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Brian Lehrer: Now after the ethical morass of vaccine eligibility, the public health system and officials at every level of government have repeated that in the push to end this pandemic, the people most in need should get vaccinated first. That's frontline workers, the elderly people who live in communities hard hit by the virus and people with heightened risks of more serious infection, they should be first in line. That makes sense, everybody agrees in theory.

Some of the fears about inequitable access to vaccines are coming true. The rollout has been chaotic as we've discussed on the show and we'll talk about it again with the mayor next hour. It's been marked by confusion, poor planning and scarcity of supply. Folks have heard all this before. Some have exploited loopholes to jump to the front of the line, you've heard the stories about people from wealthier parts of Brooklyn and Manhattan showing up at vaccination sites in low-income neighborhoods where they never otherwise go that were specifically intended to serve vulnerable members of those communities.

Maybe you've also heard about the 55 year-old casino magnate from Canada who chartered a plane to the remote Yukon territory and posed as a local motel worker to get his COVID shot. Did you hear that story yet? Or the executives of Florida Nursing Home company accused of giving vaccines to wealthy donors in January.

When the official rollout is this messy and the loopholes are so easy to exploit if you have the right amount of power and privilege you, the rest of the civilians, the ordinary people, trying to do your part in ending this pandemic and protecting your own health and the health of people close to you, you're left with a bunch of ethical questions. Should you cut the line if offered a chance and it's not really your turn? Is there a straightforward yes or no answer to that ethical question and how do you go about making that decision?

With me now is Faith Fletcher, assistant professor in the department of health behavior at the University of Alabama at Birmingham school of public health and a senior advisor to The Hasting Center, a leading US research Institute in bioethics. She cited in an NPR story called, "is it ever okay to jump ahead in the vaccine line?"

Listeners, we're going to invite your calls right away. What are your questions about the ethics of getting vaccinated ahead of people who may be more vulnerable than you? 646-435-7280. If you're one of the people who's been fortunate enough to secure an appointment online here in New York or elsewhere, were there any ethical questions you work through when making the decision to click yes or confirm appointment?

No 90 year olds need call in, but if you think you're in some kind of gray area, give us a call 646-435-7280, and reveal your inner dialogue a little bit. 646-435-7280 and we should note that our goal here is not to make anybody feel bad about wanting to take the coronavirus vaccine, but to point up some ethical complexities. Professor Fletcher, thank you very much for joining us. Welcome to WNYC.

Faith Fletcher: Thank you for having me here today.

Brian Lehrer: I'll start with the obvious. Is there a straightforward yes or no answer to the question in the NPR headline? Is it ever okay to jump ahead in the vaccine line?

Faith Fletcher: Excellent question. I'm glad you talked about the ethical complexities because we're having these conversations and we're having more conversations about the role of bioethics and resolving ethical issues and also presenting information so that individuals can make autonomous decisions. There are some clear responses to some of the questions raised, and I will even say in the NPR article, but there's also some complexities that we should consider when making these decisions.

Brian Lehrer: There were a couple of different hypothetical scenarios laid out in that NPR story. One was, "If I hear at a grocery store that they have extra vaccine doses that are going to waste, is it fair for me to get one even if it's not my turn?" I heard this morning from somebody about a 20 something who was in that position. They were around the grocery store had, as I heard the story, doses that were going to go to waste. They went in and got one.

On the surface that doesn't sound so bad, but another one was, "If I'm not eligible in my county, but I could be, if I lived in the county next to mine, should I drive over and get it there?" In these hypotheticals, what side do you come down on?

Faith Fletcher: I'll say, and I'll start with the idea of being at a grocery store with additional vaccinations. I believe my ethicists colleagues would agree that if you are offered and if there is additional vaccination that may go to waste, you should be okay with accepting the vaccination.

Some of the concerns, of course, as it relates to even what might be more ethically possible or ideal, of course, if that vaccination at the grocery store could go to someone who was more vulnerable or more medically vulnerable, however, there must be systems that are set up to directly reach out to those folks. There are currently vaccination sites that are working to do that, to sign folks up on site who possibly are not able to sign up because of lack of access to information and the internet. That's one scenario.

As it relates to going county over, I just want to highlight that there was a lot of dialogue after the NPR article about all people being entitled to the vaccination. I agree that especially, ideally, all of us would have universal access to the vaccination, but right now there are limitations. Within this framework, we have to think about how can we get the vaccinations to those who are most vulnerable, those who are most medically and socially vulnerable. I just wanted to set that framework so that people are clear that all people should have access to the vaccination. That's the first piece.

It's also important to think about people in the article. I highlighted that people are going from wealthier neighborhoods to poorer neighborhoods, and that does create complexities and it also really undermines health equity strategies to serve those who are most vulnerable. We're hearing a lot about communities of color not having access, being really hesitant. The same around rural communities. I guess there are a few things that we have to think about around these issues.

