For some, vaccination poses a moral dilemma: Do I wait so others can get their shot?

The advice of public health officials is unequivocal: If you’re eligible for a COVID-19 vaccine, get one as soon as possible.

But for Tracey Brooks in Stoney Creek, Ont., the situation isn’t so simple. The 50-year-old mother of five would likely qualify for one because she has an autoimmune disorder and is the caregiver to her son with Down syndrome.

But as a homemaker in a small community, Brooks said she has the luxury of being able to live “off-the-grid,” when many front-line workers have to put themselves at risk every day in order to earn a living.

Given that vaccine supplies are limited, Brooks said she’s been wrestling with an ethical dilemma: Should she book her appointment, or leave a slot open for someone else with a greater risk of exposure?

“I feel that other people who basically need it more for their daily life would be best off to have it first,” she said. “Where do I fit in the eligibility?”

The disparities of Canada’s piecemeal vaccine rollout has created a crisis of conscience for some Canadians who are considering delaying their shots to ensure there are enough doses for people they believe to be more deserving.

At the crux of this conflict are two competing moral imperatives, say ethicists. For every person who gets vaccinated, we are that much closer to bringing the COVID-19 crisis under control. But with shots still being rationed, people need to wait their turn to protect those at the highest risk.

Personal factors may be part of this ethical equation, some experts say, but there are also systemic forces at play that make it hard for individuals to make informed decisions in the interest of the collective good.

It’s commendable that some Canadians want to put others’ needs before their own in deciding when to get their vaccines, said Maxwell Smith, a bioethicist at Western University and member of Ontario’s Vaccine Distribution Task Force.

Despite these good intentions however, the reality is that some of these personal sacrifices may not serve the broader goal of protecting the community, he said.

“These strategies have been devised to make sure we’re really getting the best bang for our buck.”

For example, said Smith, it may seem counterintuitive that under Ontario’s framework, a healthy young person who works from home in a COVID-19 hot spot would qualify for vaccination. But when you zoom out to the community level, he said, that risk calculation changes.

“When people are being invited to become vaccinated, it’s (not only) because we think it’s important that they themselves are protected,” said Smith.

In high-infection regions where hospitals are already strapped for resources, maximizing the number of residents who are immunized could be crucial to preserving critical care capacity, he added.

Immunization decision-makers, Smith notes, have been charged with designing a strategy that will reduce the disease’s death toll, alleviate strain on the health-care system, account for racial and social inequities, manage supply chains, and eventually, achieve herd immunity.

However both policy-makers and individuals have the moral capacity to contemplate their role in the bigger picture, says University of Toronto bioethicist Kerry Bowman, and these considerations can be more complicated than checking off eligibility criteria.

“Let me be clear: If you’re called up, I do not see an ethical problem with getting it,” he said. “Having said that, I really respect that it’s a question of personal conscience as to whether you feel you should be getting it right now or not.”

Canada’s vaccine rollout has reached a morally murky juncture where wider swaths of the population qualify for the vaccine, but the order of the lineup has become more jumbled, said Bowman.

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Many jurisdictions have broad vaccination guidelines that leave room for interpretation, he said. This allows people to factor in personal circumstances, Bowman said, but also creates openings for opportunism.

For every person holding off on getting vaccinated on ethical grounds, there are others devising ways to game the system in their favour, Bowman noted.

In deciding when to get vaccinated, Bowman said it’s important to consider not only the letter of the eligibility requirements, but the “spirit” of the public health priorities they’re meant to serve, chief among them being protecting the most vulnerable.

“The big wake-up call for all of us since the pandemic began is that the rights and choices of the individual are not the most important thing. It’s actually the well-being of society.”

But Toronto nurse Nick Tsergas believes most people tend to underestimate their own level of risk, and the danger they could pose to their families and communities.

Based on his experience on the front lines of the COVID-19 fight, Tsergas says Canadians have a duty to book the earliest appointment available to them.

While several of his patients have expressed concerns that getting their jab would mean taking one away from someone who needs it more, the fact remains that most Canadians remain vulnerable to COVID-19, said Tsergas.And with more contagious variants sending younger patients to hospital, the threat of severe outcomes extends across the population.

He entreated everyone who is eligible to exhaust all legitimate avenues to get their shots, and encourage their friends to do the same.

“Don’t feel guilty,” he said. “Get angry and get noisy, and help people around you recognize that the best thing they can do is go and get vaccinated as soon as possible.”

This report by The Canadian Press was first published April 15, 2021.

Note to readers: This is a corrected story. A previous version erroneously attributed a quote about balancing the well-being of the individual versus society to Western University bioethicist Maxwell Smith. In fact, the quote was stated by University of Toronto bioethicist Kerry Bowman.

TORONTO STAR

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