Vaccination, Conscience and Choice Ross Jones SJ

There seem to be at least three broad categories of objections to compulsory vaccinations against COVID-19. 1 Risk

Because the development of the anti-COVID vaccines has been relatively recent, there are some who are anxious about potential and unknown risks associated with a new medication. Understandably. What if a particular vaccine has side effects which have not yet had time to manifest themselves? The same reservations have been raised with the advent of vaping and its rather speedy legislative approval. How could we allow people (especially the young) to vape when no one has assessed any long-term risks? There are genuine concerns that, although authorised by relevant medical bodies, the approval process was (by necessity) much quicker than it might normally be. However, prior to their release, the vaccines (at least the ones in the western world) have been subjected to trials by respected government/medical agencies apropos their use generally, or by different age groups. Testing continues – the use of Pfizer and Moderna have recently been approved for use for children from 12 years of age. Of course, no amount of screening can give absolute assurance, but the most stringent processes have been engaged. There is – sadly and maliciously – a great deal of misinformation being put about concerning vaccinations in social media. They claim, for example, they will make women sterile, or that the acknowledged side-effects (such as blood clots) are more likely to be encountered than the authorities are prepared to admit, or (more extremely) they kill more people than the number dying of COVID itself1 , or it is all part of a plan to “reset the global economic system”. Recently, groups have altered some QR codes to shops or businesses, directing the scanner to anti-vaxing websites. This is a minority group, but still significant enough to “spook” some people.

1 In Australia to the end of August, there have been 293 reports of myocarditis/pericarditis with Pfizer out

of 9.4 million doses (single shots) administered (0.0003%), and, with AstroZeneca, out of 9.6 million doses administered, 125 cases of thrombocytopenia (0.0001%) and 9 deaths (0.00001%). (Note: more than one thousand people have died of COVID in Australia since the pandemic began.)

2

Anxiety about vaccines is not confined only to the recent context of COVID. Australia has known movements of anti-vaxxers concerning compulsory childhood vaccinations in recent decades. But open any box of medication – prescribed or ‘over-the-counter’ – and one will find a list of possible side-effects to be alert to. This is something we live with day-to-day with medications. Of course there is always a measured/tolerable risk involved. But the COVID situation is more than just “risk to me”. Here there is a risk that is asked for a greater good. That is what it means to be a responsible member of a community. The fewer the number of people vaccinated in a population, the greater the chance of mutants like the Delta strain emerging. So the anti-vaxxer is prepared to “stay safe” and thereby not contribute to the group as a whole. That is, to let all the others take the risk, so that they can ride into herd immunity on the shirt-tails of the risk-takers. This could be construed as an act of selfishness as well as of fear. A final consideration. Whilst figures vary in daily reports, the vast majority of COVID patients in intensive care in NSW are unvaccinated.2 Antivaxxers therefore might consider the burden their choice puts on an over-stretched hospital system (ICU beds are needed for others with critical illness), the clear toll it is taking on exhausted doctors and nursing staff, to say nothing of the impact on the government’s healthcare budget. Pope Francis recently described getting a vaccine as “an act of love”. It is “a simple yet profound way to care for one another, especially the most vulnerable,” he said. 2 Moral Positions

Some in the Catholic tradition (though not exclusively so) have been concerned about the origins of the cell lines used to produce some of the vaccines. Such considerations have long been explored by Catholic moral theologians. But in the current COVID crisis, the moral dilemma has come more strongly to the fore. Perhaps because, as a pandemic, the choice to be vaccinated is facing more people. The moral concern hinges upon the use of so-called “cell lines” derived from aborted foetal tissue, in particular HEK293, a kidney cell line that was isolated from a terminated foetus in 1972. AstraZeneca has used HEK293 for each step in design and development, then production, and then confirmatory laboratory tests. Moderna and Pfizer used HEK293 cell lines for the confirmatory laboratory tests only.

2 From 16 June to 21 August this year in NSW hospitals ICUs, only 0.8% patients were unvaccinated and

14.1% partially vaccinated.

Reflection 1

Imagine a little rural NSW village surrounded by bushfires eighteen months ago. The villagers meet at the town centre to prepare a firebreak. “We need everyone who is able-bodied to build the firebreak effectively, though it could be dangerous,” says the Rural Fire Brigade Captain. All the fit and able people immediately start to put on the orange overalls. All except for two who say, “It’s too risky, we might get burned.”

