Vaccine Ethics: If You Are Not “Essential,” Just Wait—or Die
This evening, I received an email from my primary care physician, an internist and gastroenterologist affiliated with New York Presbyterian Hospital. He began:
“Hello everyone on this very memorable day!
“It has finally arrived.”
He was hailing, of course, the Pfizer/BioNTech vaccine approved this week by the Food and Drug Administration (FDA). The FDA and the Centers for Disease Control (CDC) are both agencies within the Department of Health and Human Services.
Welcome to the sprawling bureaucracy created to keep us safe.
Welcome to the sprawling bureaucracy created to keep us safe.
My doctor (who might not want to be named in connection with this article) went on to say “We are all eagerly awaiting distribution and mass vaccination (spoiler alert … it will take a while).”
And after this introduction, the doctor’s chief remaining topics were two:
- The efficacy of the vaccine (95 percent as compared with 50+% efficacy required for FDA approval) and minimal side effects (a big concern with vaccines). Moreover, the Pfizer/BioNTech vaccine is only the first. Other companies involved in the Trump “Warp Speed” development program are also streaking to the finish line: Moderna, AstraZeneca, and Johnson & Johnson. (Interesting that during the recent presidential campaign, the Democratic candidate, Joe Biden, and the whole “Beat Trump” political-media-academic horde made “Trump did nothing” its biggest issue.)
- How soon the “tightly controlled” distribution might permit us to get the vaccine. As I read what the doctor had to say on this second issue, I felt myself slipping into the role of the Little Citizen hanging on every word from Big Brother about when I might be permitted—given my relatively “inessential” life—to get the vaccine; when my wife, my son, my brother might be vaccinated.
So, for us “least essential,” maybe almost another year of stay at home/masks/no visits.
My doctor gave his best estimate for me, my son, my wife, my brother—all in Phase 4 & 5 (see below): “This process [getting to the “least-essential” citizens] could take as long as the first nine months of the new year.” So, for us “least essential,” maybe almost another year of stay at home/masks/no visits. And in those nine months, some “less vulnerable” and “least essential” Americans will die. Just statistics.
My doctor anticipated the response. “I anticipate many people want to get it but I really don’t think that there will be a way to get it by ‘gaming the system or jumping the line.’ We all have to wait our turn. I do not know where I am on the line myself but will be eagerly taking it when my number is called. The process by which one signs up for it has yet to be revealed.” (Doc, you have a very mild personality!)
I speculate it is likely that the good doctor knows already that through his affiliation with one of America’s premier academic medical centers, he will be at the head of the line. He informs us: “New York Presbyterian Hospital [with which he is affiliated] will be receiving the vaccine and will administer it to front line workers and the community as per the timing schedule that the state allows.” That is Phase 1. But the good doctor counsels patience and resignation for the rest of us.
Response to the pandemic as early as January 2020, certainly in months that followed, was an international response by pharmaceutical sciences organizations and governments. That was taken for granted.
In the United States, as in many countries, the government (the Trump administration) seized control of the research process simply because populations everywhere had long been accustomed to respond to any emergency by asking: “What is the government doing?” (Despite government’s response, however, when it came to health, it seems, by the time of the 2020 presidential election, Donald Trump was personally responsible for every COVID-19 death— the “mass murderer” as Hollywood likes to say.)
With little choice, the Trump administration went the whole hog, with the Operation Warp Speed program of guarantees, subsidies, and legal immunities offered to every leading pharmaceutical company or consortium. The effect was to use taxpayer money to relieve the companies of virtually any financial risk in the highly risky game of new drug development. In addition, all the relevant agencies of government such as the CDC became active partners and supporters of all vaccine efforts.
The quid pro quo from Warp Speed was that the vaccine for all Americans would be free. That does not mean a gift from the pharmaceutical companies. It means that the government contracted with the companies to pay for certain prepaid doses.
The Warp Speed program’s impact is unknown, of course. The pharmaceutical companies already were prioritizing a vaccine. Warp Speed probably removed any restraint in investing in the efforts, forced collaboration among companies, and exerted pressure. The real asset was decades of experience of American science with vaccines, including annual new flu vaccines, American education in biomedical science, and the profit incentive of the pharmaceutical companies.
And so, at present, the federal government asserts complete control over the triumphantly produced vaccines. It has been reported that the Department of Defense has been assigned to the logistics of vaccine delivery. The doctor reports: “The CDC is developing a Vaccine Administration Management System (VAMS) to manage vaccine administration and provide real-time data from mass-vaccination clinics to federal agencies and state public health departments.”
That means the federal government is exerting maximal control over the availability of the vaccine. But if you think that is the only bureaucracy, you haven’t been paying attention to how the pandemic has incited a power grab by states and cities.
