Last week, as friends of mine learned they would soon be eligible for a COVID-19 vaccination, I received a slew of angst-ridden text messages. A teacher who sees students only once a week wondered if she should wait so teachers who were more at risk could get a shot first. A friend with a health condition who is mostly able to stay home and isolate pondered letting her dose go to someone more deserving. On social media, I stumbled across posts from friends who are eligible for vaccination but could not get appointments — and who were angry that others they knew, whom they considered lower risk, had already been inoculated.
As more and more Americans become eligible for COVID-19 vaccines despite their limited supply, deciding whether to take an available shot has turned into a moral quandary. There’s no question that vaccine access has been inequitable across parts of the country. But many medical ethicists agree: If you are eligible for a vaccination, you should get it, no matter how worthy — or unworthy — you feel.
“If they call you to get vaccinated, you should go,” said Arthur Caplan, a bioethicist and the founding director of the division of medical ethics at New York University’s Grossman School of Medicine.
There are a number of reasons to get a shot if it’s offered to you. For one thing, there’s no reason to believe that if you forgo your dose, it will go to someone with a higher risk.
“As we’re finding out, that’s not really the way the vaccine allocation systems are being set up,” said Debjani Mukherjee, a psychologist and a medical ethicist at Weill Cornell Medical College. Many vaccines are being distributed by institutions that can’t transfer extra doses elsewhere or to specific populations, explained Kyle Ferguson, a medical ethicist at the Grossman School of Medicine.
Put another way, it’s entirely possible that the vaccination you decline will be given to someone at lower risk than you. Worse, it could get thrown away if it’s not injected into someone’s arm before it goes bad. Discarded doses do no one any good — which is why, after a freezer broke in a Northern California hospital, administrators violated state guidelines and offered the shots to everyone they could, regardless of eligibility.
So the belief that turning down a vaccination or waiting to get it will somehow benefit society — “I think it is just outright false,” Dr. Ferguson said. There’s a “delusion of moral purity and keeping one’s hands clean that’s at work when people are tempted to do that.”
If you turn down a vaccination based on the belief that you’re not particularly high risk, you might also be fooling yourself. It’s difficult for people to accurately measure their own risk level; research has shown that people underestimate their risk in all kinds of situations. These optimistic biases, as they are called, often lead people to perceive, wrongly, that public health campaigns are more relevant to others than to themselves.
In other words, the notion that other people need vaccination more than you do may simply be a product of irrationally optimistic thinking. After all, the science on COVID-19 is not yet fully understood, and it is evolving rapidly, especially given the emergence of variants of the virus.
When you get a vaccination, you’re not the only person who benefits, either. Scientists aren’t yet sure how much vaccination thwarts the transmission of COVID-19, but preliminary data suggests that it reduces spread to a degree. When you get the shot, then, you’re not only protecting your own health; you’re also likely slowing the spread of infection in your community and reducing the chance of overwhelming hospitals. In addition, if you are inoculated and friends or family members fall ill with COVID-19, you are better able to care for them, since you probably won’t get sick.
Still, people may yell at you for getting a shot when you’re eligible if they feel you don’t deserve it as much as they or their loved ones do. And you may not be able to appease them with rational answers. Deep down, individuals who are angry about unfair vaccine allocation are upset at the system, and understandably so. In that situation, you’re just an easy scapegoat. “I think the best thing to do in a situation like that would be to say that you care for that person and hope they get the chance soon, too,” Dr. Ferguson said.
It’s important not to conflate the systemic problems plaguing vaccine rollout with the choices we make as individuals within this flawed system. Even if you feel it’s unethical that you have been offered a vaccine, that doesn’t mean it’s unethical for you to accept it. You’re not going to fix the broken system by opting out of it. If anything, you might make the situation worse.
Melinda Wenner Moyer is a science and health writer and the author of a forthcoming book on science-based parenting