With vaccine still scarce, and eligibility differing from place to place, some people have easier access to "extra" doses than others. Careful, ethicists warn. Going out of turn is a slippery slope.



When it comes to getting the COVID-19 vaccination right now, the fine print changes state to state, county to county, and that opens loopholes. So we have NPR health reporter Pien Huang with us now to talk about the ethics of who gets vaccines when, whether it's ever fair to cut the line. Thanks for being with us.

PIEN HUANG, BYLINE: Thanks for having me, Scott.

SIMON: We've heard about people lining up at the grocery store pharmacy in anticipation there might be some extra shots left over at the end of the day. And often they're conspicuously young, healthy and certainly not in a priority group. What is the ethical call on that?

HUANG: Well, bioethicists say, yes, it's totally fine for them to get them if it is truly going to waste. Ruth Faden from the Johns Hopkins Bioethics Institute says the top priority right now is using all the vaccine we have.

RUTH FADEN: The worst possible thing that could happen in the context of a vial of Pfizer or Moderna vaccine would be to have to throw even a single dose away.

HUANG: You know, that waste could come from people not showing up for their scheduled appointments. Or last week, we heard about a freezer failure in Seattle that caused over a thousand vaccines to thaw at once. But if you're a healthy young person with low COVID risks, Faden says, there are ethically preferable things you could do in those situations.

FADEN: If you've got a colleague or a family member or a neighbor who's already in a priority group and you can call them up and you can help them get there, of course that's better.

HUANG: So for someone like me who's under 65 and works from home, it would be better to try and match that dose with a person at higher risk before I go ahead and take it.

SIMON: Pien, if I'm not eligible to get it in my county but I would be in the county next door, what are the ethics of wandering over the county line to get it?

HUANG: The answer in this case is, no, you should not do that because here, what you're doing is not preventing a vaccine from going to waste. You're actually taking an appointment that's meant for your neighbor. Faith Fletcher, a bioethicist at University of Alabama, says that kind of line cutting is a form of vaccine entitlement.

FAITH FLETCHER: There are certain people who feel justified in skipping the line and going county over or state over because they're so accustomed to having access, they're going to find a way.

HUANG: That said, many people have real frustrations with all the different rules and how it's going fast in some places and slow in others. So if you think the rules are unfair, you should feel free to speak up, to organize, to email your elected officials. Bioethicists say that the moral action here is not to cheat the rules but to put pressure on the system to fix them.

SIMON: What about people with underlying health conditions, Pien? Because they're often listed as a group that's especially vulnerable, distinct from the general population. But what counts for that? Those conditions can be fuzzy. Is it, for example, fair to prioritize smokers who, to some people, would have caused their own damage?

HUANG: Yeah. Well, smoking is tied to health issues like lung damage, and that puts people at higher risk of severe COVID, we know, and also to social ills, like stress and poverty. And Gabriel Lazaro-Munoz, a bioethicist at Baylor College of Medicine, says it's key to remember that the goal of the U.S. vaccination strategy is to use the scarce supply of vaccine we have to save the most lives possible.

GABRIEL LAZARO-MUNOZ: Focus on risk. Focus on exposure. And just - let's save lives, you know? Let's not focus on which of these lives we think might be more valuable for society. Let's just save lives, period.

HUANG: He says that if some people think smokers don't belong on the list, others might have similar arguments for people with obesity or diabetes. Some might even argue that young lives are more valuable than old lives because they have more time to live. So it gets really complicated really quickly.

SIMON: NPR health reporter Pien Huang, thanks so much.

HUANG: Thanks for having me.

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