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Development of a Covid-19 Vaccine Amidst the Pandemic

Stacy Rivera

California State University Channel Islands

HLTH 307: Issues and Ethics

Professor Juan Betancourt

12/08/2020

Overview:
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The invention of vaccines has eradicated deadly diseases such as polio, tetanus, and

smallpox amongst other diseases that used to be prevalent in the United States. The influenza

virus caused an astounding 50 million deaths worldwide (at least) in the 1918 pandemic (CDC,

2018) compared to 290,000 to 650,000 flu related deaths worldwide on average today (WHO,

2019). However, despite the huge advances in public health as a direct result of vaccines they

continue to be a controversial issue as related to autonomy and individual liberties. Supporters of

anti-vaccination movements argue that the use of vaccines go against nature, violate religious

beliefs, and expose recipients to adverse reactions caused by biological components used as

ingredients in vaccines such as mercury and aluminum. Furthermore, they argue that the

government doesn’t have the authority to interfere with an individual’s right to make decisions

regarding their own body and care. However, in the midst of the Covid-19 pandemic politicians

and public health officials alike are eagerly waiting for the approval and release of a vaccine to

help end the pandemic that has taken the lives of thousands and counting. The question is, “will

the public accept the vaccine or reject it as a continued infringement of autonomy and personal

liberties”?

Morality of Vaccines

It is safe to say that the goal of most medical professionals is to help people. In fact, one

of the first tasks that eager medical students complete is taking the Hippocratic Oath in which

they promise to “do no harm” and devote their lives to providing quality care for patients. The

underlying tenet of this oath is non-maleficence. This goal is straight-forward and easier to

accomplish when dealing with people on an individual level. However, the matter becomes more

complex when focusing on populations as a whole. Utilitarianism, also known as

consequentialism, is the concept of doing “the greatest good for the greatest number of people”
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in order to maximize the good. Therefore, since the focus and goal of public health is to organize

efforts to improve the health of a population rather than individual health the use of vaccines to

prevent the spread of a disease is justified as they protect the greatest number of people. The use

of vaccines does not violate the principle of justice in the United States as they are available to

all citizens and nobody is denied vaccinations on account of their socioeconomic status, race,

religion, etc. However, the concept of doing “the greatest good for the greatest number of

people” in public health can infringe on autonomy, individual rights and liberties which can

make it an unpopular approach in the court of public opinion. According to Petrini and Gainotti,

“the most important critique to utilitarianism is grounded on the view that it easily leads to

unfairness and to the sacrifice of individual rights and freedoms to warrant the public utility”

(Petrini & Gainotti, 2011). The concept of autonomy plays an interesting role regarding vaccines

because while opponents of vaccines present valid arguments they overlook the goal of public

health which is to improve population health and maximize “the good” to better the greatest

amount of lives possible. Specifically in the case of vaccines, the United States has seen the

reemergence of diseases previously thought to have been eradicated. For example, Grzybowski

et al. explain, “It has been proven that many populations have a decreased herd immunity, which

in the United States was the reason for an outbreak of measles in California (Disneyland

measles)” (Grzybowski et al., 2017). Additionally, the CDC reported that in the first half of 2019

the number of measles cases surpassed the total cases per year for the past 25 years and they

warned, “If these outbreaks continue through summer and fall, the United States may lose its

measles elimination status” (CDC, 2019). For this reason, utilitarianism prevails in public health

and public health policies have to consider the greatest number of people even if a small group

feels their autonomy is violated in the process.

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Background Information:

In December 2019 a new strain of the coronavirus called the novel coronavirus was

identified in Wuhan, China. The virus quickly spread throughout China causing the government

to implement isolation and quarantine measures in an attempt to contain the spread of the virus.

However, by January 2020 the United States identified patient A in Washington State after

returning from a trip from Wuhan, China (Taylor, 2020). Since then the virus has wreaked havoc

and there have been roughly 58 million cases and nearly 1.4 million deaths worldwide (CNN,

2020). When describing the manifestation of the virus Hengbo Zhu et al. (2020) explain, “It can

cause symptoms including fever, difficulty in breathing, cough, and invasive lesions on both

lungs of the patients. It can spread to the lower respiratory tract and cause viral pneumonia. In

severe cases, patients suffer from dyspnea and respiratory distress syndrome” (Zhu et al., 2020).

Specifically, the elderly and those with compromised immune systems are considered high risk.

While in some cases patients only experience flu-like symptoms and quickly recover, in other

cases patients living with comorbidities experience severe complications that can lead to death.

Additionally, the long incubation period makes it difficult to identify cases and without clinical

symptoms such as fever or chills, body aches, loss of taste or smell, and sore throat it has been

challenging to limit the spread of the virus. Currently, the Centers for Disease Control and

Prevention (CDC) and the World Health Organization (WHO) are playing an essential role in the

response to the Covid-19 pandemic. Each organization has played a key role in establishing the

guidelines on how to best handle the pandemic and limit the spread. Both organizations have

recommended wearing a mask, practicing social distancing, and frequent handwashing to prevent

the spread of the disease. However, since the virus can spread during the incubation period

Covid-19 cases continue to be on the rise.