That means the federal government is exerting maximal control over the availability of the vaccine. But if you think that is the only bureaucracy, you haven’t been paying attention to how the pandemic has incited a power grab by states and cities. The doctor’s report goes on: “It [the new vaccine] is a limited resource that is tightly regulated by states and hospitals. … This cannot be distributed by decentralized systems [for example, by my doctor] but rather by complicated health-care systems like hospitals and eventually pharmacies, we suspect. There may be mobile units/trucks and clinics that are managed by the state and local counties as well. (There is the issue with distribution that this vaccine created by mRNA technology has to be stored and transported at incredibly low temperature [-94 degrees F.].)
“We all have to wait our turn…”
Nothing new, here. Governments federal, state, and local (e.g. New York City) are assuming the right to decide, in detail, category by category, who will get the vaccine and when. This is a decision about who should live and who may be permitted—regrettably, of course—to die.
With all compliments for the doctor’s determination to give patients information, here is our government’s order of priority for protection from COVID-19:
Phase 1
Workers in nursing homes and care facilities, the most at-risk residents as well as frontline workers in ICUs, and EMS workers.
Phase 2
First responders like police and firefighters, teachers, grocery store workers, and other essential workers who regularly interact with the public like pharmacists as well as people with high health risks.
Phase 3
People over the age of 65 and people under 65 with underlying health conditions.
Phases 4 & 5
All other essential workers and the rest of the population will be vaccinated in the final phase … in the first nine months of the new year.
(I would like to know where state governors, Congressional Representatives, and Senators fit in, here? If they are not 65, they are in Phases 4 & 5 and must wait for nine months? We may need a Phase 6 to include all politicians on every level. And we aren’t even talking about a phase for those who are a threat to the country.)
Phase 3 comprises Americans 65 years of age and older. About three weeks ago, a man I know in East Hampton died an agonizing death from COVID-19 pneumonia. He had had a stroke, gone to Southampton Hospital, and been released the next day to a rehabilitation facility. Unfortunately, there was an epidemic of COVID-19 in the rehab facility. He contracted COVID pneumonia, was sent back to the hospital, and died two weeks later, calling his wife dozens of time a day to say, “I only want to die.” Because of hospital health precautions, his wife never could visit him in person before he died.
The life of this man would have been saved had he been vaccinated. But if he were alive, now, he would not be getting it for months. His life was dispensable by the calculus of “essential workers” like grocery store workers and teachers. Early in the pandemic, states like New York began valorizing “front line” workers and “our heroes,” often in ads with a distinctly racial/proletarian tinge. (Don’t you see? These are the important people: the “workers.”)
Equally early, the discussion of distribution began. By now, hundreds of articles have been published on the same subject. At first, the emphasis was egalitarian. Everyone, everywhere, must get the vaccine for free. But genuine strategic thinking about at-risk populations came together with an egalitarian mindset to create the game: Who do I think should live? Blacks? Immigrants? Essential workers? Nursing home residents? Uber drivers? Predictably, Pope Francis said: “the poor.” Prisoners and poultry factory workers.
Factions and pressure groups are exerting political pressure for prioritizing certain groups.
Factions and pressure groups are exerting political pressure for prioritizing certain groups. That is the function of pressure groups when government controls the scientific establishment, the health and medical care system, and prioritizes who is important to treat and who can wait. Who is essential, who is not? And the answer: Those who serve the public. That, as a matter of fact, is mostly government employees.
No one to my knowledge dared propose that the market should determine the distribution system.
No one to my knowledge dared propose that the market, which year in and year out successfully keeps millions of essential goods and services of every conceivable variety available everywhere in America, should determine the distribution system.
But what if the vaccine had been left to the incentives of profits, scientific reputation, and the public spirit of the pharmaceutical giants and their university collaborators? That system despite financial risks and grueling regulation strives for new products and developed the laboratory, clinical, and population-based trials that produce safe, effective, and constantly improving drugs for virtually every need.
If the vaccine and its distribution to maximize profits had been left to the pharmaceutical companies, with the vaccine available at market prices set by supply and demand, what would have been the outcome?
No one can predict the specifics. We know that this time around the speed of developing a new vaccine set historical records. Credit is given to Operation Warp Speed. To establish the truth of that hypothesis would require a controlled trial. Right?
We do know that half-a-dozen companies and university organizations working independently with different technologies all managed to reach the finish line at almost the same time. They had behind them the experience of decades of vaccine research and annual development of a new flu vaccine.
The tax dollars (and, of course, future tax dollars to pay debt) spent on Warp Speed reportedly dwarfed all previous costs of vaccine development. (So how about distribution of the vaccine starting with those who pay the highest taxes? Think the Biden-Harris team might go for that?)
Seriously, though, the notion that supply and demand on the open market should be the distribution system today is literally unmentionable.
“The vaccine is much too important. Lives are at stake.”
