Mapping the Covid Vaccine Landscape

As the Covid-19 vaccine has increased its distribution the last several weeks and more people are faced with the decision of whether or not to get it, the internet has been filled with a myriad of narratives and perspectives–which is no surprise. As we’ve seen with many things surrounding the coronavirus–from the level of danger the virus poses to the merits of various mitigations measures–debate and contrary narratives inundate the web, podcasts, publications, and the news media: not to mention our own community and social spheres. At its heart, we are faced with decisions that have ethical implications for ourselves and our neighbors, but few of us are equipped with the necessary frameworks and categories to make informed ethical decisions about such things. Unfortunately, before an informed ethical decision can be made, people need to know what questions they should even be asking as well as what perspectives and options have been offered. Below is a brief attempt to map the covid vaccine conversational landscape. It’s not an attempt to answer all the questions, but rather to outline the major viewpoints and to raise questions that not enough people are asking.

Big Question 1: Should I get the vaccine?

This is the primary question most people ask. For some people, they do not have the luxury to think about this question for very long because their work requires that they get the vaccine or they are in a context which either requires or strongly suggests they get it, such as nursing homes or care facilities. Some people may have the option to decline to get it, but for most in these contexts, they just get the vaccine. Fair enough.

But for everyone else, this question looms large. The answer to this question is far from simple. At first blush, many people find themselves in one of two camps.

Yes, because the vaccine will stop the spread of the virus, create herd immunity, protect me and my neighbor, and help society get back to some semblance of normal.

No, because the vaccine is new and relatively untested; it uses methods never used in a vaccine before; we don’t know what the short or long-term side effects might be for the vaccine; the vaccine may benefit from aborted fetal tissue; and the fact that this happened so quickly and everyone is being pressured to get it (including people who have already recovered from Covid) is suspicious.

The “yes” people often misunderstand the “no” people. They think the “no” people are being motivated by one or more of these things:

-A knee-jerk distrust for science and the authority of experts. AKA: these people are anti-intellectuals, or anti-science, or anti-experts.

-A knee-jerk distrust for government intervention and government mandates. AKA: these people prefer personal independence to the government telling them what to do because the government is untrustworthy.

-A general mistrust of vaccines in general.

-A general bent toward personal autonomy/freedom/selfishness.

The “no” people often misunderstand the “yes” people. They think the “yes” people are being motivated by one or more of these reasons:

-A blind faith in the government and scientists who tell them everything will be ok once they get the vaccine.

-Overblown fear of the virus and too much faith in untested remedies.

-Lack of research into the potential dangers of the vaccine in favor of wishful thinking.

Of course, there are a lot of people in the middle who either get the vaccine but don’t fault their neighbor for hesitating to get it, or those who hesitate to get it but don’t fault their neighbor for getting it.

In the end, though, this is where most people stop, and not enough questions are being asked that go beyond this. Because of this, it’s very hard to have the conversations that are required to make an informed ethical decision. Often, then, people are motivated by what they don’t want to be like.

“I don’t want to be anti-science or unloving to my neighbor, so I’ll get the vaccine and it’ll probably be fine.”

“I don’t want to be duped or cause myself potential long-term harm with an experimental vaccine, so I won’t take it and it’ll probably be fine.”

Or, people will just do whatever the majority in their context does.

Many people just chalk it up to “conscience,” that as long as people follow their conscience they’re ok; but “conscience” is often a Christian way of saying people can just do whatever they feel like: essentially, “conscience” maps onto the same forms of decision making that I just discussed.

While all these responses are understandable, they are not the best for an informed ethical decision that Christians should be pursuing. As we know, moral choices aren’t simply about the action one takes, but the reasons and intentions behind those actions. So in order to make a more informed ethical decision, we need to unpack the implications of this dilemma even more.

Big Question 2: Is the answer to whether one should get the vaccine context dependent?

Often in these conversations about whether people should get the vaccine it seems to be “all or nothing”–particularly when people who are pro-vaccine are making the argument. But what if the question should be nuanced?

Should a healthy 25 year old get the vaccine? Should a 45 year old with underlying health problems get the vaccine? Should a 75 year old in a nursing home get the vaccine?

Age is not the only factor that needs to be considered. What about living situation? Is there a different answer for someone living alone and someone living in a larger communal space? What about frequent contact with at-risk people? Is there a difference between a 35 year old who makes weekly visits to his elderly mother and an 18 year old college student who very rarely interacts with someone over 65?

To answer these questions, we have to ask even more questions.

Big Question 3: If all the people who are not at a statistical risk for serious covid-related complications (>.01%) do not get the vaccine but all the people who are at a statistical risk for serious covid-related complications do get the vaccine–what threat does this pose to the general population?

This question partially gets into the concept of herd immunity, but also asks larger questions about the relative effectiveness of the Covid vaccine.

Is the strength of the vaccine in its effectiveness in the individual or is it in the effectiveness in the group when everyone (or nearly everyone) gets it?

Of course, one also recognizes that there will always be people who don’t get the vaccine (for one reason or another) who are still at serious risk or who may become at risk over time.

The bottom line for many people is if they get Covid but all the vulnerable people in their context have the vaccine, then is that person with Covid much of a threat?

One may argue that it’s not so simple: the threat is only neutralized when the virus stops actively spreading ( which is caused by herd immunity), and many people won’t know they’re vulnerable.

But someone else may argue that this is only relevant if there was a possibility of eradicating Covid from the general population through vaccines and herd immunity. But given that Covid is continually mutating and the vaccine is not projected to eradicate nor last in its effectiveness for more than a year or two, the answer may get more complicated as true herd immunity doesn’t seem to be a serious expectation.

