In the UK, an Oxford city councillor has been suspended after mentioning on social media that she had received a COVID vaccination from a private doctor. Meanwhile, media reports suggest that two Spanish princesses, who did not yet qualify for vaccination in Spain were vaccinated while visiting their father in the United Arab Emirates. They are among a number of ultra-wealthy people getting vaccinated in that country.
So how concerned should we be about these cases?
One issue relates to the lawfulness of providing a vaccine outside the national allocation scheme. In the UK, COVID vaccines are not authorised outside of the NHS. The Medicines and Healthcare products Regulatory Agency is carrying out an investigation into the Oxford case.
Strict controls over the distribution of a vaccine are justified to ensure the safety and efficacy of vaccines. Regulations are partly to protect patients, but also to protect the public at large. If someone receives an ineffective vaccine, they may be falsely reassured and go on to unwittingly spread the virus. Someone who receives an unsafe vaccine may experience side-effects that not only harm her but also undermine confidence in vaccines in the wider community.
But an even more important reason for ensuring that access to the vaccine occurs in an orderly way is based on considerations of justice. Approved vaccines are still a scarce resource. Not everyone who wants to access a vaccine has yet been able to. So there needs to be an ethical decision about who should receive the vaccine first. That is why there is a queue.
Two ways to jump the queue
It is important to separate two cases. In some cases, queue jumping is wrong because it involves displacement – taking someone else’s place.
To use a trivial example, if there are 100 seats in a cinema and you jump a queue of 100, someone who has waited will not get a seat. This sort of displacement can be wrong because it disrupts a fair process for allocation. Someone misses out.
But with vaccines, there is a more important reason. Vaccine allocation schemes prioritise those at greatest risk of severe COVID. If someone jumps the queue, another person who is at higher risk will have their vaccine delayed and may become seriously ill in the meantime.
But other cases do not involve displacement. In the case of the Oxford councillor or the Spanish princesses, they did not take the place of someone in the UK or Spanish allocation schemes. Their vaccines were from a separate pool. No one had their vaccine delayed. That is like someone avoiding the queue for the cinema by paying for a private screening.
Queue jumping is not necessarily wrong if no one is displaced. Actually, in some cases, queue jumping is morally the right thing to do.
Some people have been vaccinated early using doses that would otherwise not be used. It would be morally wrong to waste COVID vaccines given the global scarcity. So if you are offered a vaccine through the national scheme, it is best to take it, regardless of whether you are in a current priority group.
Queue jumping and inequality
Some people object to queue jumping, even if it does not clearly involve displacement. One thought is that it might be unfair for someone to get the vaccine earlier than they are supposed to, even if it doesn’t affect anyone else’s access. For instance, allowing people to pay for vaccination outside of the public system would introduce new forms of inequality.
Yet the claim that all inequality must be avoided is controversial. Our society is unequal in many ways – the very existence of private healthcare is one example. We could make everyone equal by taking away any option for private healthcare, but that would make some people worse off and no one would be better off. Philosophers call this “levelling down” inequality.
Another reason for concern about public figures jumping the queue is because of the message it sends. It might undermine confidence in the national allocation of vaccines if politicians or public figures are seen to bypass the scheme.
Social solidarity is a key component of a successful response to the pandemic and may be threatened if public figures are seen to circumvent the rules everyone else is abiding by. That may be less of a concern for private citizens.
Right now, it is vital that vaccines are distributed in an orderly and ethically informed way. The English famously love to queue – and to complain about those who are pushing in. But all queue jumping is not equal, and not all queue jumping for vaccines is wrong.
Authors: Dominic Wilkinson – Consultant Neonatologist and Professor of Ethics, University of Oxford | Jonathan Pugh – Research Fellow, University of Oxford