Responsibility for Vaccination 1: Moral Responsibility

In a population which is susceptible to a dangerous virus like covid, a virus that can kill up to 5% of those it infects and which spreads very rapidly, the only option is to vaccinate. This is the only option if the strategy is to mitigate the effects of covid as much as possible. Doing nothing is a strictly speaking also an option, but then life could not go on as normal because of the rising infection rates, severe cases of the disease and mortality. Even if a state that finds itself covid-free shuts its borders to everyone, this would not be life as normal. If vaccination is the only option, does it follow that people have a responsibility to be vaccinated?

This following example appears to show that they do. Suppose P has covid and gives it to Q. Regardless of how ill Q becomes, she has been harmed by P. Normally, if P harms Q, then P has done something to Q that caused the harm. In this case P has done something, namely passed on the virus, but she did she actually do anything to Q, perform some action, which caused Q to be harmed? It may seem that P actually did nothing; the transmission was passive - if any action was performed, it was by the virus that ‘actively sought’ a new host. But this implies a too restrictive view about what it is to act. To elaborate the example a little, suppose P met Q for a cup of coffee and she knew she had covid. Even if P’s intention was just to meet Q for coffee, which is, let us say, how she represented her action to herself, what she did can also be described as “giving Q covid”. And this what happened: Q got covid and she got it from P when they had coffee, so the events that took place at the time, P entering the café, ordering, sitting down and talking to Q, and so forth, are (also) correctly described as “giving Q covid”.

This analysis relies on the notion that the physical movements that make up acts, people moving their limbs, making sounds and so on, can be described in different ways, ways which incorporate more or less distant outcomes. Another (famous) example will help to clarify this. In 1914 in Sarajevo, Gavrilo Princip threw a bomb that assassinated the Grand Duke Ferdinand and started the first world war. What Princip ‘did’ can thus be described variously as “throwing a bomb”, “assassinating the Grand Duke” and “starting world war 1”. It would be unusual if, after the fact, the authorities were to begin their interrogation by asking Philip’s views on which of these descriptions applied to what he did, however it is clear that he intended to kill the Grand Duke so he would have admitted to “assassinating the Grand Duke”, not merely for “throwing a bomb”, and he was certainly responsible for that action. But he could not have known that this would start a world war, so “starting world war 1” was not an action of ‘his’ and he could not be held to account for that. This way of putting the issue is a little unusual, but we have now an alternative way of talking about the relationship between agents and the outcomes of their actions. In the post before last we saw that if P could not have known about the harmful effects of her act, she is not responsible. This alternative says that if P could not have known that her action could be described as harming, then she is not responsible. The alternatives are essentially equivalent, but referring to different descriptions of what P does is useful her because it allows us to see more clearly how she can be responsible for passing on covid. (This passage is a little advanced perhaps: anyone interested in knowing more about action understood in this way, could look at Chapter 4 of my book The Responsible Scientist (Pittsburgh, 2009).)

I believe a strong prima facie case can be made for P being morally responsible for infecting Q with covid and thereby harming her. The next step would be to see if P had some excuse, and I think the only possible excuse would be if she did not know she had covid and that she had no reason to believe she could have covid. Unless this condition is satisfied, then P is morally responsible for infecting Q. We have agreed that agents can be responsible for reckless or negligent behaviour, so if P had any reason at all to think she had covid, either symptoms or recent close proximity to others, and she still was out and about having coffee with Q, then this is reckless. And we have agreed that agents can be responsible for negligence, so if in spite of all the information about the dangers of covid, P was simply unaware of the dangers, then unless she can give an account of why she was unaware, this is not an excuse. As for justification, it does not appear that there could be any justification. For there to be a justification, then P would need to show that her action prevented more harm than it caused. Some fantastically contrived scenario could be made up in which giving Q covid somehow prevented harm, but setting this aside, I think we can conclude that P could have no justification.

 

If people could not be held to account for giving others covid, then they would not have any responsibility to be vaccinated. But is the fact that people can be held to account for spreading the disease, sufficient for concluding that they have a responsibility to be vaccinated? Recall that according to common morality, agents are morally responsible for the harm they cause, but unless they have some special forward-looking responsibility associated with some role, then they are not (normally) obliged to prevent harm. With this in mind, we may think that, after all, agents are not obliged to get vaccinated. But recall also the remarks at the end of the last section: a special responsibility to prevent harms, role responsibility, has to do with harms that the agent herself did not cause. ‘Ordinary’ agents are supposed to behave in such a way as not cause harms to others: this is the basic premise of common morality and as such it is not usually referred to as a responsibility. But what is different, probably uniquely different, about infectious diseases like covid is that all people have to do to infect and hence harm others is to be in sufficient proximity to them for transmission to occur. It is hard to think of any other kind of harm that eventuates simply when one person is in close (enough) proximity to another, has unknowingly has covid and unknowingly passes it on. However, what is known is that this is possible and that vaccination can prevent transmission, can prevent severe disease and can prevent death. I believe we can therefore conclude that not only can agents be responsible for passing on covid, they are obliged to take measures to prevent this happening, including being vaccinated.