There's distrust and skepticism that really results from a lack of information, misinformation and disinformation. Then there's also a lack of tailored outreach to communities, especially communities of color. Some strategies might include really working with faith-based institutions as well as other historically Black colleges and universities to really deliver information and vaccinations to the communities that are most in need. I strongly encourage people not to go from one county or one state to another state if they're not eligible in that specific state or county.

Brian Lehrer: Let's take a phone call. Chris in Bushwick. You're on WNYC. Hi, Chris.

Chris: Hi, Brian. Hi, thanks for taking the call. I reported to [unintelligible 00:08:01], I'm a teacher, I teach freelance though, I teach music and I teach meditation. I'm a teaching artist and not currently teaching live though. I teach all online at the moment, but I'm technically eligible. I have had colleagues and friends say, "Hey, this might be an option for you," but it doesn't quite seem like my time.

Faith Fletcher: Excellent question. I really appreciate these questions because it just really highlights that many people are grappling with these moral and ethical decisions and having these conversations is very important and we need to have these conversations from an interdisciplinary perspective. I'm glad to be here and take part in this conversation.

I'll say that if your intent behind the [unintelligible 00:08:47] is because you hope that someone who's at higher risk will receive it, we can't necessarily predict who that vaccination might go to. There's also a lot of dialogue recently, and I think it's really important dialogue about folks who might even underestimate their risks of having-- Their COVID-19 risk or also understanding more about undiagnosed chronic conditions. These are things that should be considered.

What we can predict is that if vaccinations aren't used within a certain timeframe, of course, they will go bad and that just doesn't benefit anyone. I would say you're doing what you should do, gather all the information to really inform your decision. Basically, before you actually register for the vaccination, be sure that you actually plan to get the vaccination because there are some folks who are registering and don't get it, and then that vaccination could be thrown away.

Those are just some considerations, as I said, I think people have to be empowered to make their own decisions, but these are some things that you should consider in this morally complex climate.

Brian Lehrer: Is that helpful at all Chris, as you grapple?

Chris: I guess so. Actually it makes things feel a little more complex than I thought. It seemed like a pretty clear ethical line that maybe I'm not technically eligible, but not really the one that they had in mind for it, but if it's possible that the vaccine would go to someone who's maybe even less in need or other people are doing the same thing, of course, we don't want it to go to waste. Of course, we want people to have vaccines. It does feel like a tricky question.

Brian Lehrer: Chris thank you for-

[crosstalk]

Faith Fletcher: I think the issue is that we can't always predict if the vaccination will go to someone who's of higher risk. Again, people are encouraging folks if you are eligible for vaccination, of course, the goal is for all Americans to get vaccinated, that you should go ahead and accept the opportunity and engage in a vaccination.

Brian Lehrer: Some of these ethical concerns would be mitigated if there was universal vaccine access, but until that happens, what can the government and public health systems do, Professor Fletcher, to keep the burden of ethical responsibility from falling so heavily on individuals like Chris?

Faith Fletcher: That's an excellent question. I've given this some thought. I would say when ethical complexities are encountered, let's say within hospital systems, there are ethical consultations we call them bedside consultations to really help patients and their families to make this decision. Part of the reason why I'm so excited to have this conversation is because we really need to think about establishing more ethics infrastructure across the United States.

This is the one time where it has become clear that there's moral distress and the public is grappling with these moral issues but again, more ethics education and more funds allocated towards ethics research. We have many centers of ethics and programs of ethics, but if we start to invest in those programs, then we can start to establish more infrastructure so that people can call in into ethics centers to receive information, to help them, to guide them and to provide information and consultation in order to make these decisions. That's one approach.

Another approach is guidelines. We have many guidelines that help healthcare providers and other institutions to make decisions about delivering vaccinations or COVID-19 treatment but there's not enough spaces and places for the public to turn to in order to get information, to help them make these decisions. I think in some ways this was really showing a deficit and ethics infrastructure in the US but also it highlights the importance of bioethics and really grappling with these moral decisions,

Brian Lehrer: Maria in Sunset Park. You're on WNYC with bioethicist Faith Fletcher. Hi Maria.

Maria: Yes. Well, good morning. Just this week alone, I have either watched on city council two o'clock in the morning with the replay of the city council hearings, or whether it be whatever, program after program, hearing after hearing of what is not going right with vaccine distribution and what should be done.

It's like one program, but it's being repeated by different talking heads but the problem, I think, it was you Brian, who just mentioned, availability is still an issue. Aside from that, and I'm a senior, I'm 72 years old, I cannot take the vaccine right now, even if I wanted to, because my doctor said, "No, with your allergies and whatnot, let's wait it out a little bit, let's see what gives." Fine. I'm okay with that.

I have been offered by two different people, $500 to give them my place should I be offered the opportunity to take the vaccine. That's serious business. I would never do that. I said, "No, no, no, no, no, if I did, I was allowed to give my place for me to decide, which I don't think they would let me, why would I accept your money? I would certainly give it to you or somebody."

Brian Lehrer: A black market in vaccine appointments.

Maria: Yes. I am telling you, I had heard about this and I said, "Oh, come on, no." [chuckles] I should have known better. I've been on this earth a little while and I said, "Of course, why not?"

