Rationing, Responsibility, and Vaccination during COVID-19: A Conceptual Map

Abstract

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics.

Keywords:

• COVID-19
• public health
• rationing/resource allocation
• pandemics
• reciprocity
• responsibility for health

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ACKNOWLEDGMENTS

The authors thank Paul Billingham, Rebecca Brown, Chris Dietrich, Tom Douglas, David Jones, Jonathan Pugh, Sadie Regmi, Zofia Stemplowska, Robert Truog, and Sarah Van Goozen for comments on earlier drafts that significantly improved the paper.

Notes

1 A further issue is that even if vaccination status is binary, patients or their families can provide incorrect information for a variety of reasons (perhaps particularly if vaccine status is known to be relevant to treatment entitlement). Robertson acknowledges this, and says that his proposal would require a universal vaccine registry.

2 We are grateful to Zofia Stemplowska for bringing our attention to this reply.

3 While Fenton discusses the “scope” of justice, she subsumes both questions of what we have termed currency, and what we have termed scope, under this idea.

4 Note that by “flexible,” we mean “within the worker’s control.” So-called “flexible” hours which are in fact unpredictable shifts given out by employers, and “flexible” jobs in the gig economy which require people to be readily available to work, are not what we have in mind.

Additional information

Funding

Ben Davies’s research was funded by the Wellcome Trust, Grant 221220/Z/20/Z. For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.