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The corona vaccine will probably look like this - or something similar
Photo: Laci Perenyi / imago images / Laci Perenyi
Since the beginning of the corona pandemic, the world has been waiting for a vaccine, now there is concrete hope that a serum will soon be approved that - according to the manufacturers Biontech and Pfizer - will prevent infection in 90 out of 100 people vaccinated.
However, even after the vaccine is approved, it will not be immediately available to everyone.
Therefore the question arises how it can be distributed fairly.
To the author
Icon: enlargePhoto: Marcus Simaitis
Christiane Woopen
, 57, is Chair of the European Ethics Council and Professor of Medical Ethics at the University of Cologne.
She has also been a member of the Federal Government's Data Ethics Commission since July 2018.
Should chance decide?
Should it be based on age, occupation or income?
It is not yet known how the vaccine works in different age groups and with previous illnesses, how long its protection lasts and whether vaccinated people can transmit the virus.
But this is important information for a distribution that people can consider fair for good and understandable reasons.
So who should get the vaccine first?
And according to which criteria should a decision be made?
Vulnerable First?
At first glance, it makes sense to give priority to people in need of protection: people who are at high risk of falling seriously ill and dying.
This would give people with previous illnesses and the elderly access first.
For example, it might make sense not to give priority to vaccinating people in nursing homes who do not leave the house anyway and who have few contacts.
However, there are considerable differences in this group.
Some are in the middle of their work, others live in retirement homes or nursing homes, some are mobile, others are bedridden, some see a lot of people every day, others very few.
These differences should be taken into account in the distribution.
For example, it might make sense not to give priority to vaccinating people in nursing homes who do not leave the house anyway and who have few contacts.
This is countered by the fact that this would seem to put those who are already doing badly at a disadvantage.
The allegation of age discrimination is foreseeable.
This allegation could be dispelled if contact persons at the entrance of nursing homes are examined with rapid tests.
This would also save old people and people in need of care from the risk of possible side effects of a vaccination.
In any case, it becomes clear that we should not narrow our focus on vaccination, but should always look at the broad spectrum of protective measures.
People with many contacts
Preference should also be given to vaccinating people who are at a particularly high risk of infecting themselves or others.
These are not only people in the health professions, but also in professions that involve close contact with others, such as shop assistants, but also people who live and work in prisons or homes.
It becomes difficult with the workers in the meat factories who have become known through corona outbreaks.
Here the wretched working conditions should be abolished and not indirectly stabilized by preferential vaccinations.
And what about the schools?
There are currently more than 300,000 schoolchildren in quarantine, including their parents, who are then absent from work.
This is why vaccination should be carried out at an early stage, as schools are of great social importance and their failure increases the burden on large parts of society.
So it is not only health risks and medical issues to consider for a fair distribution, but also social, cultural and economic aspects.
Schools with many students from precarious backgrounds should be given priority.
The last few months have shown that people who are already disadvantaged are often additionally burdened by the pandemic.
Aid packages, no matter how large, cannot completely heal fears and needs, be it worries about the workplace, domestic violence or mental illnesses such as depression and addiction.
And if school is absent for a long time, it can affect the whole life of children.
Social inequality as a criterion
I therefore believe that social inequality should also play a role in the distribution of vaccines.
For example, schools with many students from precarious backgrounds should be given priority.
That would strengthen social cohesion and prove the long-term self-image of our welfare state that is so important that justice and solidarity count.
The same applies to the future prospects of children and young people, who are currently severely restricted not only in terms of education, but also in their leisure time opportunities.
It's not about parties and celebrations that can become spreader events, but about basic needs for development and development such as sports, playing and making music together or just spending time together.
They shouldn't be too low on the prioritization list, because children and young people need reassurance and opportunities for the future.
In summary, in my opinion, three distribution criteria should form the basis of a national vaccination strategy:
the risk of the disease getting severe or fatal
the risk of becoming infected or of infecting many people
the avoidance of special social burdens
Can these criteria be transferred to the European or even international level?
This week, the EU Commission and Biontech / Pfizer agreed on a contract for the delivery of up to 300 million vaccine doses.
But how should this vaccine be distributed in Europe?
The EU Commission has already made a decision; its spokesman described the proportion of the EU population as the only fair criterion for distribution across the member states.
This may be formally obvious, but behind it is the ethical claim that everyone counts equally.
Distribution according to European values
However, the content-related criteria that should count in a community of values based on the Charter of Fundamental Rights are not taken into account.
The European Ethics Council is committed to this, however, and last week it submitted a statement together with a group of high-ranking scientific advisers.
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He recommends that the distribution of scarce products and services should follow criteria of need based on European values of solidarity, equality, non-discrimination and social justice.
Particular attention should be paid to disadvantaged groups such as the elderly, the chronically ill and people with disabilities, as well as disadvantaged regions beyond the European Union.
This recommendation possibly contradicts the plan of the Biontech CFO, Sierk Poetting, who "definitely does not (wants) that there is an unfair inflation of the batches in individual regions".
This approach would be problematic if Poetting rules out any excess.
Because it might well be fair and ethically justified to give an older society more vaccine than a younger one.
Biontech now wants to decide on the distribution together with Pfizer.
Can that be correct in terms of international justice?
The World Bank recently calculated that the pandemic will plunge up to 150 million people worldwide into such extreme poverty this year and next that their very survival is in danger.
You will have an income of less than $ 1.90 a day.
A vaccine will not solve this problem, but distributing it fairly can help alleviate it.
The two companies may be making good decisions.
Nevertheless, it should not be left to the market and the moral motivation of individual entrepreneurs to establish international justice.
This year and next, the pandemic will plunge up to 150 million people worldwide into such extreme poverty that their very survival is in danger.
The World Health Organization recently founded the "Covid-19 Tool Accelerator" together with other international organizations.
Together with governments, civil society and industry, it aims to accelerate the development, production and fair access to corona tests, therapies and vaccines.
This campaign is a significant step towards internationally shared responsibility.
However, on the website of COVAX, the vaccine-related part of the tool, it can also be read that the serum is to be distributed to the participating countries according to population size.
I think that's problematic.
Distributive justice has a measure that precedes distribution.
How urgently a country needs the vaccine in terms of health, social and economic damage is not determined by its population.
We should all be concerned with avoiding harm.
This includes creating the legal framework and organizing the mass production of vaccines, their transport and the vaccination itself.
Education and transparency
But let's assume we have enough material to vaccinate - and nobody goes.
It is rightly pointed out again and again how important education, transparency and good communication are so that as many people as possible accept vaccination protection.
Only scientific data that anyone interested can understand because it is appropriately prepared and communicated can promote and justify the trust of the population.
Only on such a basis will ultimately sufficient people be vaccinated to achieve so-called herd immunity and to ensure that the virus can no longer spread uncontrollably.
An important discussion has started.
It should be conducted broadly.
The vaccine is not yet available.
Whoever gets it first, when the time comes, will say a lot about our understanding of humanity.
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