By Abigail Harmer.
Vaccines have always been a hotly debated subject, invoking incredibly strong opinions, whether this be for or against their use. This has particularly been the case in light of covid-19. Towards the end of 2020, when the first vaccines to protect against coronavirus were approved for use, vaccines were everywhere you looked; on the news, in the media, everyone was talking about vaccines.
While development and research into vaccines has a spotted past, they are an extraordinary piece of medical technology, which I believe we often take for granted. Thanks to vaccines, diseases such as smallpox have been eradicated, and the vast majority of medical professionals in the West will never see a case of diphtheria in practice.
Vaccines stir up a lot of ethical questions: If we can prevent the spread of communicable diseases by being vaccinated, is there a moral obligation to do so? How do we understand that obligation? Is it grounded in a duty to prevent harm? In social justice? Does it apply to groups of individuals specifically or is the duty the same for everyone?
I chose to focus this paper on seasonal influenza because I found this particularly challenging in the context of a moral obligation to vaccinate. As I was researching this, I found that attempts to apply a moral obligation to vaccinate against influenza were fraught with difficulties. The Duty of Rescue as proposed by Peter Singer was my ultimate starting point. If individuals could rescue others by being vaccinated against influenza (by reducing the transmission of infection) at minimal cost to themselves, then they may be obligated to do so. However, this was problematic at every level. The Duty of Rescue sets no thresholds on minimal costs to the rescuer, and no guidance on the force and scope of the duty more generally. This made the duty difficult to apply in practical terms without making it overdemanding to the rescuer. The traditional Duty of Rescue did not seem well suited to supporting a moral obligation to vaccinate.
Inspired by and built on the works of Rulli & Millum, the primary focus of this paper is how an Institutional Duty of Rescue supports a moral obligation to vaccinate against influenza.
This perspective creates a shift from the individual to the collective. Rather than the moral obligation falling on the individual to be vaccinated, the obligation instead falls on institutions (such as government institutions) to provide and administer vaccines.
An Institutional Duty of Rescue has two important aspects. Firstly, it looks at a wider context of rescue. Rather than focusing on seemingly random unpredictable rescue cases such as Singer’s child drowning in a pond analogy, the institutional view emphasises the need to examine the greater landscape of rescues. Detecting patterns in their occurrence and asking questions such as ‘how did the need for rescue occur in the first place?’ and ‘how can we prevent this happening in the future?’. This perspective allows room for discussion on more organised, preventative rescue measures which would not be suitable under the traditional view of the Duty of Rescue.
Secondly, an Institutional Duty of Rescue addresses some of the problems around force and scope seen in the traditional view. By shifting obligation onto institutions, this removes the possibly overdemanding moral burdens which could be placed on individual agents and shares them out among a collective within an institutional setting.
Working in National Health Service primary care, I have seen first-hand the incredible amount of hard work and effort that goes into organising and delivering the influenza vaccine programmes each year, as well as the importance of working together collectively to administer those vaccines to the most vulnerable in our local community. No individual alone would be able to achieve such a task, which highlights the fitting nature of an Institutional Duty of Rescue in wide scale vaccination programmes such as those for seasonal influenza.
This paper is limited in that it only covers a very small facet of the ethical discussion on vaccination. A number of the points I have raised throughout warrant further consideration and analysis which were unfortunately beyond the scope of this work. Nonetheless, I hope it provides a fresh perspective on how we understand the Duty of Rescue, as well as some insight into the significance of collective moral obligations in the vaccination debate.
Author: Abigail Sophie Harmer
Affiliations: Inter Disciplinary Ethics Applied Centre, University of Leeds
Competing interests: None declared