Across the developed world, there has been widespread agreement that health care workers and residents and staff of long-term care facilities should be the priority group for Covid-19 vaccination programmes.
In Ireland, the residents of nursing homes, frontline health and social care workers and the older general population were identified as the first recipients of the vaccine roll-out by Brian MacCraith’s High Level Task Force on Covid-19 Vaccination.
In applying an ethical and values framework based on moral equality and the principle of fairness, the task force developed a 15 tier priority list of groups for phased vaccination.
Unfortunately, as with every area of public policy, stakeholder interests soon intervened with the demands by an array of various groups for special consideration for their members, eroding any sense of social solidarity that is essential in defeating the pandemic.
Prioritising the prevention of death in vulnerable groups means that using age in determining one’s place in the vaccine queue is a clear-cut decision. This strategy of saving lives is defensible, clear and ascertainable. Protecting people who keep our hospitals with limited capacity functioning on a daily basis to deal with Covid and every other hospitalisable condition is and should always remain top of our list of priorities.
Hence, people who have face-to-face contact, and face the most direct risks with Covid have to be prioritised in the allocation of vaccines. Beyond that is where things get more complicated, more especially in the definition of what constitutes an essential/key worker.
The high level task force has recognised the role of key workers, and the importance of the continuing functioning of essential services. They also have clearly stated that this category requires further refinement and clarification. In so doing, they have fully recognised that the implementation plan needs to be flexible and is able to respond to local experiences and/or international best practice.
As in all developed economies, key workers in Ireland constitute a very large group of the workforce, so policy makers have the unenviable task of determining why one sector should be prioritised over another. Nevertheless, it is important that any such determinations must continue to be based on the ethics and values that matter most to us a society, and not as a means of placating those who shout the loudest.
Ethical values and principles must always feature prominently in decisions about the allocation of Covid-19 vaccines, as already the pandemic has highlighted long-standing, systemic health and social inequities.
What is the morally relevant reasons why some groups should be prioritised over others? If the reason is that the group is at elevated risk of contracting the infection and is not in a position to be able to reduce their risk through their own actions, for example, long term care facility residents, then that becomes the reason why a group should be vaccinated.
If the moral reasoning is long term developmental harm, children and adults with special needs and their carers and educators should be vaccinated.
How to prioritise access to the Covid-19 vaccine is not an exclusively political or medical decision, but an ethical decision. It must be informed by good science, but
But other values also include questions of fairness, equity and reciprocity, recognising that some groups over the past 10 months have taken on more risks and more burdens, or indeed have had more burdens imposed on them so that the rest of us could live more normal lives. Many of us have had a better chance of staying healthy because of the sacrifices of a wide range of frontline workers. Health and social care workers, gardaí, retail workers, cleaners, transport workers, delivery workers are functioning in essential jobs outside of their homes on a daily basis.
In the face of increased calls from various interest groups for special consideration in the vaccine roll-out, perhaps it’s time to think about character, personal values and social solidarity and emphasise the importance now more than ever of the virtues of patience and empathy.
Before calling for special consideration for their members, can interest groups recognise that not everybody can protect themselves in the way that other sectors of society can from infection and disease?
In short, while we are all suffering, some of us are suffering far more than others. Bono’s recent comment that “We’re not all in the same boat, but we are going through the same storm” is most apt.
In the face of ongoing criticism, the challenge for Government in the coming months is to ensure that a clear and consistent message is conveyed to the Irish people in order to reignite the social solidarity that we all witnessed in the early stages of the pandemic. Most of all, courage and foresight will be required by a wide range of stakeholders including government, opposition parties, and the wide array of interest groups that influence public policy decision making.
Vaccinating Ireland is the biggest logistical challenge in the history of our nation. It is also an enormous moral challenge, requiring us to think hard about who will get the vaccine, when, and most of all, how to ensure it's just and equitable availability to all citizens.