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The (im)morality of line-jumping to get COVID-19 vaccines

Driven by “selfishness and fear,” many Americans are jumping the vaccination line with an elbows-out, I-deserve-it-more attitude.

Signage directs frontline workers to the Eugene J. McCaffrey College Center at Rowan College of South Jersey where vaccinations are taking place.
Signage directs frontline workers to the Eugene J. McCaffrey College Center at Rowan College of South Jersey where vaccinations are taking place.Read moreALEJANDRO A. ALVAREZ / Staff Photographer

Rich, white New Yorkers flock to a low-income Dominican community and crowd out neighborhood people awaiting COVID-19 vaccinations in a cynical moment of intracity vaccine tourism.

Former 76ers basketball great Charles Barkley tells the world that NBA players “deserve some preferential treatment” in getting vaccinated because they pay such high taxes.

A Manhattan SoulCycle spin instructor whose followers include Madonna and Kelly Ripa announces she’s an “educator,” and therefore more worthy of getting a shot than, well, just about anyone else.

Driven by “selfishness and fear,” many Americans are jumping the vaccination line with an elbows-out, I-deserve-it-more attitude, say ethicists and medical observers.

The evidence is anecdotal. But there’s no doubt that when demand is high and supply is limited, people are capable of outrageous self-regard, experts say.

» READ MORE: Pharmacies soon will offer COVID-19 vaccines to seniors in Philadelphia. No options yet for the homebound.

“It’s completely unsurprising, but totally disappointing,” said Holly Fernandez Lynch, a lawyer and professor of medical ethics at the University of Pennsylvania. “We’re seeing an absolutely unethical gaming of the system: ‘If you don’t find loopholes to help yourself,’ people say, ‘you’re the sucker.’

“It’s all pretty horrible.”

Lots of Americans, not a lot of vaccine

Right now, according to AARP, the top three vaccine-priority groups are health-care personnel and long-term care facility residents (numbering 24 million people); frontline essential workers, as well as those ages 75 and older (49 million); and Americans who are ages 65 to 74, or ages 16 to 64 with high-risk conditions, as well as other essential workers (129 million).

That adds up to 202 million people, leaving an additional 131 million out of the count. And, of the 202 million designated as “priority,” fewer than 30 million actually have been vaccinated so far, data from the U.S. Centers for Disease Control and Prevention show.

That means a lot of Americans are coveting a vaccination they may not see for a while.

So, it’s no surprise, for example, that moneyed folks have offered tens of thousands of dollars to their doctors for a syringe dripping with life-sustaining liquid manufactured by Moderna or Pfizer, according to Fernandez Lynch.

» READ MORE: RNA vaccines have never been manufactured before, so making millions of doses was bound to take time. Here’s how it’s done.

States such as New York are threatening the licenses of physicians who participate in these schemes. But it’s hard to police. And who’s to stop hospitals, such as the one in Augusta, Maine, where officials dangled injections to big-time donors?

We’ve long demonstrated ourselves to be “self-interested, rugged American capitalist individualists,” noted Fernandez Lynch, cheating on taxes, doping out ways to get ahead, and grabbing up all the toilet paper in the grocery store at the first hint of trouble.

That “I’ll do whatever it takes” ethos, Fernandez Lynch said, was epitomized by people like actress Lori Loughlin, who pleaded guilty to one count of conspiracy to commit mail and wire fraud in the nationwide scandal of rich parents trying to buy slots for their kids in big-time universities.

In North Philadelphia, healthy people are constantly asking Charito Morales, a registered nurse and widely known neighborhood advocate, to connect them to someone with available vaccine.

» READ MORE: In Philly, only certain health problems get you to the front of the COVID-19 vaccine line

“Philly is small,” Morales said, “and people know I have resources and contacts. One city employee wanted me to get them the vaccine for their parents, just so they could travel.

“‘No! Wait till it’s your time,’ I tell them,” Morales said. “This is just entitlement among people. And let me be clear: It’s not just whites. We can blame this one on all kinds of people being ignorant.”

Such behavior is abhorrent, said Usama Bilal, a Drexel University epidemiologist, not only because it’s unjust and immoral, but because “it builds mistrust and makes the jobs of health departments vaccinating us that much harder.”

‘People will scam’

The truth is, when you have a scarce resource like the vaccine, “people will scam to get it,” said Al Sacchetti, director of clinical services in the emergency department of Virtua Our Lady of Lourdes Hospital in Camden.

Speaking on the day he vaccinated dozens of residents at a New Jersey site he declined to reveal, Sacchetti said that healthy 30-year-olds will lie about being sick to get vaccinated. “Their ethics are, ‘Why inject an 88-year-old who won’t live long while I’ll live another 50 years?’ ” Sacchetti said. “ ’Better spend resources on me.’ ”

This kind of thinking has consequences.

When people buck the line, it means they’re taking the vaccine out of someone else’s arm, ethicists tell us.

“The perspective of ‘I might as well do what I can to get the shot’ pushes aside the high-risk people in nursing homes and prisons,” said Art Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine.

» READ MORE: COVID-19 vaccine rules spark confusion for some in Philly. Others are jumping the line.

Pulmonary and critical care physician Douglas White, director of the Program on Ethics and Decision Making in Critical Illness at the University of Pittsburgh School of Medicine, agreed: “Every person who is young or healthy who’s line-jumping is taking away the vaccine from someone more likely to die from COVID.”

Some have argued that age or frontline status shouldn’t even matter. All people should be offered the shot, because the goal should be to achieve herd immunity, which occurs when enough people become immune to a disease to make its spread unlikely.

That kind of thinking is “complete nonsense,” said White, and Caplan agreed:

“Telling Grandma, ‘Don’t worry, even though you didn’t get vaccinated, I did,’ is not the right stance to take,” Caplan said. “It’s just a rationalization for selfish behavior.”

Caplan said the ethics of vaccinating would be better served if sites had improved plans for how to utilize excess vaccine. When he received his second shot (Caplan is 71), he said, “I saw firsthand, they had too much and they were looking to get anybody to have the vaccine, instead of trying to find someone suffering with asthma or something.”

Such extra care would avoid the haphazard distribution of the precious commodity to just anyone, as in the case of the ill-fated vaccination organization Philly Fighting COVID, when the group’s leader, Andrei Doroshin, admitted to taking doses home and injecting his friends.

» READ MORE: The city trusted a group of ‘college kids’ to lead its vaccine rollout

Ultimately, queue-jumpers engage in “unjust” behavior because they have forgotten what they had learned as children: Cutting in line is “shameful,” said Nancy Berlinger, research scholar at the Hastings Center, an independent research institute on bioethics in Garrison, N.Y., north of New York City. “It’s also unethical because it’s a deception.”

If people are ever confused about the morality of pushing to the head of the vaccination line, suggested Fernandez Lynch of Penn, they should take her easy litmus test: “Would you be proud to tell your own children what you did?”