One vaccine shot or two? Who should get the vaccine? And should there be limits on those who don’t?
If you’re unaware, here’s the quick version.
There is a runaway trolley and up ahead are five people tied on the track. You are standing some distance off in the train yard, next to a lever. If you pull this lever, the trolley will switch to a different set of tracks. However, there is one person tied on that side track.
You have two options: Do nothing and allow the trolley to kill five people, or pull the lever, diverting the trolley onto the side track where it will kill one.
What is the right thing to do? It’s a problem that has plagued ethicists for decades; there’s no right answer.
In many ways, our governments and health departments are standing in the train yard, with a whole bunch of levers to pull with regards to the coronavirus. But to make matters worse, they’re operating on a foggy day and can barely make out some people on the tracks.
To put you in their shoes, we’re going to walk you through three real coronavirus dilemmas. Ask yourself, if you had the ability to pull the lever, would you?
Let’s say you have two elderly grandparents. And let’s say you have only two doses of the Moderna vaccine — you’ll probably get more, but you’ll have to wait a couple of months.
The dilemma: Do you vaccinate grandpa and schedule his second dose as recommended in four weeks, or do you vaccinate both grandpa and grandma with one dose now and hope to schedule their second doses down the road?
It makes sense to take the 80% odds of keeping both grandma and grandpa healthy instead of the 94% chance of keeping one healthy, right?
And, well, grandma doesn’t want to reenact the devastating first 10 minutes of Pixar’s “Up.” Grandma wants to stay healthy now, too.
The United Kingdom has made the move to one dose over two, leading to real questions now for state and federal lawmakers. But the U.S. is not making that move, and officials from the Utah Department of Health say while they’ve been following the situation in the U.K., “They have not made any decisions to adopt a similar approach, and would not without some sort of consensus or direction at the national level.”
So if it was up to you, what would we do?
Save lives or stop spread?
Let’s say you’re a doctor with one dose of the vaccine on hand, and you’re pretty sure you’ll get a second dose in four weeks. In your waiting room are two patients:
• One is relatively healthy 85-year-old man. He lives at home with his wife of a similar age, but they don’t get out often. His son calls a couple of times a week but rarely stops by. They get groceries delivered. If he got the coronavirus, the odds of him dying are roughly 10%.
• The other is a relatively healthy 35-year-old college professor. She teaches math to about 250 total students — two large seminars in a big hall with about 100 students, and to two smaller seminars with about 25. She is unlikely to die — her odds are about 1 in 10,000 — if she contracted the virus. But, thanks to her teaching job and the way she has to shout to make sure those in the back of her class can hear her, she could be a superspreader.
The dilemma: Do you give the vaccine to the elderly man or the college professor?
There are two goals of the vaccine: to prevent death and to prevent the spread of the virus. These goals are sometimes, but not always, aligned.
Back to our hypothetical.
Giving the vaccine to the elderly man is more likely to directly prevent a death. But the ongoing chain of coronavirus infections caused by one college professor might end up creating more risk of death down the road, if the virus spreads from the professor to her students, and then to their family members, multiplying each time.
There are also lots of complications due to COVID-19 to consider, for both the elderly man and the college classes. What is the likelihood of hospitalization, or of long-COVID symptoms? How many hours of work or school will be missed due to quarantining? And what impact will sitting out have on these students’ education?
Of course, you can replace the college professor with any number of professions, from:
• Those who work in jails, homeless shelters, hotels, youth centers, etc.
• Postal workers, grocery store clerks, fast-food employees, bank tellers, and many more in the service industry.
• Those who were willing to risk their health to be a part of the scientific trials for the vaccine, only to get a placebo.
If you were on Utah’s vaccine committee, whom would you argue to prioritize?
Which activities will require vaccination?
Let’s say our 85-year old grandpa doesn’t drive anymore, instead he uses public transit. He’s already been vaccinated long ago, but he knows his vaccine is only 90% effective. And he knows there’s a 10% chance that if he contracts COVID-19, he will die. Combine the odds, and if he takes a seat on the bus next to someone with the virus, there’s about a 1 in 100 chance he will die.
The dilemma: How far should the government go to keep grandpa safe?
Requiring people to prove they are vaccinated isn’t exactly new: Many African countries require you be vaccinated for yellow fever before visiting, and all U.S. states have vaccination requirements for attending schools. But it is new for most U.S. adults, and there are real ethical questions.
Enacting vaccination passports serves to protect the health of those who are vaccinated, and limits the rights of those who aren’t. So midway through a public vaccination process, how many rights are reasonable to restrict? Is there a right to fly on an airplane or ride that bus? Should vaccination be required for certain jobs, or to attend a concert or sporting event?
How fair would it be to restrict access depending on people’s status in a vaccination queue they have no control over? Knowing the world, that probably creates a black market for vaccinations, or simpler, fake vaccination IDs.
On the other hand, it’s also not super fair to restrict access to a full life for those who have already had a vaccine?
So if you were in charge what, if any limits, would you impose on those who haven’t been vaccinated?
Now, it’s time to squint through the fog as best as possible. You’re standing in a train yard, next to a box full of levers. Which ones do you pull?