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1. We don’t talk enough about the complex and wrenching moral dimensions of #CovidVaccine allocation and distribution - an open discussion about the issues and tradeoffs could give us a clearer path forward.
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2. This issue was tackled in the excellent commentary by @sandrogalea and @mdsteinmd , including issues related to life expectancy and public health behaviors. But there are many more dimensions. https://www.publichealthpost.org/the-turning-point/
3. For example, vaccinating smokers before non-smokers would protect public heath as a whole, but some would argue that this penalizes “good behavior”. But then add the layer of socioeconomic disparities in smoking and cigarette marketing, and it gets more complex.
4. Similarly, it seems unambiguous that we should prioritize vulnerable communities of color. But within those communities, the same challenging questions of priorities arise, and should a wealthy and healthy person in those communities go before a vulnerable person elsewhere?
5. Allocation across countries is also challenging. Having vaccines go first to the developed world seems like a clear moral failing (and empirically, could extend the pandemic). But what leader will publicly say they will sacrifice some from their country for the greater good?
6. Individual morality adds a layer of complexity. How many people would voluntarily give up a vaccine to save the life of someone more vulnerable than themselves, if it is a risk to their own health and well-being?
7. Of course, this is why we have governments and public priority lists, so we can have policies for the greater good. But I haven’t heard many leaders openly talk about the motivating philosophy and complex tradeoffs.
8. I know we don’t elect philosopher-kings, and I don’t expect a public discussion about utilitarianism and the Rawlsian veil of ignorance. But it would be refreshing to hear open discussion about what we are willing to sacrifice in exchange for something else.
9. Because even if we are strict utilitarians, there are many dimensions that feed into utility. For example, should we save more lives at all costs, or would we accept more deaths to open schools sooner?
10. It sounds stark and a bit cruel framed in this way, but the reality is that if you have to choose between teachers vs. those with co-morbidities to go first, that is the choice you are making. There’s no single right answer, but acknowledging reality is an important step.
11. Of course, in many ways this is no different from other forms of health policy or public policy, since policy choices inevitably involve tradeoffs among populations. It is more extreme with COVID-19, which is why we need to talk about it openly.
12. But perhaps this can help us get our arms around some of the broader issues of morality, justice, equity, and complex tradeoffs that are central to the policy process.
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