3

The moral question has been raised: Is the development, the provision, or the use of such products “tainted” by the source of the material? Are the researchers, the healthcare professionals, or the recipients, complicit in a morally evil act perpetrated a half-century ago? This is, in fact, a consideration broader than just anti-COVID vaccines. For years vaccines have been available and employed against chickenpox, rubella, hepatitis A and rabies – all derived from such cell lines, but mostly without wide controversy compared to the present. The simple response to this is that the abortion was not carried out to procure those cell lines. This is not “doing evil to achieve good”. It is akin to a person who has pledged to be an organ donor, being murdered by someone in a rage. His/her organs are used in life-saving transplants. The organs are not ‘tainted’. The evil of the murder is independent of the harvesting of organs. ‘Intention specifies reality’ in moral choices. In November last year, the Chair-Bishops of the US Conference of Catholic Bishops (USCCB) Committee on Doctrine and also its Committee on Pro-Life Activities both stated it was not immoral to be vaccinated with Pfizer and Moderna vaccines. They said:

Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development or production. … They are not completely free from any connection to abortion, however, as both Pfizer and Moderna made use of a tainted cell line for one of the confirmatory lab tests of their products. There is thus a connection, but it is relatively remote. … Some are asserting that if a vaccine is connected in any way with tainted cell lines, then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching.

They were echoing the Vatican’s Pontifical Academy for Life, which in 2017 issued a Note on Italian Vaccine Issue, which stated:

The cell lines currently used are very distant from the original abortions and no longer imply that bond of moral cooperation indispensable for an ethically negative evaluation of their use.

Then the Congregation for the Doctrine of the Faith released a Note on the morality of using some anti-Covid-19 vaccines in December 2020. In that document the Congregation said:

When ethically irreproachable Covid-19 vaccines are not available (e.g. in countries where vaccines without ethical problems are not made available to physicians and patients, or where their distribution is more difficult due to special storage and transport conditions, or when various types of vaccines are distributed in the same country but health authorities do not allow citizens to choose the vaccine with which to be inoculated) it is morally acceptable to receive Covid-19 vaccines that have used cell lines from aborted fetuses in their research and production process. [Original italics]

4

The Congregation further argued that:

The fundamental reason for considering the use of these vaccines morally licit is that the kind of cooperation in evil (passive material cooperation) in the procured abortion from which these cell lines originate is, on the part of those making use of the resulting vaccines, remote. The moral duty to avoid such passive material cooperation is not obligatory if there is a grave danger, such as the otherwise uncontainable spread of a serious pathological agent – in this case, the pandemic spread of the SARS-CoV-2 virus that causes Covid-19. It must therefore be considered that, in such a case, all vaccinations recognized as clinically safe and effective can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive. It should be emphasized, however, that the morally licit use of these types of vaccines, in the particular conditions that make it so, does not in itself constitute a legitimation, even indirect, of the practice of abortion, and necessarily assumes the opposition to this practice by those who make use of these vaccines. [Original italics]

Then, while respecting that some in good conscience might choose not to use such a vaccine, such a decision also came with a moral responsibility and certain consequences for them:

At the same time, practical reason makes evident that vaccination is not, as a rule, a moral obligation and that, therefore, it must be voluntary. In any case, from the ethical point of view, the morality of vaccination depends not only on the duty to protect one's own health, but also on the duty to pursue the common good. In the absence of other means to stop or even prevent the epidemic, the common good may recommend vaccination, especially to protect the weakest and most exposed. Those who, however, for reasons of conscience, refuse vaccines produced with cell lines from aborted fetuses, must do their utmost to avoid, by other prophylactic means and appropriate behavior, becoming vehicles for the transmission of the infectious agent. In particular, they must avoid any risk to the health of those who cannot be vaccinated for medical or other reasons, and who are the most vulnerable. [Italics original, bolding by the author]

Despite the aforementioned USCCB statement of November 2020 and now this Congregation statement, the Archdiocese of New Orleans in February 2021 broke ranks, stating:

It is under the same guidance that the archdiocese must instruct Catholics that the latest vaccine from Janssen/Johnson & Johnson is morally compromised as it uses the abortion-derived cell line in development and production of the vaccine as well as the testing.

Some other American bishops share this position. In this regard, Professor M. Therese Lysaught from the School of Medicine, Loyola University Chicago (and a corresponding member of the Pontifical Academy for Life) wrote:

I fear that in the zeal to advance the cause against abortion, outdated advice on Catholic teaching may have inadvertently led this handful of bishops to take a position that is –

5

ironically – anti-life. What might have led them to articulate a position that urges Catholics to privilege a theoretical moral purity over the value of their own lives, the lives of others and the common good?

To complicate matters further, the National Catholic Bioethics Centre (NCBC) in December 2020, asserted there was an ethical hierarchy among the vaccines based on how close they were to the original fifty-year-old foetal cell lines in their development or testing. But the Pontifical Academy in 2017 suggested that all contemporary vaccines “are very distant” from the two original sources. Using a planetary analogy in critique of the NCBC’s analysis, Lysaught suggested:

Jupiter is less remote to us than Saturn or even the Pluto, but none are proximate in any meaningful way. Likewise for these vaccines. Thus, this putative "ethical hierarchy" is based on distinction without a moral difference.

