Opinion: Vaccine refusers should be last in line for limited medical resources

The Delta variant of COVID-19 is spreading rapidly. Meanwhile, vaccination rates have hit a plateau. Approximately 51 percent of Michiganders have been vaccinated, which puts us in the lower third of states.

Although vaccinations are effective against the variant, the Delta variant accounts for a significant percentage of cases and the vast majority of hospitalizations. The combination of the spread of the Delta variant and stagnant vaccination has caused some to anticipate yet another wave of infections in the fall or winter.

We have seen other waves stress the available health care resources. Right now in Michigan, like much of the nation, we are seeing a severe shortage in available blood. But scarcity may strike at other resources, such as staff or oxygen. This time around, however, will be different in one important way: those hospitalized will mostly be unvaccinated adults.

This group of people should be last in line for limited resources, such as blood products, when those vaccine refusers get sick with COVID-19.

By now almost every adult in Michigan has had some opportunity to get the vaccine. Those adults who have had access to the vaccine but have willingly refused it should be our last priority in allocating limited medical resources.  

The resource allocation scheme we should adopt is this: for a particular limited resource that is used to treat COVID-19, vaccine refusers infected with COVID-19 should be the last to get this resource – everyone else who needs it should be offered it first.

For example, if two people are hospitalized, one of whom is a vaccine refuser being treated for COVID-19 and the other is not, and each person needs one unit of blood but only one unit of blood is available, it should go to the other person and not the vaccine refuser. The same goes for other limited resources. Vaccine-refusing COVID-19 patients go last.

But unlike other allocation schemes, the argument for this scheme is not a moral argument. Instead, the argument that vaccine refusers should be de-prioritized rests on the fact that this is the scheme that is most acceptable to everyone. Consider vaccine refusers. This scheme should be perfectly acceptable to them.

From their point of view, they have no reason to expect that they will become hospitalized with COVID-19. They deny the very premise that they personally may need a limited resource for treatment of COVID-19. Since from their point of view their hospitalization for treatment of COVID-19 is not a live possibility, they should be unconcerned that they are last in line. If they are so concerned, they should rethink their vaccine refusal. 

Now consider those adults who have been vaccinated or who are unvaccinated due to other medical conditions or lack of access. De-prioritizing vaccine refusers should be perfectly acceptable to these people as well. Doing so reduces the potential strain on a resource these other people may need, which makes it more likely the health care system can allocate that resource to them.

 Other ways of prioritizing the allocation of scarce resources should be less acceptable. Vaccine refusers themselves have no reason to prefer one scheme over another – to them it should make no difference where they are in line. But a scheme that puts vaccine refusers right in line with everybody else should be less acceptable to everybody else because it decreases the likelihood that they will get the limited resource in the event they need it.

This means that putting vaccine refusers last in line for scarce resources should be, overall, acceptable to everyone.

We can’t say this about other ways of making hard decisions about who gets what. As more and more unvaccinated adults put pressure on the health care system, this high degree of acceptability is reason enough to adopt this way of prioritizing the sick.