The Unscientific, Un-American Ethics of Vaccine Distribution

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Science and industry have done their job. In the face of a dangerous new virus, researchers shifted into high gear to develop new vaccine technologies at record speed. Pharmaceutical companies poured resources into mass-producing the vaccines without assurance that they would be approved.

But when it’s come to the distribution of the vaccine, this can-do confidence has too often been replaced by confusion and pessimism. Government rationing has been aggravated by uncertainty in defining eligibility for the vaccine. In some U.S. states, doses have even been thrown out when candidates could not be found who met state rules for “equitable” distribution.¹

Many of those rules have since been revised to be more discretionary. More and more states are now making all adults eligible for the vaccine. But it’s not been long since Americans had to deal with a patchwork of shifting, sometimes double, standards that didn’t make it clear when someone was unfairly “jumping the line” or was instead stopping a dose from going to waste.

Some journalists, observing the confusion about the ethical criteria driving government rationing, have written articles with headlines like “To Beat Covid, Politicians Need to Think Like Philosophers.”² But a closer look at the advice from today’s leading moral philosophers should erase hope that they have anything like scientific expertise with which to advise government.

What we need is not alleged moral experts defining government’s rationing criteria for the vaccines. What we need is a philosophical approach that embodies the scientific spirit that made the vaccine possible in the first place. We also need an American approach: one that embraces the individual freedom to make our own decisions and pursue our happiness.

An elusive philosophical consensus

No sane person would question the expertise of scientists who have produced a successful, lifesaving vaccine. We judge them by their fruits, which have grown from a widening body of shared knowledge. But today’s moral philosophers don’t have this shared foundation. They disagree fundamentally about the major ethical concepts at stake in the vaccine debate.

One philosophical dispute concerns whether the vaccine should have gone first to those who were at the greatest risk of dying or to those whose immunity would have helped decrease the spread of the disease.³ Some have associated the first position with the philosophy of Immanuel Kant, who identifies morality with mysterious, unconditional duties we owe each other, while the second is said to align with the “utilitarian” philosophy of John Stuart Mill, which equates morality with somehow determining what will maximize the happiness of the greatest number of people.⁴

To appreciate the significance of this disagreement, it’s worth noting that many utilitarians argue that the government priority that’s been assigned to older people is completely mistaken. They argue that if we want to maximize overall happiness, we need to count the years of life saved, not just the number of lives.⁵ Vaccinating the elderly might allow many to live a few extra years. But prioritizing younger people may not only stop the spread to the old, but also save the fewer vulnerable younger people who have many more years of life to live than the elderly.

Then again, another faction of moral philosophers says that we should prioritize historically oppressed minority groups (who are statistically more likely to be victims of Covid) to rectify entrenched inequalities.⁶ Still another faction asks why the federal government should prioritize oppressed minority groups in the United States — or anyone in the United States — when poor and oppressed people in the “Global South” need the vaccines most?

The debate over who should be first in line for government rationing of the vaccines — those who are most vulnerable, those who are most likely to live the longest, or those who are most historically downtrodden — comes down to a debate among rival Kantian, utilitarian, and egalitarian standards of morality, which amount to conflicting ethical worldviews. Is there any hope that today’s moral philosophers could someday resolve this conflict?

An unscientific methodology

Competing theories are not unheard of in the sciences. Darwin’s theory of evolution was controversial for decades, the atomic theory for well over a century. But these controversies were eventually settled because the scientific method provides an agreed-upon framework for testing and proving hypotheses. By what method would today’s academic philosophers propose to settle their fundamental conflicts?

It turns out that the method today’s philosophers rely on is far from scientific. It is more like the “method” of psychics and fortunetellers.

Is the relevant standard for settling the debate about vaccine rationing the duty to save the most vulnerable, the utilitarian’s maximization of life-years saved, or some version of “social justice”? In practice, the way philosophers propose to settle debates about rival standards is by probing their own feelings (“ethical intuitions”) about which standard seems right.

Philosophers try to settle debates about their standards by first considering artificial examples: e.g., should the driver of an out-of-control trolley switch tracks to save five lives even if it means killing one innocent bystander? If switching the tracks feels right to some philosophers, they take this as “evidence” that utilitarianism is correct. If it feels wrong, so much for utilitarianism. These “thought experiments” may be adjusted further to see if the right lesson has been drawn from the story. But ultimately it’s still these “intuitions” that are supposed to deliver the lesson.

Some philosophers think that it’s unscientific to trust our intuitions about particular cases. After all, they say, we only react to them the way we do because of our evolved biology, not because of any connection to the truth. So they propose that if it feels bad to switch that trolley (or push an innocent bystander on the tracks to stop it), we should ignore the feeling. We should instead pay attention to the good feeling we are supposed to have about the abstract rule that we should count the interests of all people as equally important. From that rule we supposedly deduce the conclusion that we should work to maximize overall happiness (however we feel that is to be calculated).⁷

Even as they talk about “thought experiments” and deductions from first principles, the “data” these experiments and principles draw on is nothing more than feelings. How are feelings supposed to provide a window into the truth?

Since scientists don’t learn anything about the natural world from their feelings, the philosophers who don’t want to say that morality is nothing more than an expression of our feelings instead have to hold that intuitions somehow reveal truths about some kind of “non-natural” reality.⁸ This just piles mystery upon mystery.