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Target Population

Being in the midst of a pandemic, the release of a Covid-19 vaccine would benefit the

worldwide population. However, this virus leaves the elderly and those with compromised

immune systems due to comorbidities especially vulnerable to complications that could result in

death. Zanettini et al. (2020) explain, “COVID-19 mortality rate is higher in the elderly and in

those with preexisting chronic medical conditions. The elderly also suffer from increased

morbidity and mortality from seasonal influenza infection, and thus annual influenza vaccination

is recommended for them” (Zanettini et al., 2020). In short, those who are considered high risk to

influenza complications are similarly considered high risk to coronavirus complications.

Likewise, frontline professionals such as the doctors and nurses treating the patients are a target

population as the rising number of hospitalizations have kept them in close contact with the virus

as they treat patients. Generally, the trends show that healthcare professionals, educators, and

those in the scientific community are accepting of the use of vaccines as a standard and

acceptable practice therefore would likely be accepting of a Covid-19 vaccine as well. Despite

these trends, the worldwide population would benefit from a Covid-19 vaccine as the incubation

period makes it challenging to identify cases so people of all backgrounds continue to be infected

on a daily basis. Shin et al. (2020) stress, “A vaccine is crucial, in particular because data

indicate asymptomatic transmission of COVID-19”, meaning no one person is safe from the

virus.

Recommendations:

The race for a Covid-19 vaccine is on and major players like Pfizer, AstraZeneca,

Moderna and more are currently conducting trials on their vaccine and hoping for fast track

approval from the FDA. According to Adam Renton et al, (2020) from CNN, “Pfizer announced
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last week that its vaccine has a 95% efficacy rate. They included more data than they have before

– looking at 170 confirmed cases of Covid-19, and they said it has 94% efficacy for people 65+”

(Renton et al., 2020). The efficacy of this vaccine is undeniable and it is clear there is no

alternative option to end this pandemic. The CDC and WHO guidelines have been implemented

to give people the best chance of staying safe and nonetheless cases continue to be on the rise at

the start of flu season. Deontology ethics encourages one to act solely out of duty in any situation

and stresses the categorical imperative which states this moral obligation to act out of duty is all

binding and has no exceptions. The elderly population and those living with a compromised

immune system cannot protect themselves from this virus without a vaccine and a group effort to

establish herd immunity through vaccination. Additionally, there is no alternative in the realm of

public health as utilitarianism prevails in order to do the greatest good for the greatest number of

people. In conclusion, while opponents of vaccinations feel they are an infringement of

autonomy there is an unspoken duty to protect those who cannot protect themselves, and this

duty should supersede all personal feelings especially when it is a life or death matter. However,

the question remains, “will the public accept the vaccine or turn their back on moral obligation

and reject it as a continued infringement of autonomy and personal liberties”?

References
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1918 Pandemic Influenza Historic Timeline. (2018, March 20). Retrieved November 22,

2020, from https://www.cdc.gov/flu/pandemic-resources/1918-

commemoration/pandemic-timeline-1918.htm

Cable News Network. Tracking coronavirus' global spread. CNN.

https://www.cnn.com/interactive/2020/health/coronavirus-maps-and-cases/.

Grzybowski, A., Patryn, R. K., Sak, J., & Zagaja, A. (2017). Vaccination refusal.

Autonomy and permitted coercion. Pathogens and global health, 111(4), 200–205.

https://doi.org/10.1080/20477724.2017.1322261

Petrini, C., & Gainotti, S. (2011, March 04). A personalist approach to public-health

ethics. Retrieved from https://www.who.int/bulletin/volumes/86/8/08-

051193/en/#:~:text=Utilitarianism%20asserts%20that%20decisions%20should,happiness

%20of%20the%20greatest%20number%E2%80%9D.

Renton, A., Reynolds, E., Upright, E., Macaya, M., & Hayes, M. (2020, November 23). Where

things stand in the race for a Covid-19 vaccine . CNN. https://www.cnn.com/world/live-

news/coronavirus-pandemic-11-23-20-intl/h_db78fd5ddcb521b7874381158a26e04f.

Shin, M. D., Shukla, S., Chung, Y. H., Beiss, V., Chan, S. K., Ortega-Rivera, O. A., …

Steinmetz, N. F. (2020). COVID-19 vaccine development and a potential nanomaterial

path forward. Nature Nanotechnology, 15(8), 646–655. https://doi.org/10.1038/s41565-

020-0737-y

Taylor, D. B. (2020, February 13). A Timeline of the Coronavirus Pandemic. The New York

Times. https://www.nytimes.com/article/coronavirus-timeline.html.
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U.S. measles cases in first five months of 2019 surpass total cases per year for past 25

years. (2019, May 30). Retrieved November 22, 2020, from

https://www.cdc.gov/media/releases/2019/p0530-us-measles-2019.html

WHO launches new global influenza strategy. (n.d.). Retrieved November 22, 2020, from

https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-

strategy

Zanettini, C., Omar, M., Dinalankara, W., Imada, E. L., Colantuoni, E., Parmigiani, G., &

Marchionni, L. (2020). Influenza Vaccination and COVID19 Mortality in the USA.

https://doi.org/10.1101/2020.06.24.20129817

Zhu, H., Wei, L., & Niu, P. (2020). The novel coronavirus outbreak in Wuhan, China. Global

Health Research and Policy, 5(1). https://doi.org/10.1186/s41256-020-00135-6