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Matt Katz: I'm Matt Katz, you're listening to the Takeaway.

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Matt: Getting a vaccine right now might depend on who you know, how lucky you are, not whether or not you're next in line. That has a lot of people, a lot of you are angry, especially if you haven't been able to get your shot. This anger has also extended to the point where people are shaming the people they know who received the vaccine before them, accusing them of jumping the line. As Nicholas Evans, an Assistant Professor of Philosophy at the University of Massachusetts Lowell explains, vaccine shaming is misguided, since inequities with the rollout are based on systemic problems rather than individual actions.

Nicholas Evans: What we're seeing is that the background infrastructural injustices that exist in the United States of America have mapped on to the way that we have tried to do vaccine distribution, in ways that exacerbate the inequalities that exist in this country.

Matt: I spoke with Nick, breaking down vaccine shame, vaccine guilt, and vaccine envy. We started by talking about how he views inequities amid the pandemic.

Nicholas: It's a combination of things we more or less knew will likely to happen. Combined with in many practitioners’ minds, a sense of shock that the worst cases that we thought could arise, were in some ways not nearly bad enough. We didn't expect that people would be quite so blase about the pandemic, at least on the level of government in the United States, or the United Kingdom. We didn't expect that to go on for so long as death tolls mounted. In some ways, this has been a real wake-up call that there's been a lot of moderate discourse in bioethics about what we ought to do during pandemics. I think that we're slowly coming to the realization that maybe that was just a little bit too moderate and slightly more radical solutions are needed.

Matt: What kind of radical solutions?

Nicholas: We should push much, much harder for a unified public health system in this country. That public health system should be disentangled at least as much as it can be, or should be from political actors. That we lack an institutional memory of really any kind in public health, at least at the highest level of this country, because we continue to perform ad hoc task forces to deal with pandemics. Rather than appropriately fund and staff, the actual groups that would be most appropriate to deal with this. Then finally, that the long standing injustices in American healthcare, including the lack of access to affordable healthcare, are only weaknesses when it comes to a disease like COVID-19. That there really is no reason to not have universal health coverage as a form of protection against pandemics.

Matt: Let's talk about vaccine shame and what that is, and how some of these systemic problems with distribution might be exacerbating this?

Nicholas: Vaccine shame is a really interesting phenomenon, because it's actually pretty multilayered. On the one hand, we have what anyone who lives online, which is all of us at the moment, is probably familiar with. Which is people shaming each other, or shaming people in general for "jumping the queue" when it comes to getting access to a vaccine. In my own home state of Massachusetts, the governor had to discontinue allowing carers of people who were eligible for vaccines from getting vaccinated at the same time. Because by the state of Massachusetts’ view, people were cutting the line by claiming to be carers, when in fact they were not, just for the purposes of getting a vaccine. Finding yourself a grandparent that you can latch onto, so you can get vaccinated early.

Then we have the standing shame. A colleague of mine who is an ancient philosopher, so she studies Plato has pointed out, there's the public shame that people are feeling when they get vaccinated. Legitimately according to the frameworks that have been laid out by the states, but perhaps a little bit earlier than they otherwise should have been. You might be declared essential personnel, for example, if you work in science that is attached to a hospital. Even though you have never stepped foot in the hospital for the purpose of treating patients during this pandemic, and you live and work at home, like the rest of us, and you can do all of your work from a computer, you're still eligible for the vaccine.

Increasingly, we're seeing people who are entitled to the vaccine or the framework, but perhaps not under the ethics of this distribution, feel a sense of concern, or even shame around how and why they got the vaccine in the first place.

Matt: Should those people feel shame? Should somebody who works at a hospital, but does not practice medicine, works in an administrative office, but was eligible and took the place in line. Should that person feel any degree of shame over getting vaccinated?

Nicholas: In what might be the best philosopher answer ever? I think that it depends on what you mean by shame. It's not clear to me that they should feel deeply personally responsible for committing their own injustice. They haven't been stealing vaccines. Maybe what they should feel is shame at the scientific and medical and public health infrastructure of this country has been designed in such a way that people benefit from those in justices if they want to benefit from them. We might all be better off.

As someone who works in health policy, I do at times feel a sense of shame about what this country does to its most vulnerable in the name of public health. A lot of other people should think that this is a totally acceptable kind of shame to feel. If you're a scientist, and you've received a vaccine perhaps earlier than you should have, I think that it's acceptable to feel this more general sense of shame at the way that science, medicine, and public health in this country are constructed. Certainly from time to time, I do feel a sense of shame at what our system does to the most vulnerable people in society, and the fact that we could change this if we wanted to, but we haven't.