It’s little wonder that philosophers seem to be unable to resolve their basic disagreements. In the end, the methodology they practice is no better than what is offered by psychics and fortune-tellers. Of course psychics and fortune-tellers these days only claim to offer an amusing form of entertainment. But today’s moral philosophers, are claiming to have the expertise to advise us on matters of life and death. It’s crucial that we resist their charms.

The spirit of science demands individual freedom

How much of what’s been good about the pandemic response would have been possible if scientists had allowed the feelings of external authorities to dictate what is true?

Katalin Karikó fled communist rule in Hungary to research RNA in the U.S.⁹ Even in the U.S., for years she couldn’t convince corporations or governments to fund her research into the idea of an mRNA vaccine. Even her scientific colleagues were skeptical.¹⁰ But she didn’t give up, and is now a senior vice president of BioNTech, which worked with Pfizer to develop one of the first mRNA Covid vaccines. (This author is now a grateful recipient of her creation.)

There’s a clue here as to what a scientific moral philosophy would look like, in opposition to the dead end of the philosopher’s intuitions. When Karikó refused to give up in the face of skepticism, it’s not because she was making a detached scientific judgment. She was making a passionate commitment to seek the dispassionate objective truth, in opposition to the prejudices of others. That commitment represents a value that’s at the core of the scientific worldview. Yet it’s not a feeling or intuition, it’s the commitment to the idea that feelings aren’t any guide to the truth.

The scientific value of commitment to the truth also implies a deeply American value, the value of individual freedom. Karikó could only find the truth because she was left to do it on her own without coercive interference. Had she been forced to follow some conventional rules of vaccine research, she’d never have created a completely revolutionary alternative, and nothing she’d have uncovered would have been a real truth seen through her eyes.

But if she should have been free to discover the truth that led to a vaccine, why should she not be free to sell it to those of us who also see the value of her discovery? Why should we all be coercively constrained by government bureaucrats conferring with alleged moral experts about how they should ration the vaccines? They didn’t invent the vaccines. And they didn’t create the wealth through which millions of doses have been purchased — we as individual taxpayers did.

Had we been free to purchase the vaccines — just as we are free to purchase other vitally needed things like food and shelter — we could have made rational, individual decisions about this crucial area of our lives. Instead, we each wait for some bureaucrat to regard us as morally worthy of receiving a vaccine.

The same anti-scientific, anti-American attitude that people can’t be trusted to judge risks for themselves led regulators to adopt restrictions that needlessly stopped individuals from taking their own measures to stop the spread of Covid. They restricted labs from developing their own tests for Covid at the beginning and still have not fully permitted private individuals to purchase home Covid tests.

The same attitude also led regulators to stop people from participating in “human challenge” trials of vaccines, which could have dramatically enriched the data about the vaccine at a much earlier stage of the pandemic, leading to its early adoption and the saving of hundreds of thousands of lives.

As it rations the vaccines under the advice of leading ethicists, our government has lately been doubling down on the same paternalistic ethics. We should reject this approach and demand a more American one.  

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1. See Dana Rubinstein, “After Unused Vaccines Are Thrown in Trash, Cuomo Loosens Rules,” New York Times, January 10, 2021. Vaccinators have even been censured or criminally charged when they gave out doses to ineligible parties to avoid throwing doses out. See Elizabeth Weise, “‘Don’t waste vaccine!’ After early confusion, experts say it’s always better to use leftover shots than toss them,” USA Today, February 20, 2021.
2. John Authers, “To Beat Covid, Politicians Need to Think Like Philosophers,” Bloomberg Opinion, December 31, 2020.
3. Authers, “To Beat Covid.”
4. In one twist, if it turns out that the Covid vaccine doesn’t actually stop the vaccinated from spreading the virus to others, the utilitarians might have to support vaccinating the most vulnerable as well: preventing their deaths first would be the most direct way of saving lives and minimizing suffering. But this loophole would not end the controversy because of the dispute that follows.
5. Alberto Giubilini, Julian Savulescu and Dominic Wilkinson, “Vaccine distribution ethics: monotheism or polytheism?,” blog of The Journal of Medical Ethics, November 11, 2020.
6. Emily Bazelon, “People Are Dying. Whom Do We Save First With the Vaccine?,” New York Times, December 24, 2020.
7. For Singer’s disqualification of intuitions about the importance of helping people in our immediate environment, see his Preface to Famine, Affluence and Morality (New York: Oxford, 2016), xxv-xxvii. For his case for deducing utilitarianism from one of Henry Sidgwick’s intuitive ethical axioms, see the afterword to the 2011 edition of The Expanding Circle: Ethics, Evolution, and Moral Progress (Princeton NJ: Princeton University Press, 2011), 200–203.
8. Though this view has its roots in the philosophy of Plato, it is far from an ancient relic. The most prominent and influential twentieth-century advocate of the method of intuitions, who thought they revealed truths about non-natural properties, was G.E. Moore. See his Principia Ethica (Cambridge, UK: Cambridge University Press, 1971/1903). For recent prominent advocates of the same view see Derek Parfit, On What Matters (Oxford: Oxford University Press, 2011) and David Enoch, Taking Morality Seriously: A Defense of Robust Realism (Oxford: Oxford University Press, 2011).
9. Stéphanie Trouillard, “Katalin Karikó, the scientist behind the Pfizer Covid-19 vaccine,” France24.com, December 18, 2020.
10. Damian Garde, “The story of mRNA: How a once-dismissed idea became a leading technology in the Covid vaccine race,” STAT, November 10, 2020.