Big Question 4: Should this be approached from a risk/reward paradigm? And is that paradigm different for different groups and contexts?

The hard truth is that there is a lot we don’t know about the potential effect of the Covid vaccine. There is a reason that most vaccine trials last many years. In favor of the vaccine, people have noted that the vaccine trials for Covid included far more people than most vaccine trials do, which enabled scientists to have a fair sample size. But one could argue that the large sample was more effective for testing the immediate effectiveness of the vaccine for protecting from the disease, but was not effective in testing for short and long-term side effects from the vaccine itself.

There are plenty of legitimate questions about how the vaccine could potentially affect people down the road (https://childrenshealthdefense.org/). Anyone who dismisses these questions out of hand isn’t being realistic. Of course there should be questions; of course there are still things we don’t know. Further complicating things is the fact that data is starting to come out about potential covid-vaccine related events and deaths.

Those who are suspicious of the vaccine will point to these articles and statistics as supporting their hesitancy, while those who are pro-vaccine will argue that there is no solid proof that the vaccine has actually been the cause of these adverse effects. Correlation does not prove causation. The fact that something could possibly go wrong doesn’t mean there’s any measurable risk that should change someone’s course of action.

Both arguments have legitimate points.

Given these questions, might different people have different risk/reward paradigms? Does the potential risk of short or long term Covid effects outweigh the potential risk of short or long term vaccine effects in certain groups more than others? Might the risk of Covid outweigh the risk of the vaccine in older populations but the reverse be the case in the younger population?

Some may argue that even those who might be more at risk for vaccine-related complications should still get the vaccine out of love for those who are more at risk for covid. It’s a bad situation we’ve all been put in, but on the whole the risk of covid is far more significant than the potential risk of the vaccine. Vulnerable populations are risking their lives every day because of Covid: non-vulnerable populations should be willing to embrace the slight risk of the vaccine for the sake of those who are at greater risk.

That may be a legitimate and persuasive argument. But another question should be raised.

Big Question 5: What is our risk threshold?

The reality is that we all live with risk all the time and no one can actually take a “safety first” approach to life. If we did that, we’d never go out our door (covid or not). In reality, we take a “safety third” approach, putting other priorities above safety as long as there isn’t a high risk for harm. We drive on the road even though we know that we could get killed because the risk is low and our other priorities supersede that low level of risk.

Given this, how much should we allow the potential risk of harmful vaccine side-effects guide our decisions? The fact that there is a risk is certain, but how high is that risk? Are there other priorities that outweigh the level of risk?

Further complicating this is that the risk is largely unknown. Whereas we know (generally) the relative risk driving presents, we can’t possibly know the relative risk of the vaccine until months or even years down the line. Lack of knowledge feels like it increases the risk. If we knew there was a 1 in 1000 chance of becoming sterile (for instance) in taking the vaccine, would we take it? Probably. But we don’t know the chances, so the risk seems higher.

Suppose the vaccine did pose significant risk. Some people will argue that even so, the risk of Covid outweighs the risk of the vaccine, so we should get the vaccine, even if it kills people or gives them life-long health complications. More people will die from or be permanently harmed by Covid than by the vaccine. That might be true.

But that leads us ask other questions.

Big Question 6: Is there something intrinsically worse in human-caused death over nature-caused death?

The reason I bring this up is because some people say that anti-vaccine people have an irrational fear of human-caused death and an irrational trust of nature, unaware that nature is incredibly deadly and we should do everything we can to stop nature from causing such devastation.

But what if the reason people are averse to human-caused death (such as vaccine-related effects) is because there’s something intrinsically different about it. (Of course, some will argue that Covid itself was “manmade,” but we’ll set that aside for now). The nature of tragedy (in the classical sense) is that the hero is the cause of his own downfall. Often in tragedy the “hero” in his hubris will take actions that unwittingly lead to his death or the death of those he loves the most. And we all (or at least most of us) get a sense that there is something different about that kind of death in contrast to other forms of death and suffering. What if the aversion to the vaccine is an instinctual recoil, a distancing from the possibility of tragedy, of acting in hubris and haste, destroying ourselves by way of the very thing we created to prevent our own destruction. That’s a powerful fear.

Of course, many will argue that not doing what we can to prevent the spread of covid is another form of causing our own downfall. That out of fear for the potential effects of the vaccine we allow far worse effects of the virus. That seems pretty tragic, too.

In light of all of these questions and fears, many will find themselves in the middle, wanting more time to “wait and see” if there is more evidence of harmful vaccine side-effects. But that leads us to another question.

Big Question 7: Is a “wait and see” approach ethical when death numbers continue to rise?

While “wait and see” can often be the wise approach on an individual level, it raises some ethical questions when it comes to the covid vaccine.

Is it ethical to allow others to be guinea pigs when you aren’t willing to take the risk yourself?

Is waiting a good option when time directly correlates with further death?

The reality is that unlike many decisions, this one doesn’t just affect the individual. Because of that, it creates a tension within the “wait and see” approach. Might I be putting other people at risk by delaying getting the vaccine when it becomes available to me?

This is only the beginning of mapping the complex landscape of the covid vaccine. My attempt here is to challenge the reader to think more deeply about our own perspective on the vaccine and make an informed ethical decision. It should also be a challenge for those of us who are quick to judge others who see things differently than us. Things are often more complicated than we make them out to be.

I don’t know what my answer to all of these questions is at the moment, but we have the responsibility under God to seek out wisdom, to pray for guidance, and to try as best we can to love God and neighbor in this difficult and complex situation we find ourselves in. Whatever we do, we do it before the face of God.

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