A brief treatise on the ethics of immunizations
The Covid-19 saga is down to a race between virus and vaccine.
The current wave of the disease has been brutal. Almost as if it knows that vaccines are nipping at its heels, the pandemic coronavirus has turned on the afterburners: far more contagious variants like B.1.1.7, 501Y.V2, and CAL.20C have emerged, sending the number of cases skyrocketing around the world, cramming hospitals and intensive care units as the global death toll rockets well beyond two million.
In reality, the novel coronavirus doesn’t “know” a thing. Like all viruses, it’s a mindless beast, endlessly mutating via trillions upon trillions of replications as it feasts upon us.
Thus far, thankfully, it appears that the new vaccines against the virus are likely to be effective against the new variants as well. But the longer the virus runs wild, the higher the chances that new mutations will escape vaccine coverage — in which case we may well be back to the drawing board.
The pressing need to get as many people vaccinated as quickly as possible can’t be overstated. Once front-line health-care personnel, long-term care-home workers and everyone over fifty are successfully immunized, this pandemic will essentially be over; the rest of the operation will be mop-up.
Thus far, however, we’re severely constrained by limitations in vaccine supply; and we’re hamstrung in most countries by choppy, disorganized vaccine distribution. (Israel is the glaring exception; with ample vaccine in hand, thanks to buying her way to the front of the procurement line, that nation is vaccinating with military precision: almost 30 per cent of its population has received a first dose of vaccine, compared with less than 1.5 per cent in Canada.)
Mind you, the mere fact that we have a vaccine to complain about is nothing short of a miracle. Never before in human history have safe, effective vaccines against a new contagion been engineered with such astonishing speed.
In a marvel of scientific ingenuity likely to permanently transform humanity’s battle against infectious diseases, scientists at Moderna and Pfizer-BioNTech harnessed God’s own alphabet to generate Covid vaccines; they used messenger RNA to induce the human body to manufacture bits of viral spike protein — whereupon the immune system generates protective antibodies against that protein, preventing live virus from gaining access to cells.
As a front-line physician on the downhill side of 50, I was extremely fortunate to receive my initial Covid vaccine (Pfizers’s product) on December 28, and a booster on January 18.
For me, the decision to take the vaccine was a no-brainer.
But by the lights of the anti-vaxxer crowd, my decision is proof of no brain.
Which highlights a disturbing reality: It’s not just production bottlenecks and distribution challenges that threaten the success of the Covid immunization drive. It’s also the reluctance — and outright refusal — of numerous people to be immunized.
The anti-vaxxer movement, as it relates to Covid, can be broadly separated into three camps: those who think that Covid is a hoax; those who believe that all vaccines are dangerous; and those who are convinced that vaccines are immoral.
I haven’t the space here, let alone the patience, to address the shaky premises of the first group — the cranks who deny, in the face of all evidence, the grim reality of Covid-19. Nor will I tackle the second group, which had its genesis in the shenanigans of British doctor Andrew Wakefield, who published a tiny, dishonest study in The Lancet in 1998 alleging that vaccines cause autism — a position he has stubbornly clung to despite being stripped of his medical license for fraudulent “research”, and despite his “study” being thoroughly discredited by his peers and retracted by The Lancet.
I’ll focus instead on the third group: those convinced of the immorality of immunizations.
That stance is rooted, in the first place, in religious faith: the notion that trusting in vaccines to protect us implies a corresponding lack of trust in God.
Far be it from me to cast stones at the unwavering faith of such folks. Nonetheless, it seems to me that God, Creator of intelligent, inquisitive creatures who naturally engage in scientific exploration, would expect us to use what we learn for the protection and betterment of our health: a concept referred to in religious circles as “using the means” provided by God.
And, indeed, we have used what we’ve learned. Discoveries around public hygiene and sanitation, antibiotics, and yes, vaccines, are the major drivers of the dramatic elongation in human lifespan we’ve witnessed since the turn of the 20th century, from an average of around 45 years then to more than 80 years today.
The positive impact of vaccines can’t be over-emphasized. Thanks to vaccines we live in a world devoid of the scourge of smallpox; we pass our days largely unthreatened by the likes of polio, diphtheria, and tetanus.
