By Helen Watt

The race is on to produce a COVID-19 vaccine:  teams are working hard and fast across the world. We all long to see a vaccine in record time – but must, of course, have an eye to ethics too.

Debates on vaccine ethics tend to focus on risks, whether to participants in clinical trials, or to the public when the product is released.  It is rare for discussions (or at least, biomedical discussions) to highlight another ethical concern.

As an ethicist, I regularly receive enquiries from the public about vaccines made using foetal cell-lines.  I received the latest enquiry only last week.  Sometimes the person is aware of the history of the vaccine at issue and aware of a non-foetal alternative, but is finding the latter very hard to access.  Sometimes the person is unsure about some vaccine offered and whether foetal (‘human diploid’) cells were in fact used in its manufacture.  In any event, this is one of the most common kinds of ethical enquiry I receive.  I work in Britain, and in some other countries, such concerns will be very much more common among those learning of the origin of some vaccines.

It is important for those who may be tempted to dismiss these concerns not only to consider the possible health effects of a boycott on the person and on others but to try to appreciate the reasons behind the person’s stance.  It may help to imagine how we ourselves would feel about using a vaccine grown (if that were physically possible) on a cell-line produced from an adult kidney harvested from, let’s say, a dissident killed by an unjust regime.  That tissue was, let’s imagine, sold or donated by the regime to a tissue bank to which researchers then had access.

If such political killings had ceased with the fall of the regime and the vaccine now available was many years old, we might be happy (or at least, willing) to accept the vaccine for our children or ourselves.  This does not give out bad messages, we might say:  the offence is in the past and everyone agrees it was unconscionable and will not be repeated.  And after all, we ourselves had nothing to do with the execution or indeed, the tissue harvesting, the cell-line creation or the creation of the vaccine.

However, would we be so happy or willing to accept the vaccine if the regime was still very much in force, still executing dissidents and making their tissue available for the creation of useful cell-lines?  What if the vaccine we want, and perhaps even the tissue-harvesting, dates to the very recent past?

Whether or not this imaginative exercise works for us, and whatever our own view on use of foetal cell-lines, this is undoubtedly a ‘make or break’ issue for some individuals and some parents.  Moreover, since cell-lines are not (as is sometimes suggested) immortal, ethical concerns are only likely to increase as new vaccines are brought out, perhaps using foetal cell-lines much more recently created.  The foetus used may indeed have been aborted via a method like delivery by ‘water bag’ that better promotes live birth and tissue harvesting.  Is ‘moral distress’ in such matters so surprising?

At a public health level, such conscience issues should in any case be taken seriously, lest the effectiveness of a vaccine campaign be impacted and some parts of society left unprotected. The concerns of those refusing the vaccine will, after all, impact (other) vulnerable people, including those who cannot themselves be vaccinated for health-related reasons.

Departments of Health take note:  those who feel unable (or whose parents feel unable) to accept a vaccine will be at risk themselves and will pose a risk to others, including those for whom the vaccine is medically unsuitable.  Drug companies take note:  by pre-empting the (surely understandable) concerns of some members of the public, you may increase your market share by offering ‘vaccine refugees’ an alternative they will not only welcome but promote widely.

Among the COVID-19 vaccine projects are, as it happens, some using ethically uncontentious cultures such as tobacco plants, insects, and hamster ovary cells.  When COVID vaccines come to market, will governments seek to purchase those that command near-universal acceptance?   Or will they purchase vaccines which predictably result in moral distress, conscientious objection, and inevitably, some lowering of protection?

Author:   Helen Watt

Affiliations:  Anscombe Bioethics Centre and Blackfriars Hall, Oxford.

Competing interests:   None