Is it ethical for a physician to vaccinate a healthy 20-year-old against COVID-19?

Doctors take the Hippocratic Oath, in which they promise, depending on the version, to “do no harm”, do what will benefit their patients, and avoid “overtreatment.”

Suppose that a healthy slender 20-year-old calls up to a doctor’s office and says “By governor’s order, I am not allowed to leave my house unless you stick me with a COVID-19 vaccine.” Is it ethical for the doc to vaccinate him/her/zir/them?

A healthy slender 20-year-old is more likely to be killed in a car accident driving to/from the doctor’s office than he/she/ze/they is to be killed by COVID-19. Can the doctor ethically and consistently with the Hippocratic Oath intervene in this person’s body? Even if we had years of data proving these brand-new vaccines safe, they are unnecessary for a 20-year-old with no health conditions that would render him/her/zir/them vulnerable to COVID-19. A doctor isn’t supposed to do unnecessary things to patients.

How about the argument that sticking Patient A with a vaccine with help Patients B, C, D, and E? That’s a fine public health argument, and maybe a technician working for the state could do it, but it doesn’t seem consistent with the physician’s oath.

I asked a medical school professor friend for his thoughts on this. He couldn’t think of any other situation in which doctors apply procedures to patients for whom there is no medical benefit with the justification that others will benefit. He did not believe that vaccinating the young/healthy against COVID-19 was consistent with the Hippocratic Oath.

Readers: Are we breaking new ethical ground here? Is there an ethical problem? (If the answer is that there isn’t an ethical problem, can we start harvesting organs out of young people in order to keep old people alive? Common sense organ control tells us that young people don’t need two kidneys and a full-size liver, right?)

Ethical question #2: Is it ethical to throw out vaccine doses because you’re too lazy to post on Facebook or Twitter or call a few friends? From “CEO of Health Center Explains Why COVID Vaccine Doses Had to Be Thrown Out” (NBC Boston):

The CEO of the Brockton [Maskachusetts] Neighborhood Health Center says doses of the COVID-19 vaccine were thrown away on Christmas Eve while they were vaccinating health care workers, due to some of those workers not showing up for their inoculations.

“Since the vial is only good for six hours after we start using it, there was no way we could put it in your fridge like we do the other vaccines and just use it in the morning,” Joss said. “There was just no way to salvage the remaining doses.”

“For our staff, that vaccine is just like gold. They’re protecting it like nothing else,” said Joss. “And yet, I think, at the same time, just by the fragility of the vaccine, I think it’s probably, it’s probably going to happen here and there.”

It’s like gold, but sometimes we need to throw gold away because it is too tough to find additional humans in thinly settled eastern Maskachusetts (Brockton itself has a population of roughly 100,000 and a continuously raging coronaplague among its low-skill immigrants). (Of course, in New York “providers who knowingly administer the vaccine to individuals outside of the state’s prioritization protocols may face penalties up to $1 million, as well as revocation of all state licenses” by governor’s order, but our governor hasn’t issued any new orders since #59 on December 22 (the “emergency” declared nearly a year ago continues, but we’ve had no new orders for two weeks).)

14 thoughts on “Is it ethical for a physician to vaccinate a healthy 20-year-old against COVID-19?

  1. Its also an ethical problem because the trials didn’t go on long enough to discover whether there was a risk of “vaccine enhanced disease” after the initial sterilizing immunity fades. The FDA’s Emergency Use Authorization for the Pfizer vaccine says (and Moderna’s has the same text), where the “Sponsor” is Pfizer:

    https://www.fda.gov/media/144416/download
    “The Sponsor identified vaccine-associated enhanced disease including vaccine-associated enhanced respiratory disease as an important potential risk [….] risk of vaccine-enhanced disease over time, potentially associated with waning immunity, remains unknown and needs to be evaluated further in ongoing clinical trials and in observational studies that could be conducted following authorization and/or licensure.”

    A medical journal notes that after the dengue vaccine’s initial effects faded:
    https://www.frontiersin.org/articles/10.3389/fcimb.2020.572681/full
    “vaccinated children in the 2–5 year age group, were found to be nearly 8 times likely to be hospitalized for severe dengue, compared to children in the placebo group”

    If that turned out to be the case with covid-19 vaccines: it could be that a young person at low risk of a problem if they are infected now has a noticeable risk of a severe case.