Matt: Then, given that, you feel a more universal shame if you will, about the systemic issues that we are complacent about on a normal daily basis. If you have the opportunity to get the shot, should you get the shot and feel the shame at the same time?

Nicholas: Yes, I don't think there's any contradiction in that. We benefit from injustice all the time. My accent is from Australia, my passport is from the United States of America, but I have lived in two colonial nations. My ancestors were the people who took land away from the Indigenous populations of Australia, I know that. I can feel happy to be born in Australia and received all the opportunities that I have, but still feel a sense of shame at the ways that came to be.

I think that you can feel relieved that you have a vaccine and you feel safe from this terrible disease and that depending on which vaccine you have, you are less likely to give it to the people that you love and care about. Also feel this kind of deep, universal sense of shame at the reasons why you are able to benefit from that.

Matt: Nick, people seem to also be hustling any way they can to access vaccines, mostly, because as you said earlier, the state has not done its proper job with vaccine distribution. Is there anything immoral about actively jumping the line when circumstances are so precarious?

Nicholas: I think that that's one of the hottest questions that we have to ask ourselves on a personal level about getting this vaccine. Obviously, there's this case where your friend at CVS rings you and says, "Hey, we have a bunch of Moderna vaccines or Pfizer vaccines, the mRNA vaccines in the fridge, we had to crack them out of the really, really cold storage, they aren't going to last and we need to give them to people before close a business and we've run out." It seems like it would be wrong to allow those vaccines, which are still a very scarce resource to go to absolute waste.

On the other hand, if they are just sitting up vaccine appointments, and your buddy at a hospital goes, "Hey, I can get you in." Then I think that you have to ask yourself some really hard questions about what you're doing. Because that's not taking what's left, because otherwise it will go to waste, that's potentially taking someone else's spot and those spots are in short supply. It's really hard in some places to get an appointment at all. If you're actively engaged in the process of getting one of those appointments, when you can afford to not get a vaccine right now, I can afford to not get a vaccine right now because I work from home. Then I think that you're doing something wrong.

Matt: Are you going to get vaccinated? What's your vaccination plan, given that you do work from home and like you said, can afford to not do it immediately?

Nicholas: According to the federal level of distribution schemes, I'm a phase two. I am one of the people who gets vaccinated after everybody else. My wife is a phase one, she hasn't got her vaccine yet, but she will soon, I hope. I plan to wait it out. I plan to wait until the state of Massachusetts tells me that it's time to get a vaccine. Why? Because I'm a college professor, I can and will work from home until I am forced to return to my job and my daily duties on campus. I can afford whatever premiums are necessary to have things delivered to my house and to live safely and isolated until this pandemic is over or until I have access to a vaccine in the ethical framework that has been set out for prioritizing these vaccines as a scarce resource.

It sucks. I'm an extrovert. I really want to see my friends. I would Someone with three more comorbidities get access to a vaccine before me. I would rather all of those people get access to a vaccine before me, and friends grandparents or parents, before I go and get a vaccine. My postdoc advisor just got a vaccine and because he was eligible and I would much rather he stay alive then to think that someone like him died or could have died because I cut in line first.

Matt: You following the state guidelines, the federal guidelines for this. What if somebody disagrees with the guidelines? Doesn't think that a smoker, for example, should be ahead of them in line. How does somebody suppose to face that quandary?

Nicholas: I think that we face that in the same ways as we face the fact that sometimes our states aren't listening to the guidelines that have been set down in the first place. If you think that the vaccine framework is unethical, then go for your life, go and criticize it and protest it and call your Congressman and call your state reps, until, you get the change that you need. I would also point out that if you're making judgments such as well, smokers don't deserve the vaccines, or people who are overweight don't deserve the vaccines and so on and so forth. Just remember that everyone is going to be disabled at some point.

Everyone is going to have a health condition at some point. You may not today, you may not tomorrow, but one day you will, and it will happen for the rest of your life. The American obsession with blaming people for their good or ill-health is one of the most toxic parts of our society. The sooner it goes the way of the dodo the better.

Matt: How has shame been expressing itself in real life and interpersonal relationships when it comes to vaccine distribution?

