When the first COVID-19 vaccine was authorized for emergency use in the U.S. in December, the country cheered the images of health care workers, nursing home residents and first responders rolling up their sleeves to get the very first doses.
Three months later, however, many of those lucky enough to get the Moderna
or Johnson & Johnson
vaccines are keeping the good news quiet. And that’s because the troubled vaccine rollout, which has seen each state dictate its own rules for who qualifies for the shots, has created some opportunities for people who are tech-savvy or well-connected to jump ahead of others.
And that’s led to some moral and ethical questions about who deserves to get the shot first, as well as when it’s OK to reveal that you’ve been vaccinated against COVID-19.
“It’s kind of a moral mess,” said Dr. Ruth Faden, a bioethicist and the founder of the Johns Hopkins Berman Institute of Bioethics. “Once the states started going in different ways, it did undermine, or at least confuse people about what the right ethical values are for who should go first and who should go second.”
“It feels a bit like you’re gaming the system … I do fully qualify. But I know that there are people older and more infirm than me.”
— Lisa Marsh
Eli Karp, a 20-year-old student in Evanston, Ill., has already received his first dose. He didn’t feel comfortable sharing the news on Facebook, however. “It’s weird to see someone my age get it when there are a lot of people who can’t,” said Karp, whose body-mass index (BMI) score made him eligible in his state. “Even though I got it completely legitimately, there’s lots of vaccine jealousy out there, and I’m not on [social media] to foster that,” he said.
Lisa Marsh, a writer and editor living in Washington Heights, in New York City, also skipped posting a COVID shot selfie. “I don’t need to gloat,” said Marsh, a mother of two who qualified for her first dose thanks to a pair of underlying autoimmune diseases. She’ll get her second jab on St. Patrick’s Day.
“It feels a bit like you’re gaming the system. I had a moment of, ‘I feel young. I feel like I’m in good shape,’” she said. “But I do have these underlying issues going on. I do fully qualify. But I know that there are people older and more infirm than me, and I don’t want to rub it in their faces.”
Robert, an NYC high school teacher who asked to withhold his last name, qualified in New York as a public educator. But he hesitated to get the shot at first because he was teaching remotely. His wife was still working with students with special needs in person, however, so the two of them recently got vaccinated — and just in time to learn that NYC high schools are poised to reopen for in-class learning on March 22.
Still, Robert, 39, has largely kept his own vaccination news quiet. “If it’s brought up, I have no problem saying that I got it,” he said. “But I didn’t go around broadcasting it on social media like some people do, because I know some people might feel like, ‘He’s working from home right now, he doesn’t need it right away.’”
Plus, posting a vaccine photo doesn’t just invite feelings of frustration or jealousy. It can also lead to uncomfortable questions about how one qualified for their shot in the first place.
States like Illinois, New York and New Jersey have expanded COVID-19 vaccine eligibility to adults age 18 and up with comorbidities such as obesity, high blood pressure, diabetes, cancer history, autoimmune disease, neurological conditions and liver disease. The folks diagnosed with these conditions don’t necessarily want to disclose them to the world at large as the reason why they were able to get vaccinated on the earlier side. And many of these conditions are more or less invisible, so it can be hard to believe that a healthy-looking person is actually at greater risk for worse COVID illness or death than you are.
“Many of us have health conditions that we don’t broadcast,” said Dr. Faden. “There are concerns about shame, and also concerns about medical privacy.”
And Dr. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics, also noted that some of the qualifying comorbidities raise the question of whether vice is being rewarded. For example, smokers are eligible for vaccine appointments in New Jersey.
“It raises different issues that have nothing to do with the vaccine; it’s got to do with attitudes about personal responsibility, and about people who are seen as not taking care of themselves as well,” Caplan said. “I don’t think we pay attention to who goes first and who goes next just because it’s the COVID vaccine; it’s partly because we’re having, in the background, a very uncomfortable discussion about, ‘Am I more important than you?’ and ‘Who is ‘essential?’”
