Five ethical questions raised by COVID vaccines in Michigan

Jeffrey Byrnes is giving a lot of thought these days to how a newly approved vaccine for the coronavirus should be dispensed. Byrnes, a medical ethicist and assistant professor of philosophy at Grand Valley State University, is advising Kent County health officials as the first vaccine doses become available. 

Jeffrey Barnes

Medical ethicist Jeffrey Byrnes is helping health officials in Kent County formulate a COVID-19 vaccine distribution plan for essential workers. (Courtesy photo)

His guiding philosophy: maximizing the impact of scarce supplies until there are enough doses for everyone to get vaccinated. In an email exchange with Bridge Michigan, Byrnes offered insight on some of the ethical implications of these health decisions. 

What are some of the basic ethical issues that go into getting vaccines in a fair way to the people of Michigan?

Maximize the benefits. Given that we cannot vaccinate everyone at once, how do we allocate the first doses to get maximal benefit to all the people?  Promote justice and equity: How do we administer this vaccine in a way that both treats people fairly and ensures an equitable result? Promote public trust: How to make allocation decisions and carry out vaccinations in a way that earns public trust and establishes a sense of community ownership of the process? We must show the public what we are doing.

Stories from the front  

Bridge Michigan, Detroit Free Press and Michigan Radio are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb at Bridge, Kristen Jordan Shamus at the Free Press and Kate Wells at Michigan Radio.

Does the State of Michigan have an ethical obligation to see to it that minority populations are vaccinated?

The state absolutely has an ethical obligation to protect its citizens. Yet the state cannot be falsely naive about the history of our present situation.  The state has in its possession a vaccine that it believes will benefit its minority populations. Yet the state must acknowledge that minority populations may not simply take the state’s word on that. When the state’s minority populations have had time to review the evidence and have seen the vaccine in their communities, then they can choose to be vaccinated if they feel comfortable doing so. The state, in turn, needs to be preparing now to deliver the vaccine as widely as it possibly can, paying particular attention to communities which are distant, in one way or another, from health care delivery systems.

How would one fairly weigh the need to vaccinate school teachers and staff against a power line worker or a snowplow driver?

If we had the necessary quantity of vaccine and the capacity, then we would distribute it all simultaneously. Given that the supply is limited, we are forced to make difficult decisions about the order of distribution. Comparing the secondary benefits to the community of vaccinating a teacher and a powerline worker cannot be undertaken in the realm of ethics alone. It requires input from experts in fields like statistics or data science who can model likely benefit models. In other words, there are some important empirical questions that flesh out the ethical principles. These are difficult questions that have local variation. Firefighters might have a greater utility in central California than they do in southern Louisiana.


State plans call for vaccinating staff in homeless shelters and jails and prisons, but (does not prioritize) homeless residents or prisoners. What are the ethical considerations in that thinking?

I think what might prompt the question is the fact that staff of homeless shelters and prisons are identified specifically as prioritized in Phase 1B, while residents of those institutions will receive vaccination along with the broader population. From my understanding of epidemiology, there is reason to think that vaccinating the staff is an effective use of a small number of vaccines— largely because they have contact with people on the outside and would likely bring the virus in with them. If we have data to think that prisoners are also suffering disproportionately from the virus, then this would be a reason to prioritize prisoners for vaccination as well.

How would you view the ethical right of individuals to refuse vaccination, even though that could expose others to the spread of COVID-19?

Given that the vaccine is offered by the state, one might well think that individuals have a right to refuse that vaccine. Yet, having that right on the basis of a citizen’s relationship to the state is not inconsistent with a person also having a moral duty to be vaccinated, insofar as the vaccine is shown to be safe and effective and insofar as the person can receive the vaccine safely. The list of things that one should do is longer than the list of things that the government can and should compel one to do.

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A. Bellows
Mon, 12/21/2020 - 7:47am

Give the vaccine to those who have a job first. Those taxpayers are paying for it, and their dollars are providing a lifeline to those who don't work.

Mon, 12/28/2020 - 12:50pm

By that "reasoning" (I use the word skeptically), we would give it first to rich people who pay the most taxes. Ludicrous! An individual working from home with little need to mingle among the community is not at similar level risk as the bus driver or grocery cashier or emergency room physician or orderly.
This will work best if we consider individual health risk factors along with occupational risks of becoming infected or spreading the disease to others.

Mon, 12/21/2020 - 8:12am

Great piece with thoughtful considerations. However wouldn't it make sense to ask who actually wants the vaccine first? Why start by possibly forcing people to get it when it is so scarce? Start with healthcare workers, then essential workers police, fire, teachers, then anyone who wants it. Depending on the response to that question, then look at age, underlying conditions. Depending on those responding, possibly a lottery system. Last should be the people who don't want it. Then you pass laws to make life difficult for those who refuse, unless they have a medical excuse.

Jim C
Mon, 12/21/2020 - 10:29am

What is the goal? The goal is to reduce the spread of the virus, maximize our ability to handle its victims, and reduce its death toll. This dictates action such as currently planned. The concept of disregarding this for the sake of diversity is illogical and self destructive. Fight inequality where there is truely inequality, but, don't wave the flag of anti racisim just to look more in tune than your neighbor.

Mon, 12/21/2020 - 10:20pm

Since the concern is regarding “ethics”, is it not ethical to take into account a person’s choice on whether to be vaccinated or not? First off, this virus is over 99.7% SURVIVABLE to most under age 70, if infected. The CDC is no longer counting or reporting flu deaths, WHY? Did the flu go away or are flu stats lumped in with covid? Since I stopped getting the Flu vaccine, I haven’t gotten the flu. But I’m careful about my hygiene & don’t knowingly go around sick people. I also do my best to eat well, take vitamins, supplements & get enough rest. In your analysis, you’re assuming that everyone wants the covid vaccine. I do NOT want that poison in my body. There are many that feel as strongly as I do, so don’t stress yourself.

Sun, 12/27/2020 - 3:15am

No worries, I’ll gladly take your dose of the vaccine.

Mon, 12/28/2020 - 8:50am

Elizabeth, so many of us are really grateful that you wish to be at the end of the line. We can deal with people like you later, if you happen to still be alive. No sense in dealing with your type now. After all, there is a vaccine shortage.

By the way, we note that many hypocritical people who called the virus a hoax now are trying to get vaccinated before healthcare workers.

GOP Covid deniers, like Sen. Lindsey Graham, who refused to wear a mask jump the vaccine line, adding insult to injury

Tue, 12/22/2020 - 9:26am

To the ethicist: Prisoners are living in congregate living arrangements with little or no ability to improve the safety of their living situation. They are likely in worse health than many segments of the general population. Mass incarceration does mean that there are many prisoners in a situation of scarce vaccine. Why are prisoners not a high priority, is this really an efficiency determination, and is a social devaluation of the lives of prisoners at play?

Tue, 12/22/2020 - 7:00pm

As predicted it didn't take long for the left to inject race into the way this is distributed. democrats and lefties are disgusting. But hey! At least congress got theirs first before front line workers. Well done.....smh

Mon, 12/28/2020 - 8:52am

Yeah, you don't see race or privilege.

Tue, 12/29/2020 - 9:42am

This is a very thoughtful, informative article, but some of these comments are discouraging. People who are employed are worth more than people who are disabled? I never get the flu, so I am not going to get vaccinated against a deadly disease that can be transmitted by people with no symptoms? Complicate an already complex distribution process by throwing in a lottery? Thank you, Michigan public health officials, for your steadfast, ethical slog in defense of science and the people's welfare, even though many of us don't fully appreciate what you do.