Nicholas: I haven't seen a lot of personal vaccine shaming. I've seen a little bit when the parents of colleagues or friends who are not currently eligible for a vaccine in their home state, try to wrangle vaccines out of their healthcare worker family members and things like that. I think that people have to have those hard discussions with their families that yes, mom, yes, dad, I'm a doctor, I'm a nurse, I'm an epidemiologist at a medical institution. I could get you a vaccine, I guess if I wanted to, but you need to support the pandemic as a whole. I can't buy craft or by graft get you that vaccine.

I think that there is some shaming that is going on there honestly. I think this is endemic in all social situations. Most of the shaming that I see is online, of news stories or tweets or Facebook posts about this person or that person cutting in line. People trying to shame each other for the purposes of deterring people from going to get those vaccines, as far as I can tell it hasn't really worked.

Matt: There's different kinds of shame I imagine that you see online, like shaming smokers or people who are overweight for accessing the vaccine when theoretically they could have prevented that condition. Then shaming wealthy people who go to poor neighborhoods for their vaccines. There's different kinds of shame that happen online, I guess.

Nicholas: Yes. I think that maybe something that would be really interesting for the listeners out there is there's also a form of counter-shaming that is beginning. I saw this perhaps about four or five days ago, when I saw a tweet by someone who said I'm overweight and I was entitled to get a vaccine and I got one. The medical system in this country has treated me so poorly over the decades of my life, that I feel that because of this, I am entitled to this vaccine. Don't let people shame you for being overweight and being entitled to a vaccine because you have another co-morbidity that puts you in the relevant tier for the framework for allocation.

There was a bit of counter-shaming. That the reasons that some people are higher on the framework than others is because they've been mistreated by the medical system for so long that they are now in a position where their bodies are vulnerable to death by COVID and are thus eligible for the vaccine before other people. I think that there are some really interesting dynamics here, not just around shaming, but around what I've just called counter-shaming. Because people who are eligible for the vaccine are tired of being told that they should not be eligible for the vaccine, which in their minds is another way of saying that people are comfortable with them dying over living.

Matt: Nicholas Evans is Assistant Professor of Philosophy at the University of Massachusetts Lowell. Nick, this was so interesting. I hope your number gets called soon. Thanks very much for joining us.

Nicholas: Thanks so much, Matt.

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Nicholas: We asked you, how are you feeling about the vaccine rollout?

Steve: My name is Steve from Merrick, Long Island. I received my first Moderna vaccine three weeks ago and I'll received my second on this coming Saturday. I am very excited about getting the second vaccine. I wanted it right from the get-go. No guilt whatsoever and I hope and pray that everyone gets it as soon as they possibly can.

Debbie: Hi, my name is Debbie Hemingway. I'm calling from Winters, California. I've had two doses and I feel no guilt or shame and I don't know why I should. My state and county and healthcare provider have determined that people in my age group should be protected. I would like to see an even faster and more universal roll-out, but I'm not going to be shamed for protecting myself, my family, and my community.

Participant: It seems like everyone I know is getting vaccinated from family friends who are Trump supporters and would not be quiet about the mask mandate, to people my age who are just lying through their teeth about their profession. I'm 36, not necessarily on the front lines, and I have a three-month-old child who I'm very concerned about, but I am proud to wait my turn.

Tammy: I'm Tammy and I'm calling from St. Louis. When you texted, I was in the process of getting the Johnson & Johnson one-shot. My condition is obesity. I've spent a lifetime being treated badly because of my weight with no attempt to understand the complex issues involved. I don't feel one tiny bit of guilt. It's the one time that being overweight has worked in my favor.

Alice: Hi, my name is Alice and I'm from Cresco, Pennsylvania. I've lost lobe of my lung and I still have to go every six months for CAT scans to make sure it hasn't come back. No, I don't feel guilty that I've had the vaccine. Neither do I feel jealous of the people who got it before me, because there are lots of folks out there who have far greater exposure or are at a much higher risk. What I am really frustrated about is how hard it was to find a vaccine. I was on the computer for days before I scored one. It should be a lot easier to find this vaccine in order to make it equitable.

Jessica: This is Jessica in Hayward, California. I am relatively young in my early 30s, and I was able to get my first dose of vaccine on Monday. I do feel a little guilty about being able to get it because I know a couple of elderly people who have not been able to get it. It's really frustrating that the vaccine is not available for them to get, but it was super easy for me to get. My work qualified me. I jumped on it and I'm hoping to help these friends be able to get vaccinated at some point.

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