Higgins: That’s a good distinction.
Faden: That is very different from saying whether the Israeli government has a moral obligation to Palestinians, who are not living in the territory of Israel but over which Israel has control. That is a whole separate conversation. They are linked, but you want to be careful.
Generally, there’s the question of what we sometimes call “humanitarian situations of special concern.” There are lots of places in the world where people are living where the countries that have some jurisdiction, military or political, over them, are not viewing them as citizens or residents of the country for purposes of vaccine distribution.
That’s a huge, horrible, terrible ethical morass. It’s awful. But what is going on in Israel is an example of what can be done with a really high degree of attention to detail. Within the system in which they’re operating, for people who are legal residents of Israel, whether they’re Arab or Jewish or Christian, the system is quite fair. You just have to show that you are the age at the time that that age cutoff is called up. And they also manage to largely solve the “What do we do with the doses at the end of the day?” problem.
Hamblin: We were wondering about that.
Higgins: Yeah, there was a situation in Ireland, where I am at the moment, where a doctor gave out 16 extra doses to his family because he was worried they wouldn’t get used. But then members of the public found out and were very upset, understandably. But I can see it from both sides.
Faden: So, look, this is a practical problem that needs to be dealt with pragmatically, but also with some attention to concerns of ethics and equity. The worst thing is to throw away a single dose of this precious vaccine. That’s ethically unacceptable. And from a public-health point of view, it’s just dumb. So if you haven’t planned for it and you’re at the end of the day and you’re close to the end of the window where the vaccine must be administered or tossed, I don’t have any trouble with grabbing any arm you can get from anybody who wants to be vaccinated.
But stepping back, it’s possible to anticipate that you could be in that circumstance and plan for it. Even if you schedule appointments and have a very efficient system, there are going to be no-shows and there could be extra vaccine, just based on how it’s drawn out of the vial. So whether you use social media to alert people, kind of like vaccine flash mobs: It looks like we’re going to have X doses if you can show up by Y o’clock. There’s a queue.
I live in Washington, D.C., and there are a couple of pharmacies that are reputed to let people know that they’re going to stop vaccinating at 8 p.m. and people can start queuing whenever they want in case there’s any vaccine left. It’s first come, first serve. And there have been reports of people lining up at, like, 3 in the afternoon for the possibility of a vaccine-access availability at 8.