Should the unvaccinated be deprioritized for scarce medical resources when resources are scarce and when hospitals become overwhelmed? This, among others, has surprisingly been entertained in several contexts during the COVID-19 pandemic. In the face of a seemingly never-ending waves of variants that cause hospitalization rates to skyrocket each time, and as numerous observational studies have demonstrated that being unvaccinated is significantly associated with increased mortality and hospitalizations, it is tempting to ‘attribute personal responsibility to the unvaccinated’ and deprioritize these individuals for scarce medical resources, or, as President Emmanuel Macron argues, ‘making life as difficult as possible.’ At first blush, there are at least two separate questions: (1) are the unvaccinated squarely responsible for the continuing spread of the virus and (2) are the unvaccinated squarely responsible for is responsible for the continuing burden on the healthcare system? The focus in this paper is on the second question, and I will interrogate the underlying values at stake in such a question.
I will argue that using vaccination status as a factor in scarce resource allocation is not defensible, though other ways of using responsibility may be. I argue that given the diversity of reasons for COVID-19 vaccine hesitancy, using vaccination status alone for scarce resource allocation may in some scenarios contravene widely accepted allocation principles. Recognizing objections to vaccines is critical to the first-order task of working out the relationship between vaccination and responsibility for burdening health systems in the pandemic. It may be defensible, however, to collectivize responsibility for vaccination through other mechanisms, through collective taxation for all unvaccinated individuals, for example. Increasing vaccine uptake will be central to the future of the pandemic, and policymakers must seek to understand the nature of vaccine hesitancy in their respective societies, as many have already sought to do.
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