Vaccine hoarding, or pandemic prudence? The ethics of holding onto not-yet-approved vaccines

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As the Biden administration refuses to send unused doses of the AstraZeneca COVID-19 vaccine to other countries, ethicists discussed Catholic thought on just vaccine distribution.

The New York Times reported last week that tens of millions of doses of the COVID-19 vaccine produced by AstraZeneca and the University of Oxford are currently sitting unused in U.S. facilities. 

AstraZeneca has yet to request approval from the U.S. Food and Drug Administration (FDA) for the vaccine to be administered in the United States.

AstraZeneca had reportedly asked the Biden administration to send the unused U.S. doses to the European Union, where the vaccine has been approved for use. The White House on Friday defended its decision to keep unused AstraZeneca vaccine doses in the United States, citing the need to ensure that Americans are vaccinated as quickly as possible.

On the question of sending vaccines to other countries in need, ethicists told CNA that the general decision to prioritize vaccination of Americans is not necessarily unethical. Saving unused vaccine doses for the future process of achieving herd immunity does not by itself constitute "vaccine hoarding," they said.

"I don't think that taking care of your own population first, or making sure that you've covered there, puts you in the category of [vaccine] hoarding," Dr. John Brehany, executive vice president of the National Catholic Bioethics Center, told CNA on Monday.

"The government does have a responsibility to prioritize its own citizens, to a certain degree, just like parents have a responsibility to prioritize the needs of their own children, to a certain degree, over the needs of other unrelated children," Dr. Melissa Moschella, philosophy professor at The Catholic University of America, told CNA.  

The ethical calculus for vaccine distribution is "effectively applying the golden rule," she said, or asking what the United States might consider reasonable if other countries had unused vaccine doses but still needed to vaccinate a high percentage of their populations.  

On Friday, White House press secretary Jen Psaki defended keeping the AstraZeneca vaccine doses in the United States, saying, "The president's priority and focus is on ensuring that the American people are vaccinated," and citing the need to be "oversupplied and over-prepared" in the vaccine rollout.

"There are still 1,400 people who are dying in our country every single day, and we need to focus on addressing that," she said.

Asked on Monday when countries in need of a COVID vaccine could have access to U.S. doses, Psaki said that "we are engaged with a range of countries." Biden in February pledged $4 billion to an effort to promote vaccines in developing countries.

Furthermore, several European countries-including Germany, France, Italy, and Spain-have already suspended distribution of the AstraZeneca vaccine because of concerns about blood clots, the AP reported on Tuesday. The World Health Organization and the EU's European Medicines Agency have maintained there is no direct connection between the vaccine and reported blood clots, and have said the vaccine is safe for use.

Pope Francis has been outspoken on the need for coronavirus vaccines, once they were developed, to be available to poor and developing countries.

In an August 19, 2020 audience, Pope Francis said that a COVID vaccine must be "universal and for all," rather than "the property of this nation or another." In his Christmas Urbi et Orbi blessing, he reiterated his point that a vaccine must be "for all."

"I ask everyone -- government leaders, businesses, international organizations -- to foster cooperation and not competition, and to seek a solution for everyone: vaccines for all, especially for the most vulnerable and needy of all regions of the planet. Before all others: the most vulnerable and needy!" Pope Francis said.

The Catholic doctrine of the universal destination of goods does apply in the vaccine distribution conversation, Moschella explained to CNA.

"When it comes to the genuinely superfluous goods that one person has, those goods really in some sense are the property-morally speaking, 'belong to'-the others who are in dire need of them," Moschella said.

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However, she added that more information is needed on why the Biden administration is not sending the vaccine abroad. For instance, officials could be reasonably certain that FDA approval for the vaccine is not far away-and with many Americans yet to be vaccinated, the approval could present an opportunity to more quickly achieve herd immunity.

If the United States eventually achieves herd immunity and still has extra vaccine doses on hand with other countries in need of them, she said, the doses at that point could probably be considered superfluous and it could be wrong to keep them in the United States.

Other questions apply to this conversation, too, Brehany noted-namely the high mortality rate of developed countries in the Northern Hemisphere. According to Johns Hopkins University, Czechia has the highest mortality rate from COVID-19 in the world, followed by the United Kingdom, Hungary, Italy, and then the United States.

A high mortality rate might be another reason for the United States to hold on to doses of the AstraZeneca vaccine, with so much of its population still yet to be vaccinated, he said.

Ultimately, the vaccine should be made available to other countries not out of any national interest for the United States, but because citizens of these countries are fellow human beings, Brehany emphasized. 

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