agonizing challenge of equitable access, and our fears for our own safety and those of we love. We’re here for you. Keep asking questions, and we’ll keep sharing science-based solutions. Stay safe, stay sane.
Love,
Those Nerdy Girls
Links:
NPR story with bioethics panel
Stat News on Florida clinics being access by more advantaged groups
WHYY story on “golden ticket” links
Dr. Noel Brewer’s tweet on his decision to not fudge eligibility
