Vaccine Ethics: between autonomy and the common good

The Covid-19 vaccine has finally arrived in countries around the world, and despite stops and starts, different paces of distribution, and bureaucratic obstacles, the largest vaccination campaign in history is now well underway.  Along the rocky road to recovery lie a host of unprecedented challenges that societies must face at all levels from public policy to the realm of individual decisions and behaviors.  

For many, the arrival of the vaccine represented a first ray of hope in our protracted battle with the virus, but besides the question of how to prioritize the distribution of the vaccine, which had been the subject of extensive debate in recent months, societies must also confront other nuanced problems such as vaccine skepticism (antivaxx movements etc.) and what to do in cases where individuals  are wary of being vaccinated or flat-out refuse. These issues force us to think about a longstanding question that all democratic societies must face: how do we appropriately balance between individual autonomy and societal welfare?

Vaccine Skepticism

One of the first obstacles that many societies had to confront in connection with their vaccination campaigns, was how to address the persistence of vaccine skepticism.  Dr. Mirko Garasic, who teaches Bioethics at Luiss and has been researching the anti-vaccination movement for some time, explained that in the initial stages of the pandemic, at least in Italy, there was a willingness to engage with the idea of the vaccine—even among those skeptical of vaccines in general. Now that the vaccine has arrived, he says “we are beginning to see conspiracy theories and resistance to the vaccine crop up again.”

A June 2021 poll found that 20% of Italians are still uncertain or flat-out unwilling to get the vaccine (a number, while still high among European countries is markedly down from the 62% of Italian Citizens who claimed to be wary last December). Among 40,408 U.S. respondents polled between May 25-31, 31% were either unwilling or uncertain about getting vaccinated, while Russia had the highest uncertainty rate of 53% followed by Australia (37%), South Korea (33%), Japan (33%) and France (31%).

Autonomy

The question of what to do in the cases where people are wary of the vaccine or skeptical to the point of refusing is a pressing issue. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory, but in democratic societies this is generally ruled out as a politically untenable, if not unethical solution. The next best option is to try to nudge citizens, through incentives both positive and negative (travel restrictions for the unvaccinated are an example of the latter).

In countries like the United States, with its libertarian political culture and a legal and constitutional tradition focused on the value of autonomy, nudging citizens to act in the interest of the general welfare tends to prove more difficult than it does in countries which have a more communitarian public culture.

Dr. Garasic points out that in many ways the pandemic has forced us to really think critically about our dominant conception of autonomy, and this is an important sense in which the pandemic has ignited long-hashed debates in bioethics and philosophy in general.

Many of us—at least in the Western world and outside of academic philosophy—tend to think of autonomy in an atomistic sense of an unencumbered agent acting freely according to her volition. On this view, the best way to secure and protect the autonomy of the individual is to leave them as free as possible to pursue their ends with little to no intervention. Critics of this view argue that this picture of the isolated individual agent is far from the reality of the human condition: we are indeed social animals, embedded in societies, and both our ends and our means to achieve them are shaped by these factors as well.

This leads to another, more robust view of autonomy, in which the individual is inseparable from the relational contexts she finds herself in. Thus, what individual liberty requires is not absolute freedom of choice but the appropriate social and institutional support to pursue those ends while allowing others to do the same.

Going back to the vaccination controversy, we can understand the distinction between the two types of autonomy as follows: on the atomistic view, the individual’s decision whether or not to be vaccinated is entirely her own, and should be made by considering her ends only. If she chooses to do so, it may be because she is afraid of catching Covid-19, and if not, perhaps for the reason that she is worried about the safety of the vaccine. On the more robust conception of autonomy in deciding whether or not to be vaccinated she must consider not only her own ends but those of all other agents (real or hypothetical) in her social or political context. Thus, her decision could be motivated by the fact that she wants to help quell the societal impact of the epidemic or that she would want others in her position to do the same. It is important to note here that this is not an altruistic decision—in so far as robust or embedded theories of autonomy are still rationalist moral theories, by considering the ends of others like her, our agent is still thinking of her own ends and goals. This is quite easy to see in the case of vaccination, as reaching herd immunity and being able to resume a somewhat more normal life will surely benefit her in the long run as well.

If nothing else, the spread of the pandemic has demonstrated just how connected we are and how thoroughly we depend on one another, even for our very lives, so perhaps in democratic societies where we value liberty so highly, it is time to take stock of our notion of autonomy and reevaluate what it actually requires.

Skepticism and information

Of course, antivaxx movements and outright skepticism about vaccines in general must be distinguished from the wariness many citizens feel about the Covid-19 vaccines currently on the market. In the age of round-the-clock media coverage and an eternal deluge of (dis)information from all corners of the internet, even the most discerning consumer of information can feel hopelessly adrift. Given the (albeit understandable) lack of a coherent narrative within and across national borders and conflicting expert testimony regarding all aspects of the Covid-19 pandemic, some degree of skepticism about the safety of the vaccine understandable.

If we want to walk the narrow path between the welfare of society and the autonomy of the individual—in so far as this is one of the cornerstone aims of life in a democratic society—then the task of politicians and policy-makers going forward is to ensure that citizens are provided with the assurance that the choice to be vaccinated is not only the right one, but theirs to make in good faith. This means not only keeping people educated and informed, but also providing a public platform where concerns can be voiced and addressed before they crystalize into resentment and all-out skepticism. 

Intro to bioethics at Luiss

In the field of bioethics—the subfield of applied ethics that addresses the ethical concerns arising in the context of biology and medicine—the Covid-19 crisis has brought new urgency to many long-running debates. Beyond the question of how to balance the rights of individuals and the interests of society discussed above, there are a host of other topics related to the pandemic to which bioethical theory can make an important contribution. A few of these include best practices regarding the approval of new drugs (to what extent do circumstances of emergency justify expediting the clinical trial phase?) and how to prioritize the distribution of limited supplies (such as ventilators during the first wave and vaccines today). A topic which (like the debate over autonomy) intersects bioethics and political philosophy is the recent debate over whether nations are justified in thinking of the health of their own citizens first (or exclusively) or whether justice requires that they consider the wellbeing of individuals beyond their borders.    

Always committed to being at the forefront of contemporary debates, Luiss offers a course on Bioethics, which can be taken as part of the bachelor’s degree program in Political Science. The course is taught by professor Garasic, who was quoted in this article.