COVID-19 vaccines face many of the same ethical questions as other vaccines

Bioethicist Christine Grady, PhD, MSN, discussed ethical issues in vaccine development, rollout, and utilization, with a special focus on COVID-19 vaccines, during Saturday’s ARP Keynote: Ethical Quandaries with COVID-19 Vaccines. The session, which was originally presented November 6, can be viewed by registered meeting participants through March 11, 2022.

Dr. Grady began her presentation by recognizing the importance of vaccines throughout history while also acknowledging the many ethical challenges related to the development and testing of vaccines, the distribution and allocation of vaccines, the use of vaccines as a public health strategy, and the social acceptability of vaccines.

“This is true across history, but it is also true of COVID-19 vaccines,” said Dr. Grady, Chief of the Bioethics Department at the National Institutes of Health Clinical Center.

COVID-19 vaccines are different than other vaccines in four important ways that Dr. Grady summarized as the four P’s: pandemic, platform, pace, and politicization/public views.

During a pandemic, people want answers to their urgent questions: How do we fix this? How do we prevent this? How do we treat this? Research is essential to address the urgency and uncertainty during a pandemic, Dr. Grady said, but doing research during a pandemic is quite complicated. It’s essential that vaccine development done at an accelerated pace does not compromise quality, acceptability, or ethics, she said.

The second thing unique about COVID-19 vaccines are the platforms. Historically, most vaccines have been live-attenuated vaccines or inactivated whole-cell (killed antigen) vaccines. In this case, the first two COVID-19 vaccines authorized in the United States were messenger RNA vaccines, a platform on which a vaccine had never before been approved. The third approved COVID-19 vaccine was a viral vector vaccine.

“These platforms were made possible by lots of years of good basic science,” Dr. Grady said. “We are going to see many more vaccines in the future on these platforms.”

The pace of COVID-19 vaccine development was also different. Vaccine research started within weeks of identifying and sequencing SARS-CoV-2. By October 2021, about 20 months after the virus was sequenced, more than 400 million doses of the vaccines had been administered in the U.S. and 3.6 billion doses worldwide.

“Despite the fact that the pace was extraordinary, it is helpful to reflect on the fact that all steps normally undergone in the process of research took place — they just took place faster,” Dr. Grady said.

And the fourth P: politicization.

“Vaccines have always been controversial, but the extent of politicization and divisiveness of public viewpoints about COVID vaccines is quite striking and is affecting the way that vaccines are working in the U.S. and around the world,” Dr. Grady said.

Other ethical considerations

Appropriate allocation and distribution of COVID-19 vaccines is another relevant ethical consideration, Dr. Grady said. Maximizing the public health benefit was a major priority behind the planned distribution of COVID-19 vaccines, but it was not the only priority, she noted. There was also a focus on equity, fairness, and transparency in distribution decisions.

Despite that, or perhaps because of it, challenges in the allocation and distribution of vaccines have been significant, she said. Allocation challenges include attempts to prioritize groups within priority groups. There were also logistical challenges related to distribution, as well as complications arising from different distribution decisions made in various jurisdictions. All of these factors have led to some perceived unfairness, Dr. Grady said.

There have also been major issues related to the acceptance of COVID-19 vaccines. Among the most common reasons cited for choosing not to be vaccinated are worry about the fast development process and the unfamiliar vaccine platforms. People are also confused about the data, or simply overwhelmed by the amount of available data.

“We are so on top of this that data emerges and messages change, which fuels confusion rather than making people feel better,” Dr. Grady said.

There’s also fear about side effects, and widespread misinformation and disinformation. Another key factor is a lack of trust amongst the American public about vaccines, research, and the federal government.

“All of that affects willingness to take the vaccines,” Dr. Grady said.

Dr. Grady opened and closed her presentation with the same 2014 quote from Stanley Plotkin: “One of the brightest chapters in the history of science is the impact of vaccines on human longevity and health.”

“We can all agree that vaccination for COVID-19 has really reduced the number of deaths, hospitalizations, and the number of people who get sick from SARS-CoV-2,” Dr. Grady said. “We are seeing at this point in history that most of the people who are getting sick are people who are not yet vaccinated.”