4 questions to help sort through the ethics of getting a COVID vaccine before you’re eligible

A sign reads covid-19 vaccine near people standing in line.
People stand in line to receive COVID-19 vaccinations in January at the Earle Brown Heritage Center in Brooklyn Center, Minn.
Christine T. Nguyen | MPR News file

By now, lots of people have gotten one: A tip about a nearby pharmacy that doesn’t appear to be checking the eligibility of the folks in its COVID-19 vaccination line. A text with a link to a clinic that isn’t asking questions about underlying health conditions.

Or maybe you’ve heard through the grapevine that friends or family members are signing up for a shot, even though they don’t meet state and federal eligibility requirements. 

Should you sign up, too?

It’s an ethical quandary many people are facing as Minnesota expands access to — and eligibility for — the COVID-19 vaccine. 

In just a few months, the number of doses of the three available COVID-19 vaccines has grown dramatically in Minnesota. The array of places people can get vaccinated has, too. Pharmacies, health care providers, county public health departments and even churches are standing up vaccine clinics around the state.

But the parameters for eligibility at each site — the matrix of age, health conditions, location and occupation that make people eligible for the vaccine — can vary, sometimes outside the bounds of the state’s requirements. That’s often due to a host of factors, including the organization or entity distributing the vaccine, who a clinic or site is intended to serve, and whether the particular vaccine stock has come from the state or federal governments. 

Complicating matters is a state rule that requires doses to be used quickly. That time constraint, established to speed up vaccination, has led some places to offer broader flexibility in vaccine eligibility, to keep pace. 

So: Outside of a call from your doctor or an alert from the state vaccine connector, when is it OK to sign up to get a vaccine — especially if you don’t fall within the eligibility rules the state has set out?

‘Participation in the common good’

In general, University of Minnesota bioethicist Joel Wu says, the answer straightforward: If you aren’t eligible to get a vaccine according to those state rules, you should wait your turn. 

That’s especially true as vaccine demand continues to outpace supply. The state’s phased eligibility approach was designed to prioritize vaccination for people at the highest risk of getting severe cases of COVID-19. 

Because of that, Wu said, a person’s decision to jump the line to get a vaccine for which they’re not yet eligible comes down to pitting individual desires against our obligations to society at large. 

“There really needs to be a reawakening in the idea of participation in the common good, where each of us have to play our part to be healthy and safe together,” he said. 

Wu likens it to driving haphazardly.

“You don’t get to drive any way you want, because even if a fraction of a percent of people don’t honor red lights, then the entire enterprise of traffic falls apart,” he said.

But sometimes — because of circumstance, timing or serendipity — people find themselves confronted with the question of whether to skip the line and try to get vaccinated before their turn.

If you find yourself in one of those cases, here are four questions to ask:

1) Do you have access to this shot because of privilege — or your position in society?

The state has a lengthy, detailed plan to vaccinate as many Minnesotans as possible, but it’s happening in phases, putting people at highest risk of getting, spreading and dying from COVID-19 at the front of the line. 

That includes older people; people with underlying health conditions that put them at higher risk for a severe case of COVID-19; people whose work puts them at higher risk of getting the virus on the job; and people living in congregate care. 

Young, healthy people are being asked to wait a bit longer for their shots. 

But Wu said things get dangerous when people don’t all agree to adhere to that plan — because, then, the plan stops being useful, and it stops being fair.

“The people who don’t need [the vaccine] and are at a lower likelihood of being harmed may get more of the doses, and the people who are the least privileged and have the least access will bear the greatest burden,” Wu said. 

In the real world, Wu said, this can look like someone who has the means and the time — because they work from home, for instance, or have easy access to a computer or the internet — to seek out and get signed up for a vaccine for which they’re not eligible.

Or it can look like someone who has easy access to transportation, who can get to a vaccine location on short notice. 

It can also manifest in social connections — if you have a friend or family member in a position to fit you in for a vaccine appointment at the end of the day. 

If these factors play into a scenario in which you’re able to get a vaccine, the ethical thing to do is wait, Wu said. 

2) Would your life change significantly if you waited until you’re officially eligible?

If presented with the opportunity to get a vaccine, Wu said, consider whether waiting a few more weeks to get a shot will make a huge difference in your life. And consider whether getting a shot today that’s meant for someone who is at higher risk could put them in harm’s way. 

Ask: “Am I using a particular kind of access or privilege I have that only marginally benefits me, but might hurt a lot of other people more?” he said. 

“If it’s not going to help me that much, and in the long run it’s going to make the circumstances less fair, and high-risk people stay at a higher risk for longer, I think that’s ethically problematic.”

And keep in mind: Younger, healthy people won’t have to wait much longer for a vaccine.

By all accounts, vaccine allocations are likely to increase dramatically in just a few weeks. State health officials have said it’s probable that Minnesota will be getting 100,000 doses of the Johnson & Johnson vaccine soon. 

And the eligibility groups will continue to expand. State officials have said every adult who wants a vaccine will likely be eligible by April. 

3) Do you have to lie or otherwise be vague about your status to get the vaccine?

The state has clear guidance on who is eligible to be vaccinated right now, and providers across the state are generally following it.

There are exceptions, in which some providers — including some pharmacies and clinics,  federally qualified health centers, Veterans Affairs clinics, Indian Health Service facilities and sovereign Native nations — operate under different sets of rules, laid out by, for instance, the federal government, state-run programs or by tribal governments.

But in practice, some providers who are bound by the state’s rules aren’t policing the eligibility of every person who signs up. For instance, it’s unlikely you’ll have to prove your employment in an eligible work sector or your underlying health condition if you make an appointment for a shot at a pharmacy. 

Some are taking advantage of these loopholes, saying, for instance, they work “in the courts,” as a way to qualify for a shot when, in fact, they work from home for a private law firm — or a parent saying they qualify for a shot as a “child care provider.” 

“This is ethically problematic, even though you might not get busted for it,” Wu said. 

It’s a tricky balance, Wu said. The state doesn’t want to set up too many barriers because then vaccination goes slower. 

But it also makes the system ripe for people to take advantage of it. 

4) Is this dose going to be thrown away if you don’t take it? 

Wu said this is a situation in which the rules change. 

Vaccines are scarce, and no one wants to waste a dose. So, if you have an option to take a dose that will otherwise be trashed, Wu said, you should take it, even if you aren’t eligible under state guidance. (State health officials have said this is OK, too.)

“This is ethically appropriate,” Wu said. “If it’s otherwise going to be wasted, the benefit accrues to no one in the community.” 

The benefit of any one person getting a vaccine benefits the community as a whole, he said, because it’s one tiny, additional step toward herd immunity.

“The more people we get vaccinated, the more likely we’re going to be to interrupt the transmission of the virus in the community,” Wu said. 

COVID-19 in Minnesota

Data in these graphs are based on the Minnesota Department of Health's cumulative totals released at 11 a.m. daily. You can find more detailed statistics on COVID-19 at the Health Department website.

The coronavirus is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.