But it should be noted that there’s a reason why people with comorbidities are being encouraged to get vaccinated in some states. There is evidence to suggest that they are at greater risk for getting severe COVID illness or dying. “If you are over 65 or if you have an underlying condition, you should not feel guilty if you are vaccinated,” said Dr. Laurie Zoloth, a professor of religion and ethics at the University of Chicago, and the senior advisor for programs on social ethics. “For if you did get exposed, you would be at a much higher risk than others, and this is true even if you are in a bubble.”
Indeed, the CDC warns that having obesity increases the risk of severe illness from COVID-19, and may even triple the risk of hospitalization, for example. And as one’s body-mass index (BMI) increases — which is something many Americans have experienced during the pandemic — their risk of death from COVID-19 also increases.
Dave Schaffer, a lawyer working in New York City, learned during a recent doctor’s appointment that some recent weight gain had pushed his BMI over the obesity line. His doctor wrote him a note clearing him to get the vaccine. “The immediate relief from having the opportunity to do it was tempered by should I do it?” he admitted. “I wrestled with it for most of the weekend while I was struggling to get an appointment with no luck whatsoever.” But when he finally saw a shot slot open up a week later, he jumped at it.
“What changed my mind? I go to work just about every day in an office downtown, and I ride the subway, so I’m thinking the odds of running into folks who are sick are high,” said Schaffer, 59. “So at the end of the day, I qualified as being fat, and I took the shot without any remorse — and with much relief.”
Laura, 42, a mother of two teenage girls in Virginia Beach, Va., who asked to withhold her last name, qualified for her vaccine appointment thanks to high blood pressure and a high BMI — not that she advertised her health conditions when she told friends and family that she got her shot.
“I had some of the same thought process: I work from home. Should I get it?” she said. But as a single mom, she decided she had to get the shot to take care of her kids. “I can’t afford to be ‘down.’ I gotta do whatever I can to protect my family,” she said.
“Getting the shot improves the situation for everybody,” Robert added. “Ultimately, we want everyone to have it. Slowing down the process doesn’t do anyone any good.”
Do not throw away your shot
At this point, the ethicists MarketWatch spoke with agree that it’s important to just get shots in people’s arms right now — especially after President Joe Biden pledged last week that all U.S. adults will be eligible for vaccines by May 1.
“If you cut in line, I don’t like it, I’m not happy about it, but I think you’re only delaying somebody else’s vaccine for weeks at this point,” said Dr. Caplan. “It’s very important to get vaccinated. It’s probably less important if you’re 20 and in good health than if you’re 70 and obese and have a bunch of other diseases, but nonetheless, it’s important to be vaccinated to protect others who you come in contact with from getting sick. So I’m not going to criticize anyone for taking whatever steps they can.”
Still, there are some moves that are clearly wrong, such as misrepresenting yourself by lying about your medical history, or pretending to live in a city or state to qualify. For example, when a vaccination site was opened in Washington Heights in upper Manhattan specifically to serve the local, largely Hispanic community, there were reports of people driving down from the suburbs of Westchester to take advantage of the ample appointment slots and short lines.
“Don’t cheat. It’s clearly wrong to say you have a condition you don’t have. It’s clearly wrong to call your friend who works at a pharmacy or at a hospital and say, ‘Can you sneak me in?’ And if you’re a big donor to someplace giving vaccines, don’t say, ‘Hey I’m on the board, can I have a vaccine?’ before it’s your turn,” advised Dr. Faden. “Those are all flagrantly breaking the rules.”
If you are still feeling guilty for being eligible for one of the COVID-19 vaccines, Dr. Faden suggests just getting your shot — and then making it your mission to help other people get theirs.
“If you’re concerned about the fact that other people who really are in greater need of protection from the vaccine are having difficulty getting it in your community, then take that emotion that you’re having and put it into some volunteer time,” she said. “At minimum, help one other person get vaccinated, and you can kind of wipe the slate clean. Drive somebody to a vaccination site. Or if you have the time and privilege to spend hours waiting in a standby line to get a vaccine, you surely have the time to help somebody else get a vaccine, too.”
Indeed, Karp has joined a number of Facebook groups dedicated to helping people navigate the convoluted vaccine booking process online, such as sharing when appointment slots at drugstores like Walgreens or CVS open online.
“I have been able to get one. I qualified, but at the same time, I know a lot of people who might need it more,” he said. “And I’m gonna help them get it, because I know I can help.”