Individual risk shouldn’t outweigh moral obligation of COVID-19 vaccines
Article written with Dr Adam Hannah and originally posted in the Canberra Times:
“I don't want an 18-year-old in Queensland dying from a clotting illness who, if they got COVID, probably wouldn't die”.
This was the reaction of Queensland’s Chief Health Officer Jeanette Young to the Prime Minister’s announcement that people under the age of 40 could access the AstraZeneca vaccine through their GP. Young was strongly supported by Premier Anastasia Palaszczuk, who said on ABC’s 7.30 that “I’ve got over a million people aged between 20 and 40 in my state and I don’t want them put at risk”.
These comments signal yet another line in the conflict between the state and federal governments over management of the vaccine rollout. However, in their haste to push back against Morrison’s apparent lack of planning and communication, Young and Palaszczuk have latched onto an understanding of risk that could have its own damaging consequences: one that centres almost entirely on the individual.
Rather than looking to score short-term political points, governments need to face up to the fact that supplies of alternatives vaccinations are limited and that, as the world gradually reopens, Australians are growing rapidly weary of lockdowns and border closures. In this context, we should be welcoming the collective and moral reasoning that is driving the enthusiasm of many young people for the AstraZeneca vaccine.
The Queensland CHO rightly notes that someone of a younger age profile is relatively unlikely to die from COVID. However, this constructs the risk in terms of the health risk to that one individual, and trades off the two outcomes only in terms of the consequences to that one individual. That is, the risks that they face from vaccine-related blood clots (around 3 in 100,000) or from getting COVID-19.
However, for evaluating national policy, we must also consider the socialised nature of risk. For example, some philosophers have argued that – assuming the availability of safe vaccines – we have a moral duty to be vaccinated, due to their efficacy in reducing collective harm. This way of thinking is core to vaccination itself, as one’s own choice to vaccinate or not is unlikely to tangibly impact a broader population’s level of immunity.
At the core of this collective duty is the imperative to protect our more vulnerable members of the community. While younger people may be less at risk from the virus, they can certainly contribute to its spread. Therefore, for many people, taking the vaccine is not just about protecting themselves, but also about protecting other members of the community.
Take our own situations: both of us have parents working in aged care and education and in age brackets that have a higher risk of serious complications if they catch the virus. Like many, we have friends who are immunocompromised. For us, vaccination is a way of contributing to the safety of friends, family and vulnerable strangers.
Front of mind must also be the costs that eventuate from lockdowns, border closures and the various other measures that are necessary to keep the virus ‘crushed’. While Australia has been undoubtedly fortunate compared to many other countries, the costs have still been immense and not only macroeconomic. Young workers - particularly young women - have borne the brunt, with youth unemployment reaching a 23-year high in June 2020.
In recent research, one of us has highlighted the costs of re-allocating financial risk to individual households. This same issue was present for casual employees during the early stages of the pandemic, where many without sick leave had to trade off their own personal financial risk of taking time off against contributing to the spread of the virus.
The Morrison government – contrary to its usual instincts – recognised the need to see this risk as collective, and offered sick leave pay to casuals so that they did not have to make this trade off on their own. However, these supports have largely been wound back, meaning that the only way to move beyond this new precarious status quo is widespread vaccination.
The risk of taking the AstraZeneca vaccine is not zero, with clear evidence that there have been side effects to young people in good health. But with supplies of alternatives constrained (and not without their own risks), discouraging younger people who want to get vaccinated generates its own costs. This is a dilemma that cannot be solved by reading the latest ATAGI advice.
Rather than bickering over who is really ‘following the science’, we need to recognise that we are really facing a fundamentally political and values-laden debate over the appropriate distribution of burdens, choices and blame - there is more to it than simply cases of TTS per 100,000.
Understandably, state governments do not want to feel or appear responsible for harm to young people. However, if those who have been made aware of their individual risk want to go ahead and prioritise the collective, governments should make it as easy as possible for them.