In pandemic time, humanity calls as we call it solidarity booms everywhere. Medical student participation in vaccination activities is one of implementation of solidarity. SCORE CIMSA, as an organization of medical students, massified knowledge regarding COVID-19 vaccines and its relation to bioethics through our campaign, World Bioethics Day. With this content, we collaborate with UNESCO Chair on Bioethics, Center for Bioethics and Medical Humanities UGM to answer our questions regarding the COVID-19 vaccine.
How are countries able to produce vaccines so quickly?
COVID-19 vaccine is a collaboration of all aspects. Funding, resources, and the public involved in this vaccine development. Regarding the research and development before the new coronavirus, SARS-CoV-2, arrived and started causing COVID-19, there was much research done on similar coronaviruses called SARS and MERS. So, there was already research to build on.
Currently, there are 91 vaccines in research 21 that have passed the standard clinical trial and had approval. There are steps of clinical trials, but some vaccines were previously used without passing the standard clinical trial such as Sputnik in Russia and Sinopharm in China, both were done due to the crisis as justification.
What are the ethics of vaccine trials in humans and what to do if volunteers experience complications from the vaccine being tested? Are there laws protecting doctors or scientists who are involved in the manufacture and testing of vaccines?
The use of vaccines when they do not meet clinical trials is acceptable because this action was carried out when the pandemic was at its peak, so that it was necessary to take urgent action to provide protection based on the principle of beneficence. It also lifts the non-maleficence aspect because it has passed the phase 1 test, then it has been harmedly reduced. If volunteers experience complications from the vaccine being tested, this will be the responsibility of the researcher.
Doctors and researchers are protected by law if informed consent is given to patients. In the crisis time and evidently urgent situation it’s better to do something than do nothing.
Does the policy require the public to vaccinate and not be allowed to choose a vaccine are considered a bioethical violation?
Mandatory vaccination is a program where vaccination is mandatory. This is considered contrary to the ethical principle of autonomy. There are several reasons put forward by the community, such as religion, certain commodities, and the status of EUA (emergency use authorization) approval which should give the public an option to accept or reject it.
Is mandatory vaccination ethically acceptable or not?
There is debate on this topic.
Aspects raised by the support group are:
- Beneficence: vaccines can limit transmission and serve as population protection.
- Non-maleficence: causes minimal side effects.
- Justice: resource allocation, because through vaccines, many staff are healthy so they can serve the community.
Aspects raised by the disagreeing group are:
- Autonomy: mandatory eliminates the value of autonomy because without informed consent
- Justice: not all have the same risk and severity.
WHO states that when there is a conflict between public goods and individual rights, public goods must be prioritized, but individual rights should not be infringed. There should be a trade-off principle, especially autonomy, beneficence, and non-maleficence. There are some requirements that we should look after; the risk to the patient, mandatory not to all but to the specific population at risk (health care worker, police, civil servant), preliminary screening to identify the patients with contraindications, maintaining privacy and confidentiality.
Do medical students who have not graduated become vaccine volunteers violating the principles of bioethics?
Medical students who have not graduated and are vaccinating the community are monitored by the doctor in charge so that this can be considered acceptable.
What is the bioethical response to the uneven distribution of vaccines and prioritizing someone who has more privileges?
In terms of vaccine distribution, the aspect of justice is certainly a priority. Unfair distribution if it is intended for health workers to be prioritized is considered fair because health workers are a prioritized group. But if the injustice in question is to people with more privileges, then this violates the value of justice in bioethical principles.