COMMENTARY

Money, Influence Allow Early Access to COVID-19 Vaccines

Arthur L. Caplan, PhD

Disclosures

February 12, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine's Division of Medical Ethics.

Who gets the vaccines that are out there? Who's eligible? Does it matter if people who are politicians, celebrities, or rich push to the head of the line and get vaccinated, even if they're not in a high-risk group or deemed to be an essential worker?

Well, it's already happened. We know that President Trump and some of his friends — Chris Christie, Ben Carson — got special access to antibody therapies. Rudy Giuliani, the president's lawyer, bragged about the fact that he got early access to antibody therapies. He told a radio station in New York, "If it wasn't me, frankly, I wouldn't have gotten into the hospital quickly and gotten access to early antibody therapy use." He was very proud and seemed excited about the fact that his position got him early access to a scarce resource that is very difficult for many patients who are infected with the coronavirus to get.

We can expect the same sort of pushing and juggling to get access to vaccines. People are concerned about adverse events, but there have been very few of them, maybe five, six, or seven, reported following a vaccination relative to hundreds of thousands, if not millions, of people getting vaccinated with the Pfizer, Moderna, or Chinese vaccines.

People are going to want these vaccines once they realize they work, they're very safe, and you can manage the adverse events just by keeping people around post-vaccination for 30-45 minutes to make sure they're not having an anaphylactic response. We do that, by the way, with allergy shots now. It's not as if people haven't managed the very rare adverse events that sometimes are associated with vaccination.

People are going to want these vaccines even if they're not in the highest-risk groups or the essential worker risk categories. I know already that medical centers have been approached by individuals who have money, who want to get access by being donors to big hospitals, or who want to get access for themselves and their families, even for their kids — and the vaccines haven't yet been tested on kids. People have offered money in Los Angeles where things are very bad, asking what donation is necessary to get access to vaccines.

Just like Giuliani, Carson, Trump, and Christie, we're going to see people who are rich and connected try to jump the line to get vaccines that they otherwise would have to wait for until much later in the summer or the fall.

Well, what's wrong with that? In one sense, people say, yeah, that's what happens. The rich, the famous, and celebrities always get more access. It's true that the rich have better access in the American healthcare system to many things.

I think we should still condemn it. In general, if you want people to support rationing and to back up the idea that they have to wait their turn because there are other people more at risk or more essential that have to go before them, then you have to say the system is fair and everybody has an equal chance.

Every time somebody learns that a rich person, a celebrity, a politician, or someone connected gets to go to the head of the line, they start to think that they can try that because others aren't waiting or being patient. If you're going to do rationing and you're going to have a scheme of priority, it is important that you follow it and that when people break it, you condemn it.

I doubt that we're ever going to really punish them. We're not going to send them to jail or even fine people who pull this off, but we shouldn't wink, turn the other way, or shrug our shoulders and say, well, that's the way it is.

We should speak up and say it's wrong and try to discourage it. When hospitals, medical centers, or ultimately, CVS, does it, or when a business buys access to a supply of vaccines for their own distribution according to what they want to do, we should say that that's just not the right thing to do. We may not be able to strictly enforce the rationing system that's in place, but we ought to ethically insist that it be followed.

I'm Art Caplan at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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