Jeffrey Byrnes is giving a lot of thought these days to how a newly approved vaccine for the coronavirus should be dispensed.
Byrnes, a medical ethicist and assistant professor of philosophy at Grand Valley State University, is advising Kent County health officials as the first vaccine doses become available.
His guiding philosophy: maximizing the impact of scarce supplies until there are enough doses for everyone to get vaccinated. In an email exchange with Bridge Michigan, Byrnes offered insight on some of the ethical implications of these health decisions.
What are some of the basic ethical issues that go into getting vaccines in a fair way to the people of Michigan?
Maximize the benefits. Given that we cannot vaccinate everyone at once, how do we allocate the first doses to get maximal benefit to all the people? Promote justice and equity: How do we administer this vaccine in a way that both treats people fairly and ensures an equitable result? Promote public trust: How to make allocation decisions and carry out vaccinations in a way that earns public trust and establishes a sense of community ownership of the process? We must show the public what we are doing.
Does the State of Michigan have an ethical obligation to see to it that minority populations are vaccinated?
The state absolutely has an ethical obligation to protect its citizens. Yet the state cannot be falsely naive about the history of our present situation. The state has in its possession a vaccine that it believes will benefit its minority populations. Yet the state must acknowledge that minority populations may not simply take the state’s word on that. When the state’s minority populations have had time to review the evidence and have seen the vaccine in their communities, then they can choose to be vaccinated if they feel comfortable doing so. The state, in turn, needs to be preparing now to deliver the vaccine as widely as it possibly can, paying particular attention to communities which are distant, in one way or another, from health care delivery systems.
How would one fairly weigh the need to vaccinate school teachers and staff against a power line worker or a snowplow driver?
If we had the necessary quantity of vaccine and the capacity, then we would distribute it all simultaneously. Given that the supply is limited, we are forced to make difficult decisions about the order of distribution. Comparing the secondary benefits to the community of vaccinating a teacher and a powerline worker cannot be undertaken in the realm of ethics alone. It requires input from experts in fields like statistics or data science who can model likely benefit models. In other words, there are some important empirical questions that flesh out the ethical principles. These are difficult questions that have local variation. Firefighters might have a greater utility in central California than they do in southern Louisiana.
State plans call for vaccinating staff in homeless shelters and jails and prisons, but (does not prioritize) homeless residents or prisoners. What are the ethical considerations in that thinking?
I think what might prompt the question is the fact that staff of homeless shelters and prisons are identified specifically as prioritized in Phase 1B, while residents of those institutions will receive vaccination along with the broader population. From my understanding of epidemiology, there is reason to think that vaccinating the staff is an effective use of a small number of vaccines— largely because they have contact with people on the outside and would likely bring the virus in with them. If we have data to think that prisoners are also suffering disproportionately from the virus, then this would be a reason to prioritize prisoners for vaccination as well.
How would you view the ethical right of individuals to refuse vaccination, even though that could expose others to the spread of COVID-19?
Given that the vaccine is offered by the state, one might well think that individuals have a right to refuse that vaccine. Yet, having that right on the basis of a citizen’s relationship to the state is not inconsistent with a person also having a moral duty to be vaccinated, insofar as the vaccine is shown to be safe and effective and insofar as the person can receive the vaccine safely. The list of things that one should do is longer than the list of things that the government can and should compel one to do.
Bridge Michigan is part of our coronavirus reporting collaboration with the Detroit Free Press and Michigan Radio.