The prospect of a Covid vaccine

In this case, the principle of proportionality is relevant: given the gravity of the Covid situation then, even experimental medicines, vaccines or therapies may be used, provided first that there is no other available that has passed all safety tests, provided further that the patient consents. Even experimental intervention is permissible, provided that there is some chance to cure or alleviation and provided that the burden does not outweigh the anticipated advantage. The other kind of experimentation is that which is aimed at the furtherance of human knowledge without any direct advantage to the experimental subject. In these cases, the principle is that the experimenter should be the first subject ( he should not experiment on others what he is not willing to experiment on himself), and second, that full informed consent be obtained, and third, that the experimental subject is free to withdraw from participation when he decides so.

Second, there is the “triage” issue in the broader sense. Who gets the vaccine first? The traditional approach is to classify patients ( exactly where the term “triage” comes from.) Those who are so far gone that no vaccine would help them, those who are seriously symptomatic but may still be helped by intervention, those with mild symptoms or are asymptomatic who would profit from the intervention. Given such a classification, it is clear that the second group gets the vaccines first, the third group next, while palliative care aimed at making the end more comfortable should be made available to the first. But given a concrete situation like the Philippines, these are not the only considerations. Classification should also be based on the “capacity” to obtain the vaccine. Those financially able to pay the costs of inoculation on their own should do so, without asking for government resources to be spent on them. The government must prioritize those unable to obtain the vaccine on their own.

The third is a legal point. It is in this area that Food and Drug Administration regulation, consumer protection and competition laws are of paramount importance to see to it that the products are safe, and that in the competition that follows between different pharmaceutical companies, safety and quality do not suffer, and finally that healthy competition be allowed to keep the price of the vaccine reasonable, with government regulatory schemes set in place to prevent monopolies and cartels from developing.

The fourth point has to do with the costs of research. In a capitalist order it is foolish to ask pharmaceutical companies to desist from recouping the very high costs of research and development. To insist on this is to disincentivize research, and the next time we face one more epidemic that, as Albert Camus directly writes, is “just lurking in the holes,” they may not be too willing to invest in the needed research for the development of the vaccine. At the same time, however, this is a situation that calls on the social responsibility of corporations considering that the very societies from which they draw profit are the suffering communities. While welfare states may be able to absorb the costs of vaccination, very few are ready to do so. The costs therefore must necessarily be socialized with those who can afford paying reasonably more than those who cannot. I do not think that governments should be too eager to invoke the “compulsory licensing” provisions of most domestic intellectual property laws. This does not serve the purposes of providing incentives for research.

One last issue: can vaccination be compelled? While the general rule in medical ethics is that nothing may be done on a person without his informed consent, the danger of contagion, the destruction that this pandemic has wrought on human lives and on the economy and the concern for the general welfare allow the State to exercise its police power to compel vaccination, provided that “mass” vaccination does not mean “indiscriminate” vaccination. This means that agencies of government, such as the Department of Health, must evaluate each person for possible adverse reactions, interactions with drugs already being taken and idiosyncratic sequelae.