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When Nicole Myers, 48, learned in December that she would be among the first Coloradans to receive a COVID-19 vaccine, she felt elated—and extremely surprised. As a labor and delivery nurse who has limited contact with COVID-19 patients, Myers had believed she would get the shot months after her higher-risk ICU and emergency department colleagues at Lutheran Medical Center—not simultaneously.
Though Myers’s early eligibility confused her, she signed up for the shot as soon as she could and received her first dose before Christmas. Then came the guilt.
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Today, Myers says she regrets her initial eagerness to get vaccinated. If she had known how much others would struggle to obtain what was easily handed to her, she would have waited. She thinks about the fact that while she is technically a frontline worker, she sees just one or two patients a day. That, to her, feels like far less exposure than what many still-not-vaccinated Coloradans—teachers, grocery store employees, hairdressers—face at work. Myers also feels guilty that her dad in Missouri, who, despite being 78 and on “like four waitlists,” has yet to get a shot, she says.
Myers isn’t the only Centennial Stater wrestling with COVID-19 vaccine guilt.
There is not any data on the prevalence of vaccine guilt, but Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at University of Colorado’s Anschutz campus, surmises that many people who have already received the COVID-19 vaccine probably feel like their doses could have gone to someone more deserving. “I think it’s a really common phenomenon,” he says. Wynia would know: He too experienced guilt when he got vaccinated in December, an opportunity afforded by chance. (As an academic, Wynia’s contact with patients is typically limited to one afternoon a week, but when the vaccine rollout began, he happened to be in the midst of a two-week in-patient service, which qualified him for a shot.)
Vaccine guilt makes sense. COVID-19 shots are still a scarce resource—less than 13 percent of Coloradans have been inoculated, according to February 5 data—and the rollout has been rife with inequities. Statewide, residents of color are being vaccinated less than white residents, according to the most recent available data from the Colorado Department of Public Health and Environment (CDPHE). (Of note: While the state has asked all health providers to at least ask people receiving vaccines for race and ethnicity information, patients aren’t required to provide it.) A January analysis showed that Denver’s wealthier, whiter neighborhoods have higher vaccination rates than the city’s low-income and minority communities. And Coloradans who are incarcerated and those experiencing homelessness are not currently prioritized for shots, despite being considered high risk for contracting the virus. Governor Jared Polis and state health officials recently initiated efforts to reduce racial and socioeconomic disparities, though the impact of those actions is yet to be seen.
So if you’re a Coloradan feeling unworthy about your place in the vaccine queue, the solution might seem simple: Just step back in line. But according to ethicists interviewed for this article and others, that decision won’t actually do much good, for you or for society. In fact, it could be harmful.
That’s because of the way the vaccine distribution is set up.
“If you could take the vaccine dose and walk across the street and give it to your elderly neighbor, then I would say you should do that,” says Wynia. “But you can’t. That’s not an option.” Instead, vaccine doses are distributed in bulk to health systems that are charged with getting shots into arms according to the state’s prioritization categories, which lump hundreds of thousands (and in some cases, millions) of Coloradans into the same group.
These groups—people over 70, Coloradans aged 65 to 69, frontline essential workers, etc.—contain inherent unfairness. That’s because they are “not as nuanced as life is,” explains Wynia. Not all people 70 and over, for example, are at the same risk for catching the virus. A 78-year-old grocery store worker is going to be at much higher risk than a 70-year-old retiree who can stay at home. Yet these two individuals are prioritized simultaneously because it’s just not possible to create a perfectly fair line that orders all Coloradans by their precise risk level. So if you decline the vaccine when it’s your turn, it won’t necessarily go to someone else who needs it more; it will simply go to whoever is next in line, explains Wynia.
Another way to think about it is that by accepting a vaccine, “you are not taking away a dose from anybody who wants it more,” says public health ethicist Daniel Goldberg, PhD, JD, associate professor at University of Colorado’s Anschutz campus. Goldberg says that most of his colleagues who have discussed the topic form an agreement: Given the way the vaccines are allocated, it is “ethically permissible” for you to take one if offered. Even if it feels unfair. Goldberg also points out that getting a vaccine isn’t a solely selfish act. Yes, you will aggregate most of the benefits yourself, but you will also contribute to herd immunity, he says, which is ultimately what is needed to end the pandemic.
The one caveat is if you deliberately jump the vaccine line—like a couple from Vancouver did when they flew to a predominantly Indigenous community in Canada’s Yukon Territory, ignored quarantine rules, and pretended to be locals in order to get shots. “There is a difference between accepting and even taking advantage of unfairness that exists, and creating unfairness,” says Wynia. “We all have an obligation to try not to create unfairness.”
Just because you’re offered a vaccine doesn’t mean you have to take it, Goldberg points out. “You might choose as a personal exercise of conscience not to do it,” he says. “And that’s, of course, perfectly reasonable. That’s up to you.” Such a decision, however, isn’t without risks.
An obvious risk of declining a vaccine is that you could contract COVID-19, says Wynia. Even if you don’t get terribly sick, you could still suffer long-term symptoms. About 10 percent of people who contract COVID-19 experience prolonged illness, according to a study by British researchers. You could also spread the virus to others, which yes, you could possibly do if you’re vaccinated (the vaccine isn’t 100 percent effective, and we can’t yet say that vaccination prevents asymptomatic spread). But the best available data suggests this would be very rare, says Wynia.
Another downside of declining the vaccine: You would contribute to statistics that show X percent of people in your prioritization group didn’t take the vaccine, explains Wynia. Even though you declined because you felt others were more deserving, the data will likely be interpreted as vaccine hesitancy. That could send a harmful message at a time when the majority of Americans (51 percent) remain reluctant about vaccination, according to a recent Kaiser Family Foundation survey.
Yet, despite compelling reasons to take a vaccine when offered, you may still feel guilty. Myers, the labor and delivery nurse, can relate. She realizes that by getting the vaccine, she did her part to help stop the spread. She also acknowledges that if she were to go back in time and decline her shot, she wouldn’t be able to give it to someone she deemed more deserving. Still, the guilt lingers, and it’s strong enough to stop her from broadcasting her inoculated status.
“My hospital wanted to make ‘I got vaccinated’ T-shirts for everybody,” she says. “I’m like, I don’t know if I would wear that.”
Is there anything beneficial you can do with vaccine guilt?
Yes, says bioethics researcher Govind Persad, JD, PhD, assistant professor at the University of Denver Sturm College of Law. He suggests identifying which Coloradans you think should be ahead of you in line—for example, Coloradans of color, people in prisons, those experiencing homelessness—and taking actions to try to move them up in the queue. That could mean joining volunteer efforts to physically bring vaccines to marginalized and vulnerable communities. Or contacting Coloradans in areas that have been hard hit by COVID-19—which include a disproportionate number of Black and Latino communities—and helping eligible residents sign up for a shot.
You could also call the governor or your local representatives and ask that the prioritization system contain more nuance, so that the most vulnerable Coloradans get shots as quickly as possible, Persad suggests. You could petition, for example, for people over 70 who are diabetic to have earlier access to the vaccine than those who are over 70 with no comorbidities. Or request that Coloradans who live in zip codes where the average life expectancy is lower than average be given earlier vaccine access than those in high life expectancy zip codes. Such actions, Persad believes, could help improve rollout policies without sacrificing speed.
“There are things that we can all do” to alleviate the underlying inequities in the health system, says Wynia. Just remember: No matter how guilty you feel, giving up your spot in the vaccine line isn’t one of them.