    The trials simply haven’t gone on long enough to even know whether this will be an issue, and there are a number of studies that suggest there is concern it’ll be a problem in vaccines that only target the spike protein rather than the whole virus. It seems to be mostly wishful thinking that it won’t be a problem, akin to “cargo cult science” Richard Feynman referred to.

    • There is an even bigger ethical problem with the vaccine. The public isn’t being told about this risk. An International Journal of Clinical Practice article indicated that the vaccine trial participants weren’t “fully informed” of a major risk in a way they’d comprehend. That risk still exists: yet no one is being informed of it:

      https://onlinelibrary.wiley.com/doi/10.1111/ijcp.13795
      “Informed consent disclosure to vaccine trial subjects of risk of COVID‐19 vaccines worsening clinical disease […] This risk is sufficiently obscured in clinical trial protocols and consent forms for ongoing COVID‐19 vaccine trials that adequate patient comprehension of this risk is unlikely to occur, obviating truly informed consent by subjects in these trials.[…]Given the strong evidence that ADE is a non‐theoretical and compelling risk for COVID‐19 vaccines and the “laundry list” nature of informed consents, disclosure of the specific risk of worsened COVID‐19 disease from vaccination calls for a specific, separate, informed consent form and demonstration of patient comprehension in order to meet medical ethics standards. The informed consent process for ongoing COVID‐19 vaccine trials does not appear to meet this standard. While the COVID‐19 global health emergency justifies accelerated vaccine trials of candidates with known liabilities, such an acceleration is not inconsistent with additional attention paid to heightened informed consent procedures specific to COVID‐19 vaccine risks.”

      The FDA’s fact sheet for recipients of the Pfizer vaccine for covid-19 is here and there isn’t a peep about it:

      https://www.fda.gov/media/144414/download

      Nor is there in its doc for healthcare providers, nor is it in the UK’s NHS or Canadian equivalents. Nor is the media talking about it here.

      There are a number of scientific publications warning of concerns before the vaccines trials finished. Japan seems to be able to think more clearly about this issue since they weren’t hard hit by covid-19 and aren’t panicked about getting a vaccine. There have been some media reports of prominent experts there saying they wouldn’t yet risk taking the vaccine.

    • Dengue is an outlier here: there are four different strains, and while catching one makes you immune to that strain, if you get sick again with a different strains you have a dramatically increased risk of complications. Hence the vaccine is recommended only for people who have already gotten sick once and are thus already in the high-risk group. As far as we know, none of this applies to COVID, and we do know that reinfection appears to be quite rare.

    • re: “As far as we know, none of this applies to COVID,”

      There are a number of studies that express serious concerns over the issue with these vaccines in particular that only target the spike protein and not the whole virus. There have been problems with vaccine enhanced disease that have held up the search for vaccines for other coronaviruses. There are experts that won’t take the vaccine yet because of it. Dengue was merely one example of vaccine enhanced disease: there are different mechanisms that can lead to it.

      There is a Science magazine blog that addressed the issue of antibody dependent enhancement and missed a number of points, check the comments on this entry:

      https://blogs.sciencemag.org/pipeline/archives/2020/12/18/antibody-dependent-enhancement

      and follow the links, e.g. to BuildVaccineTrust.com which has an information page with links to a number of studies.

    • JP: I’m not antivaxx for myself, at age 57. Before it was time to decide whether or not to keep schools open, Maskachusetts stopped publishing death and hospitalization statistics by age. The last dashboard to contain this info is at https://www.mass.gov/doc/covid-19-dashboard-august-11-2020/download and it shows that a 57-year-old faces some risk from COVID-19 (though it is unclear how many of those age 50-60 who were hospitalized and/or died were obese and/or unhealthy).

      I can’t find any support in the Maskachusetts data for telling a slender healthy 20-year-old “COVID-19 presents a real risk to your own health.”

