UA Professor Addresses Ethics Of COVID-19 Vaccination Rollout
STEVE GOLDSTEIN: Hundreds of thousands of Arizonans have received either one or both vaccinations for COVID-19, but there are concerns about whether communities of color, the elderly and lower-income residents have been left out disproportionately so far. That has introduced the question of ethics and the current vaccination process. To learn more, I'm joined by David Beyda, chair and professor in the (University of Arizona) Department of Bioethics and Medical Humanism. Professor Beyda, how does the structure of vaccinating and who's been vaccinated so far play into your perspectives on the ethics related to all of this?
DAVID BEYDA: So the way I look at this, if I may, is I look at the vaccine program as a three-legged stool, and each one of those legs carries the weight of the stool. So if you take one leg and you make that the vaccine doses and you take the second leg and you make that the distribution and the third leg the prioritization of the vaccines — we can look at what's happening now. One leg, vaccine doses, not adequate. The stool is weak. Number two, distribution, not adequate. We're just getting to the elderly — we're, we're not even talking about the, the disabled yet. Weak leg. Stool is weak. The third is the prioritization. Also, again, not happening. You know, we have the Phase 1A and the Phase 1B, but we do see individuals cutting the line, jumping in line and also finding a way to get the vaccine when they aren't actually, legitimately part of that group. So one of the examples that came up was, what happens when you're driving a person to the vaccine site and you happen to be in the car, but you're not within the Phase 1A, Phase 1B. Should you ask to get the vaccine? And we know that that's happening. Well, now that we know that the vaccines are limited, boy, I wouldn't even think about asking to do that. So, yeah, it is a big ethical issue. And that is should you take it upon yourself to take the moral high ground and do what you really need to be doing in order to allow protection to all the other individuals who are more vulnerable?
GOLDSTEIN: Do you have any thoughts about what the government, what the state could be doing better or learning from to make sure that the people that we would like to prioritize actually get the vaccine before others who may be less vulnerable? I suppose it's, with COVID-19, there are examples of people who seemed young and healthy, who were really deeply affected by it and ultimately passed away from it. So it's not just necessarily people we could consider traditionally vulnerable, but are there things you'd like to see them try?
BEYDA: Let me just share a thought: Who's really overseeing the vaccine delivery prioritization within the state of Arizona? Is there a committee of medical professionals, health care professionals, physicians, epidemiologists, public health? Is there a committee specifically charged with assessing the distribution and the prioritization of the vaccines? Or is it another group who are not medically based? My sense is that the more you turn to the medical profession who are charged with overseeing this, I think there would be a much better outcome because the medical professionals know what's going on. Just recently, I think a couple of months ago, and I can't give you the specifics, but there was this huge letter that was written to the state signed by over a thousand physicians saying, "Look, you need to deal with this right now." And, you know, different societies did the same thing, but no one really listened to them. And so there's this talk. "Well, you know, we're following what the science is going to tell us to do." Well, maybe you don't have the right people in the right science sharing what you need to do. So it is frustrating. Look at what happened today and this week. Not enough vaccines to get past Feb. 12. So who's dealing with that right now, and where are we going to go? Now, I need to give some, some credit to the fact that the state is vulnerable, based on what they can get from the (U.S. Centers for Disease Control and Prevention). You know, they can ask for 100,000 vaccines. And if they're only given 20, is that really their fault? No, not really, because it's distributed from a higher source. But anticipating what's going to happen, I think, is the big issue. Having this interesting knowledge that — and this came out and that is, if you're in the car with someone else who's already has an appointment, you can ask for a vaccine, and you may get it. That should never have been public. That should not even be brought up. If you're not on the list, you don't get it. So then people started taking advantage of that. Now, I can't give you the numbers on how many people did that, how many people didn't. But it would be interesting to find out. If we don't have enough vaccines to get past Feb. 12, how many of those vaccines would have been available if they were not given to those who are not on Phase 1A, Phase 1B?
GOLDSTEIN: You know, certainly we've seen elected officials — maybe that goes in a different category. What do you think about that in terms of the ethics of, let's say, all the U.S. Senate gets it but still some vulnerable people are waiting?
BEYDA: It all depends on how we define essential. Are government officials essential because they govern the country or they govern the state, and without them, the country and the states would fall apart? I don't think that's the case. I don't think that would be the case. So I think there's an overlay of what I kind of called the "me principle." When it's important to me, I'm going to do whatever I can to get what I want. When it's not important to me, when it's not convenient to me, I'm not going to do it — let somebody else deal with the issue. So that's kind of where people are at right now. It has to do with where you're in your own life, you know? Now, the question is, for example, the caretakers of the vulnerable, the caretakers of the elderly in nursing homes, the caretaker of the disabled. They're essential. Absolutely, they're essential. Should they be vaccinated first and before the elderly and before the disabled? I think they need to be done together in cohort because that way, you look at the whole concept of equity and the diversity aspect. So let's define what essential is first and then move towards vaccinating those who fit that category.
GOLDSTEIN: David Beyda is chair and professor in the University of Arizona's Department of Bioethics and Medical Humanism.