Beyond Safety and Efficacy: Ethics and the COVID Vaccine

December 11, 2020

by Rachel Wolthoff

COVID-19 continues to change the status quo. In an effort to stop the progression, the White House has created “Operation Warp Speed” to accelerate vaccine development and approval. One vaccine is in the process of receiving emergency use authorization, and it is likely that a total of two or three vaccines could be granted this authorization and be available for administration by the end of 2020. There is a lot of doubt and uncertainty about COVID vaccines, and many individuals have ethical concerns. In this post, I hope to analyze some of these concerns and offer some guidance.

Vaccines: Game Changer or Reckless Gamble?

The major question with vaccines is this: Are they truly effective and safe, or are they the careless result of too-rapid deployment? Vaccines have a history of incredible effectiveness at preventing and reducing the effects of various communicable diseases. Vaccines harness your body’s natural immunity to recognize and eradicate pathogens. Over the past 200 hundred years, these have reduced the prevalence of many diseases, and some have even been eradicated. Though the COVID-19 vaccines were developed in record time, the FDA has closely monitored them and assures their safety.

Is the Vaccine a Form of Gene Editing?

Because of how this new technology works, some have voiced concern about the potential of altering a person’s DNA through use of the vaccines. This worry stems from the fact that some of these vaccines, specifically those by Moderna and Pfizer, use the newer technology of messenger RNA (mRNA) to create viral immunity. These vaccines inject a small portion of the coronavirus’s mRNA into host cells. This causes the body’s own cells to create a protein that the body uses to recognize and destroy the coronavirus. These vaccines do not modify the DNA of our own cells, thus gene editing is not a concern.

Are Fetal Cell Lines From Aborted Babies Used?

Many have raised concerns about whether fetal cell cultures were used during vaccine development. Two common cell lines from aborted fetal tissue have been used for some COVID-19 vaccines: the HEK 293 line, kidney cells originally from a fetus aborted in 1972, and the PER.C6 line, retinal cells from a fetus aborted in 1985. Ethically, there are mixed feelings toward using these cells in research. Some see the tissue as nothing more than pluripotent cells far removed from their original source. Some, however, may feel that they are complicit with evil when they use products that came from this type of scientific practice. They feel that there is still a direct line to taking a baby’s life, no matter how many generations of cells have passed since the original abortion.

Whether or not the vaccine is required, one should carefully consider both the personal and societal implications.
However, of the first two vaccine candidates from Moderna and Pfizer, neither have used fetal tissue cell cultures in their actual production (though fetal cell cultures were used in early testing). Some other vaccine candidates have used these fetal cell lines in both early testing and subsequent production. For those who have concerns on this issue, some COVID-19 vaccines will be available that do not use these cell lines. Educating oneself on each manufacturer’s particular process for creating each vaccine is the best way to ensure confidence before receiving it.

Allocation of Vaccines: First or Last in Line?

Distributing the COVID-19 vaccines will be challenging. Balancing distributive justice, or the apportionment of healthcare resources in concert with the individual and societal best interests. Providing everyone with equal opportunity to access and benefit from limited resources such as a vaccine is a difficult issue. The solution will rely on a “risk vs benefits” analysis. The goal is to obtain the greatest positive affect with the limited resources at hand. As a result of this thought process, high risk patients, along with healthcare professionals will be the first to have access. Distribution will then move from highest risk to lowest risk. Children will most likely be the last to receive the vaccines, since they have the least severe effects from COVID-19 and have not been included in most clinical trials to this point. As supplies increase, more and more people will have access to the vaccines.

Receiving the Vaccine: Choice or Requirement?

Concerns about whether receiving a COVD-19 vaccine may be mandatory to re-enter daily, normal life are also valid. The answer to this question is still under debate. The goal is to uphold both personal autonomy and beneficence towards others. So should the vaccine be mandatory for all? While strongly recommending that everyone receive the vaccine, most authorities stop short of a federal or state mandate, which might overly trample on individual rights. Nonetheless, it seems reasonable that some private entities will require the vaccine for healthcare workers and first responders.

Whether or not the vaccine is required, one should carefully consider both the personal and societal implications. Based on our understanding of vaccines over the years, the immunity that comes from these vaccines not only protects us, but others as well. Stopping progression of the pandemic likely hinges on “herd immunity,” when 70% or more of the population has developed immunity. This prevents the virus from spreading further. The question that remains is in regards to what the “cost” will be for each individual. Different people will have varying responses from ethical and clinical perspectives. Upholding the freedom of choice that autonomy affords with the good of those around us is a difficult but achievable balance.

For a more in-depth analysis of the ethical questions surrounding the COVID-19 vaccine, take some time to listen to a recent conversation with Dr. Zach Jenkins, an infectious disease specialist, and Dr. Dennis Sullivan, a physician and ethicist.

Rachel Wolthoff is a current pharmacy student in the Cedarville University Doctor of Pharmacy Program. Rachel completed her Bachelor of Sciences in Pharmaceutical Science at Cedarville along with a minor in bioethics. Her professional interests include bioethics, promoting patient informed consent and pharmacy education, and pediatric pharmacy practice.

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