      So… I’m happy to get vaccinated myself. And, assuming that the vaccine has any effect on infection/transmission (unknown at this point), I’m delighted to see healthy 20-year-olds voluntarily sacrificing their own time, effort, and (potentially) health to get vaccinated. But if I’d taken the Hippocratic Oath, I don’t think I could stick healthy 20-year-olds since, as my med school professor friend confirmed, it is tough to see how it is beneficial to the healthy 20-year-old being stuck.

    • Measles kills 100,000 children per year:
      https://www.npr.org/sections/goatsandsoda/2019/02/02/690647658/beyond-rash-and-fever-how-measles-kills-100-000-children-a-year

      COVID-19 kills close to 0 children per year;
      https://www.washingtonpost.com/health/covid-children-deaths/2020/09/25/9df39bf4-fdad-11ea-8d05-9beaaa91c71f_story.html

      Giving a child a vaccine for measles protects the child against measles and may save that child’s life. Giving a child or young adult a vaccine for COVID-19 is almost certainly not going to have any benefit to them individually and is purely meant for the benefit of others (particularly those above the age of 80, the median age of COVID death in Massachusetts).

    • Other vaccinations have gone through the full study period, and in many cases also have years of post-approval surveillance data. I’ve taken all prior vaccines that were CDC recommended after being fully approved and wouldn’t hesitate to take any again. I’d suggest that its those that are pro-science that should have concerns about this vaccine, not merely scientifically illiterate anti-vaxxers.

      People seem unaware there are good reasons trials last a couple of years and are confused by the initial good results of these vaccines as if that somehow guarantees they are magically guaranteed to continue to not have problems merely because people wish that so badly.

      In this case these vaccines are still being studied and were merely approved for emergency use while the clinical trials are going on. To view these vaccines as being equivalent to other vaccines that have full data on them is to engage in wishful thinking, akin to “cargo cult science”, not to be advocating real science.

      Not everyone wishes to take the risk of being in a clinical trial, and for many the risks will outweigh the risk of not being vaccinated. Most don’t even grasp what the risks are, and aren’t being told.

    • RealityEngineer: Your perspective is certainly shared by the medical students, young physicians, and pharma industry employees whom I’ve talked to. They all want to wait 2-3 years before getting any of these new vaccines.

      You have raised an interesting point. #Science must be followed at all times, of course. So #Science from 1796 through 2019 told us that it took a minimum of 2-3 years to figure out the characteristics of a vaccine when applied to humans. #Science in 2020/2021, though, tells us that 2-3 months is ample. This is not an apparent discrepancy, but rather a beautiful illustration of how #Science progressive, unlike religion, which fails to progress.

    • re: ” #Science in 2020/2021, though, tells us that 2-3 months is ample.”

      Many experts were publicly concerned about the rush to approve a vaccine back before the election and the initial vaccine results: but then went silent, even though the initial good results didn’t contradict any of their concerns. I suspect its partly since the media doesn’t want to scare people from the vaccine or look like anti-vaxxers. The British Medical Journal has an important new oped:

      https://blogs.bmj.com/bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-effective-vaccines-we-need-more-details-and-the-raw-data/
      “Peter Doshi: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data
      …All attention has focused on the dramatic efficacy results: Pfizer reported 170 PCR confirmed covid-19 cases, split 8 to 162 between vaccine and placebo groups. But these numbers were dwarfed by a category of disease called “suspected covid-19”—those with symptomatic covid-19 that were not PCR confirmed. According to FDA’s report on Pfizer’s vaccine, there were “3410 total cases of suspected, but unconfirmed covid-19 in the overall study population, 1594 occurred in the vaccine group vs. 1816 in the placebo group.

      With 20 times more suspected than confirmed cases, this category of disease cannot be ignored simply because there was no positive PCR test result. Indeed this makes it all the more urgent to understand. A rough estimate of vaccine efficacy against developing covid-19 symptoms, with or without a positive PCR test result, would be a relative risk reduction of 19% (see footnote)—far below the 50% effectiveness threshold for authorization set by regulators. Even after removing cases occurring within 7 days of vaccination (409 on Pfizer’s vaccine vs. 287 on placebo), which should include the majority of symptoms due to short-term vaccine reactogenicity, vaccine efficacy remains low: 29% (see footnote).
      ..
      There is a clear need for data to answer these questions, but Pfizer’s 92-page report didn’t mention the 3410 “suspected covid-19” cases. Nor did its publication in the New England Journal of Medicine. Nor did any of the reports on Moderna’s vaccine. The only source that appears to have reported it is FDA’s review of Pfizer’s vaccine.”