However, there is one final good example: Pope Francis was himself vaccinated in March, saying at the time that it was an ethical obligation. 3 Freedom

Tuberculosis (TB) was, last century, a significant cause of death in Australia. From 1956 compulsory chest x-rays were expected in NSW with a fine of £20 (twenty pounds) for non-compliers. For those who objected to the risk of radiation, or for other medical reasons, a Mantoux skin test was the alternative. This “compulsion” was for the common good. The result was that TB had been effectively eliminated in Australia by the mid-1970s and the mobile X-ray caravan clinics were no longer to be seen in the suburbs. Furthermore, up until relatively recent times, international travellers were meant to have a World Health Organisation International Certificate of Vaccination, commonly known as “the yellow card”. Australians travelling overseas had to show evidence of vaccination against such diseases as smallpox, hepatitis, cholera, yellow fever, etc, at the times of departure and re-entry. If you went to a country that was known for, say, yellow fever, and you were not vaccinated, you faced quarantine. These examples illustrate that Australia has a long history of expectations concerning community health. Considerations of obligation concerning COVID vaccinations are nothing new. In a western democratic country, we all esteem freedom. Catholic theologians also teach that free will is the quality that sets humans apart from all other animals. But like all rights, freedom

Reflection 2

Imagine you were that HEK293 person, now in heaven, in God’s lasting embrace. And you were looking down on the world, which you never had the chance to enjoy. But it is still part of the Kingdom whose fullness is now your experience. What would you say, if you could, to someone who asked, “Should I use these derivative cell lines, even given their dark provenance?”

6

is conditional. We have freedom of speech, but not freedom to slander or libel. We have freedom of assembly, but not to form a terrorist cell. We have freedom to compete in sport, but not if we refuse (at some levels) to comply with performance-enhancing drug tests. There are some who claim that compulsory vaccination infringes upon one’s freedom, one’s civic rights or liberties. Dr Simon Longstaff, Director of The Ethics Centre (and Old Aloysian), has made a helpful distinction. He suggests there is a failure to distinguish between three types of requirements: compulsory, optional and conditional. Longstaff says:

Compulsory requirements are enforced — and those that contravene are subject to punishment. There are very few compulsory requirements in liberal democracies. Examples in Australia include: the requirement for children to be educated (e.g. attend school) … Most recently, we have had genuinely compulsory ‘lockdowns’. If you fail to abide by the rules, then you are subject to formal punishment by the state. Optional requirements leave each person to decide whether or not to engage in the specified activity — without consequence. As such, they are generally held to be uncontroversial. Conditional requirements are far more common. Typically, they are in the form of: ‘if … then’. For example, ‘if you wish to drive a car … then you must be licensed to do so’. Or, ‘if you wish to enter this mine … then you must wear safety equipment’. As will be evident, no person is required to drive a car or enter a mine site. To do so is a matter of choice. In this lies the principal difference between ‘conditional’ and ‘compulsory’ requirements.

Conditional requests are not made lightly. Coercion for the individual’s own good is not sufficient to make a condition. “No man is an island,” the poet John Donne suggested. Conditions are made not so much for the person, but for others. Will an unvaccinated person infect others? Will their refusal to wear safety equipment put others (fellow workers or the employer) at risk? Will the smoker in a public building be a hazard to “passive smokers”? Or, to choose an example apart from health concerns, will the scantily-clad visitor to a mosque or St Peter’s Basilica be allowed to offend the cultural/religious sensitivities of other worshippers? We have certain rights, but we also have responsibilities. Is there room for conscientious objection3? Of course, yes. But in so choosing, the consequences of our choices must be accepted. Like martyrs for their religious faith. More locally, like conscientious objectors to National Service in Australia during the Vietnam War being sent to military prison. Or people objecting to compulsory voting in Australia having to pay a fine. In the case of Covid vaccinations, the consequence of such objection might be that you cannot work in an aged-care facility or teach on-site in a school without vaccination. But there also remains the onus on an employer to explore how such an employee might continue to fulfill their duties in other risk-free ways.

3 Interestingly, the phrase “conscientious objector” arose in late-19th century England to describe those who

refused smallpox vaccinations for their children on religious or other grounds.

7

Considering this issue, the ACU/St Vincent’s Hospital’s Plunkett Centre for Ethics has put it this way:

Employees are entitled to refuse vaccination, but they are not morally entitled to continue to work in a job that puts others at risk. That being said, employers should only dismiss non-vaccinating employees as a last resort. Efforts should be made to find a resolution that accommodates for the non-vaccinating individual while not putting others at risk (e.g., paid leave, redeployment).

To Conclude

Coming to any moral choice engages the head and the heart. It invites approaching the question with indifference – a disposition to consider all the issues freely. It requires gathering the necessary data from all sources, sacred and secular. Discerning vaccination in this pandemic, then, might have each person consider three questions. Are my choices to be made in fear, ignorance or even selfishness? Is my moral code to exclude reason? Do my cherished freedoms also have social dimensions?

Reflection 3

“People have to be willing to bear the consequences of their objection (to vaccination), they cannot impose those consequences on others. This is a crucial — and unacceptable — moral difference from a Catholic perspective. We are allowed to accept martyrdom for ourselves, if God so calls us; we are not allowed to martyr others. [If people’s objection to vaccination] helps impede the achievement of herd immunity and helps to fuel the development of new variants, many others will bear the costs of their exemption as well.” – Prof M Therese Lysaught