Posted on May 25, 2021 at 3:22 PM
by Kyle Ferguson, Ph.D., and Arthur Caplan, Ph.D.
On May 10, 2021, the F.D.A. authorized the Pfizer-BioNTech coronavirus vaccine for use in 12- to 15-year-olds. The C.D.C.’s A.C.I.P. convened on May 12th to review clinical trial data and unanimously voted to recommend using the vaccine in this cohort. As a result, young teens started getting their shots and the protection we owe them. By getting vaccinated, these youths will help our nation achieve valuable collective goals.
We think this is welcome news. However, the expanded authorization is reigniting debates about the ethics of global vaccine distribution in the pandemic context: our kids versus the needs of the world.
Many cry foul at vaccinating American teenagers. They find it morally absurd to prioritize low-risk American adolescents over high-risk persons beyond our borders: clinicians, the elderly, and frontline workers with little to no access to vaccines. While they might acknowledge that expansion is biomedically good for adolescent vaccinees, they insist that it is ethically bad for the world. Vaccinating teens is unjust, unfair line-cutting on a global scale.
We disagree. It is a mistake to frame the issue as an either/or, pitting American youths against the world’s most vulnerable adults. That mistake flows from misunderstanding the facts and values that structure the circumstances we are in and that animate the commitments America has undertaken. When seen aright, those facts and values make vivid what we ought to do: vaccinate the teens of America now.
Rather than thinking of individual-level risks and benefits and comparing the average American teenager to the average vulnerable adult in hard-hit countries overseas, we need to think at the population level.
There are nearly 17 million 12- to 15-year-olds in America. Although this age group has been mostly spared from COVID-19’s worst, they can still be infected and transmit SARS-CoV-2. This cohort comprises a large number of potential vectors. By expanding access to this age group, as much as 87% of the total population is now eligible to get the vaccine. If, as appears to be the case, the vaccines prevent infection as well as disease, then vaccinating this age group fills gaps in the road to herd immunity. It will contribute to solidifying protection for those in our community who have been unable—or have refused—to be vaccinated.
As demand in the adult population has dwindled, sunk by a combination of hesitancy, complacency, busyness, and conspiracy-fueled fantasies, millions of vaccine doses have gone unused. According to the K.F.F. COVID-19 Vaccine Monitor, only 64% of American adults say they have received at least one dose of a vaccine or intend to do so as soon as possible. Adults’ failures mean we need our teens’ help.
Without abandoning efforts to persuade unvaccinated adults to get the COVID-19 vaccine, expanding access to teenagers will boost daily vaccination rates. This means that a higher percentage of the population will be immune and we will achieve broad protection sooner.
There are individual-level benefits too. Even if adolescents are at low risk of COVID-19’s worst, they still suffer great losses due to their current lack of immunity. The return to in-person schooling and other avenues of their social lives will be aided by vaccination. A small percentage of 12- to 15-year-olds would suffer serious illness and require hospitalization if they were infected, and we don’t know much about the long-term effects of the disease. Vaccinating teens protects them from these harms while it secures those other benefits.
Those who find the adolescent expansion unjust do not deny any of this. Instead, they find that these goods pale in comparison to needs elsewhere. In their view, vaccinating America’s teens means abandoning high-risk individuals elsewhere. Instead of immunizing our low-risk teens, we should send doses to where they are more seriously and urgently needed.
There are two reasons to reject this argument.
First, the facts. Pfizer-BioNTech is notoriously challenging in terms of logistical, transport, and storage demands. Much of the world lacks the infrastructure needed to deliver this vaccine.
In addition, there is no guarantee that donated doses would actually reach high-risk individuals in recipient countries. Where they go depends on what happens within receiving countries, their governments, their values, something donors cannot control.
Furthermore, expanded authorization doesn’t preclude distributing vaccines to other parts of the world. The Biden Administration intends to share with other countries up to 60 million doses of the Oxford-AstraZeneca vaccine. That plan is left untouched by teenagers’ new access to Pfizer-BioNTech and soon Moderna. Globally, there are untapped supplies of multiple COVID-19 vaccines, and manufacturing is ramping up. While vaccinating our teens will make a meaningful move towards herd immunity in the U.S., it won’t make a meaningful dent in global vaccine supply. Globally, the doses amount to a drop in the bucket; domestically, a potential sea-change.
Finally, the ethical perspective that simply compares risk–benefit profiles of would-be recipients in low-vaccine-access countries to those of American adolescents omits something important—these kids are our kids. As we have previously argued, a just distribution of coronavirus vaccines can reflect associative ties of community membership and leaders’ commitments to their own citizens. This is not to say that America’s teens deserve protection more than vulnerable adults in other countries. It does not mean they matter more. Instead, it is to recognize that we have special obligations to take care of our own.
Unlike general obligations, which we owe to any and all persons, special obligations arise from our particular identities, relations, and roles. These youths belong to our community. We are their caretakers. And our leaders are charged with protecting our community as a whole. Vaccinating them protects our community. Far from being morally absurd, vaccinating America’s teens is morally necessary.