      Maybe this isn’t a concern: but as the BMJ notes: *all* data is needed before the public is experimented on even further without fully informed consent.

      Note: the FDA document doesn’t specify whether there was any PCR test done for these so they may be real cases (other than only 2 serious cases where it did say they were negative). Although they weren’t “serious” cases: they occurred early on. We don’t know if cases occurring after immunity wanes might be serious, nor how quickly that might wane in the elderly (who weren’t well represented in these trials to begin with).

      Of course it isn’t since there hasn’t been time for immunity to wane to even know whether there is a risk of vaccine enhanced disease. Many experts see concerns there will be with this vaccine,

  2. The US’s piss-poor handling of COVID is driving the country to the brink of collapse. It is most definitely in a 20-year-old’s interest to get vaccinated, especially if they enjoy being able to go out to eat in a restaurant, go out for drinks in a bar, going to music festivals, or traveling internationally. These are all activities they can’t do in many places as as result of COVID restrictions. These restrictions are only going to get worse, by the way, if the US doesn’t get its shit together and hurry up with the vaccinations, because of the new super-COVID that’s thought to be ~70% more infectious (remember that this is exponential growth we’re dealing with). This is ultimately going to lead to more lockdowns, more stimulus, more money printing, and the collapse of the dollar and American empire.

    Your arguments against vaccinations come from a viewpoint of extreme selfishness, which is a big part of the reason the US is handling COVID so poorly: we vaccinate kids for numerous illnesses that they have a very low chance of contracting *precisely because we vaccinate people*. If everyone wants to be a free loader, guess what, a lot more people are going to get sick and die of preventable diseases.

    While you’re right that the vaccines haven’t been around for very long to observe possible side effects…neither has COVID! All the evidence so far points to COVID being more dangerous than any of the vaccines approved for use in the US.

    I also don’t understand your focus on healthy slender young people. The fastest-growing segment of the US population is old people and the US’s adult obesity rate is about 42%. I haven’t heard a single US politician talk about the need to address our obesity epidemic recently even though it’s obviously a huge contributor to our COVID death toll and is actually causing American life expectancy to drop. China’s life expectancy is only about 2 years less than that of the US and theirs is still rising so they’re going to pass us soon. Does it make you proud of your country to watch hundreds of thousands of people die premature deaths as a result of a disease they wouldn’t have contracted if they’d been lucky enough to live in China? I find that incredibly disturbing. We’re failing hard as a nation and we’re trying to justify it by saying “those people were and sick anyway.” First we made the majority of our population fat and sick and now we’re saying it doesn’t matter when they die premature deaths (e.g. severe obesity can reduce your life expectancy by a decade) because they were fat and sick. That’s messed up.

    • Why “focus on healthy slender young people” when “The fastest-growing segment of the US population is old people”? That’s the difference between medicine (focus on the patient who comes into your office) and public health! A physician who has taken the Hippocratic Oath is traditionally required to focus on his/her/zir/their individual patient, not consider the potential benefits for other not-present-in-the-office people of sticking that individual patient.

      (Separately, since we actually don’t know whether or not the vaccines reduce infections/transmission (as opposed to merely symptoms once infected), we currently can’t be sure that sticking a healthy 20-year-old will help an obese sick 70-year-old.)

    • @Ryan, I’m sure most of those 20-year-olds know the COVID-19 vaccine isn’t proven and that we don’t know what is its long term effect on us is, but yet this group is willing to get vaccinated in a heartbeat to get back to normal live. This shows you how tired and desperate this group is from the lockdown.

      I agree with you about the US collapsing, but it will not be due to COVID-19, it will be — and this has been ongoing for some time — from “brain drain” and our collapsing education system. If Americans and our government is this scared about COVID-19 and will go to this much extreme to save us, then I wish it would apply 1/10th of this much effort on our broken education system and “lockup” teachers, students and parents till when we eradicate our broken schools. This is what will kill us, not COVID-19.

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