Brian Lehrer: Maria, got to go because-- Do you have a question to frame because the segment's going to end.

Maria: The question is, why at this point in the game are we still waiting for people to go through a place to get a vaccine? In Sunset Park, you have the commercial streets, all the people who are now eligible for that vaccine they're working, they're working two jobs. They have families to raise. The seniors they just can't be moving around town. Why are we still doing this idea [unintelligible 00:15:40] for the algorithm? This is a pandemic. Did anyone ever care about the visiting nurse? Anyone hear about going door-to-door?

Brian Lehrer: Yes, and we're going to ask the mayor that question when he's coming on in just a little over five minutes. Maria, I apologize I have to but you definitely [crosstalk],

Maria: I've heard his answer before. [chuckles]

Brian Lehrer: Well, hopefully it's a evolved.

Maria: Right and we're talking about the ethics, the ethics is availability. Where are the ethics [unintelligible 00:16:10]

Brian Lehrer: Yes. Which is on the system more than the individuals and Maria, in addition to everything else, you definitely get our civics [unintelligible 00:16:18] award to wear with pride for this week for watching city council hearings replayed at two in the morning. Thank you very much.

Maria: Oh well, thank you.

Brian Lehrer: Maria, keep calling us. Faith Fletcher, anything in response to that call? I don't know how somebody can buy a vaccine dose on the black market. She says she's been offered $500. They have to present an ID so they would have to almost at least look like her a little bit or be in a relative age group but I don't know, have you heard that before?

Faith Fletcher: No, I haven't but I know that there are several policies, including in New York that are really tightening the parameters around getting vaccinations to mitigate some of those concerns with people getting access, folks who actually shouldn't have access. One of the things that I heard from her comment, and I thought it was especially important to bring up. She talked about talking to her healthcare provider about her risk for COVID-19 and that's critical.

A lot of the messaging really the first people to healthcare providers and we have to remember that there are some disadvantaged communities who don't have access to healthcare, who don't have healthcare providers to have these conversations with and to make these decisions. Again, I think when we're talking about health equity and ethics and social justice frameworks, you really have to think about those who just don't have basic access to healthcare and how that may impact and really increase ethical complexities and dilemmas around making these decisions.

Brian Lehrer: I want to hear one more true confession? It looks like Mary in Park Slope. Mary, I apologize, we have 30 seconds for you because we're going to have the mayor standing by.

Mary: Oh heavens. I made an unethical choice I will never be okay with. I went to another borough, not borough, but upper Manhattan yesterday, I ended up getting a shot. I'm young. I don't need one yet. I didn't even want one yet. I felt pressured by my boss to go. I went, but the thing is, the workers they all wanted to get everybody there vaccinated. They wanted to prioritize residents. They were trying to, but there were none coming to the front of the line.

There were hundreds and hundreds of young people getting vaccinated and somebody from the city or state stepped in and stopped everything right before I got my vaccination, as the doctors who were waiting to give people shots, all these people are in there like, "Well, we're inside, we should get one, we should get one." I was not saying that.

We eventually got one, but what are they doing? Where are the people that were to be vaccinating? They weren't getting in that line. They weren't behind me. They weren't coming to the front of the line and this man from the city or state came in and got them all, was mad at these people, the workers for giving us all vaccines. I hate myself that I have one. What do we do? Why is that happening? Where are the people who are supposed to go there? I'm still not okay that I went.

Brian Lehrer: You weren't in an eligible category. You were just there with the hope that you would be able to get in with unused doses?

Mary: Yes. A lot of people were being told this, through word of mouth and friends and my colleague at work and my boss were telling me I should go and I didn't really want to go, but I went, that's on me. If I didn't go, that's what was happening. There were just hundreds of people like me who were just coming.

Brian Lehrer: Was that at the Armory?

Mary: No, it was in the Bronx. I don't remember where the Armory, Armory is up there but-

Brian Lehrer: Yes, that's Washington Heights, Grand Concourse site. Mary, thank you very much. Well, a true confession. We've just got 20 seconds for a final thought, Professor Fletcher, very honest of Mary though, after the fact.

Faith Fletcher: Yes. Wonderful conversation. I think we just really have to remember as we're targeting communities of color and rural communities and disadvantaged communities that we really have to work with them and partner with them in order to really develop strategies that highlight their assets, needs and their concerns about vaccinations. I think in the next phase, it's our moral responsibility to make sure that communities and community leaders are really driving vaccination strategies and in essence, this is community engaged ethics.

Brian Lehrer: It does still go to the structural failures because in Mary's story, there were not the people who should have been there to get the vaccines. They weren't being one way or another gotten to those sites and so they were available for people like her.

Faith Fletcher, assistant professor in the department of health behavior at the University of Alabama at Birmingham, their school of public health and a senior advisor to The Hasting Center, a leading US research institute in bioethics. Thank you for being with us today and for giving such thoughtful answers.

Faith Fletcher: Thank you for having me.

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