But lives are always at stake. Anyone who works to achieve his values is spending time—hours and days of life—doing so. For government then to demand and seize those values, and direct how they are used, amounts to deciding what lives are essential and what lives are less essential. The money spent on Operation Warp Speed represented lives that were not saved. All government spending of money taken from those who earned it to benefit others who did not is spending in the coin of lives.
Almost all economists on a theoretical level agree that markets—meaning supply and demand driving the price system and investment—are the only viable system for supplying consumer goods. Given that, their game is to demonstrate “market failures” (outcomes the economist does not like) where government should intervene. The most popular example: the U.S. health-care system.
One cannot demonstrate that Operation Warp Speed and distribution by the Department of Defense and CDC are as effective (never mind more effective) as would have been the market. Where complex factors defy calculation, the appropriate guidance is principle. In principle markets always trump government in providing goods. Freedom always trumps statism in creating economic prosperity. Even the Chinese Communist Party managed to learn that.
Warp Speed is hailed by President Trump, the media, and much of the public as a triumph of government intervention. By the standards that were required to validate the safety and efficacy of the new vaccine there has been no demonstration that government achieved a better outcome than would have the market.
We have here the old fallacy of economic reasoning that involves looking at what was accomplished and ignoring the cost. The cost never is just what was spent on achieving the positive outcome. The cost always must include the worth of opportunities lost because money was not spent on them. Today, the fallacy almost always touts what government delivers and ignores what millions of individuals, their resources taxed away, failed to accomplish.
You mean great things can be achieved by government and great things can be achieved by individuals, so both are equally good?
No, there is another cost of projects like Warp Speed. It is a cost that cannot be quantified because the resource that is squandered is man’s spirit. The cost is loss of the individual’s moral integrity: negation of his judgment, choice, value priorities, and options for action. This is loss of the actuality of freedom. And it is the loss of the actuality of liberty.
And when those are the costs, nothing that is achieved is worth it.
Sidebar: A Brief History of the Private Development of the Polio Vaccine
Perhaps the best-known early vaccine victory was over polio and achieved first by Jonas Salk. Much was different. The disease had existed since antiquity, it had been known for hundreds of years, and before the Salk vaccine others had been tested, sometimes with catastrophic results. What was dramatically different, however, was the private nature of the entire polio vaccine work.
As an aside, young Salk’s first work on a vaccine was in 1942 with Thomas Francis at the University of Michigan. It was WWII and the army wanted no repetition of the horrendous swine flu pandemic of WWI, including for soldiers in the trenches. They had ordered Thomas Francis to develop a vaccine. Within two years, Salk and Francis gave the military the world’s first influenza preventative.
Salk then left in 1947 to set up his own laboratory at the University of Pennsylvania and to find the next disease to attack. The incidence of polio, with accompanying paralysis and death, had been rising fast. (Improved sanitation, it was discovered later, prevented young children from frequent mild contact with the virus which made them slightly ill—but thereafter immune.) Without that natural exposure, children exposed to the virus often got the full-blown case and ended crippled, living in an iron lung, or dead. The first category had included Franklin Delano Roosevelt, president of the United States.
Amazingly, it was the entirely private National Foundation for Infantile Paralysis (the March of Dimes) that sought out Salk, gave him the job, and all the dimes he needed to tackle it. From 1947 to 1952, Salk and his colleagues systematically attacked the virus, verifying that there were three types and deciding to use killed virus, not weakened virus, to avoid earlier disastrous trials.
Every year, the epidemic was worse and in 1952 almost 60,000 children were infected with the virus; thousands were paralyzed, and more than 3,000 died. The numbers may not sound bad as compared with COVID-19, but the panic was worse among parents. In New York, for example, someone started a false rumor that cats were the cause and that there was a bounty on them. Boys in Brooklyn rounded up 70,000 in a couple of months, and, when they discovered there was no bounty, killed the cats themselves. Dozens and dozens of causes of the epidemic were alleged. New York City, worst hit in the nation, had some limited lockdowns.
By December 1951, Salk and his colleagues had a vaccine that they repeatedly tested on monkeys, killing many at first, before they repeatedly demonstrated safety and effectiveness. It seems incredible, today, that it was not government but the entirely private National Foundation for Infantile Paralysis that in 1954 approved going ahead with a nationwide trial of 1.8 million children in 44 states. That winter Thomas Francis and a private commission studied the findings and pronounced the vaccine totally successful. In a private press conference in a small hall at the University of Michigan, Salk announced it to the world.
In 1956, a year after the Salk vaccine went into use, polio cases in America declined by half. The next year, the decline was another two-thirds. By 1961, only 1,312 American children contracted infantile paralysis, a 98 percent improvement over 1952. The polio virus was close to being eliminated.
About the Author: Walter Donway
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