As a pediatrics trainee in Brisbane, Australia in 2001, I remember inserting a hollow stainless-steel needle into the spinal canal of a critically-ill baby and watching with alarm as thick, creamy pus oozed forth; that sort of scenario has become almost vanishingly rare as the incidence of infant bacterial meningitis has plummeted in the past couple of decades — again, because of effective vaccines against pneumococcus, meningococcus and Haemophilus influenza.
Interestingly, the same people who refuse vaccines in lieu of “God will protect us” willingly secure their babies in car seats rather than allowing them to roll around freely in the backseat; they wear seatbelts themselves and apply them to their kids; they drink tap-water pre-treated to remove pathogens; they install smoke alarms and carbon monoxide detectors in their homes; they take themselves to doctors when they are sick; they ingest the medicines and submit to the surgeries that those doctors prescribe.
In short, in almost all other domains of their lives people of faith “use the means” at their disposal to secure their own health and well-being and that of their little ones.
All that aside, there is undeniably an issue with vaccines that is deeply troubling — an issue to which the charge of immorality is far more likely to stick.
It’s an issue that gets short shrift in mainstream circles, even from the likes of vaccine guru Dr. Paul Offit, who devoted only a single paragraph to the topic in his otherwise comprehensive 2011 book Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.
Medical students, as a rule, are taught nothing about this controversy; and many, if not most, physicians in practice today are unaware of it.
I’m referring to the link between vaccines and abortion.
Two cell lines, MRC-5 and WI-38, have been used for many years as cell substrates in the manufacture of vaccines; both cell lines were derived from fetal lung tissue from elective abortions performed in Europe in the early 1960s. Several new Covid-19 vaccines on the cusp of coming to market (i.e. the Astra Zeneca and Johnson & Johnson products) have also used fetal cell lines in their development: HEK-293, a kidney cell line that comes from a fetus aborted in about 1972; and PER.C6, developed from retinal cells from an 18-week-old fetus aborted in 1985.
To be clear, the Pfizer-BioNTech and Moderna mRNA vaccines already being deployed did not use fetal cell lines in their production process. But while that’s true, both of those vaccines were tested, post-production, on fetal cell lines to test for efficacy.
It’s important to emphasize here that the scientists who initiated those original fetal cell lines had nothing whatsoever to do with the decision to abort those fetuses. The abortions were not induced for the purpose of providing substrate for medical research or for vaccine development; the scientists took advantage of abortions that had already occurred, harvesting fetal tissue — which was otherwise headed for the trash can — to develop immortal cell lines, which at that time had been nearly impossible to achieve by other means.
These cell lines have since been used to produce drugs against diseases including hemophilia, rheumatoid arthritis, cystic fibrosis, and others. Regeneron’s Covid antibody treatment, used to treat President Donald Trump, used fetal cell lines as part of its testing process.
Fetal cell lines were first co-opted for use in vaccine research when researchers discovered that the monkey kidney cells they had been using were contaminated with a simian virus; human fetal cells proved to be a far superior option.
Outside of China, no current vaccines and no vaccines under development are made with fresh fetal tissue; abortions are not being performed to supply new fetal cells for the vaccine industry. (The Chinese, unconstrained by the ethical guidelines that currently govern vaccine development in the West, deliberately induced an abortion of a three-month fetus six years ago to develop a new cell line — dubbed WALVAX-2 — specifically for the purposes of vaccine development.)
It’s also important to note that ethical alternatives to fetal cell lines now exist. Immortal cells can be sourced from the placenta, the umbilical cord, and amniotic fluid; mature skin cells can even be induced to revert to a pluripotential state resembling embryonic stem cells.
The fact that these alternatives have not supplanted fetal cell lines as substrates for vaccine development is down to a combination of inertia, indifference, and lack of awareness. It’s up to us to push for change: the sooner we can remove vaccine development from the taint of abortions, the better.
But as it stands, the link of vaccines with abortion is irrefutable.
So where does that leave us?
What are those opposed to abortion to do with this knowledge? (It’s worth emphasizing that this isn’t just a “faith” issue: one needn’t be religious to be profoundly uncomfortable with termination of unborn life.)
Is it possible to be anti-abortion, yet not anti-vaccine?
If one is convinced that abortion is wrong, isn’t using vaccines corrupted by abortion-derived cell lines equivalent to using “fruit from a poisoned tree”?
Doesn’t using such vaccines implicate us in the act of abortion, even if those abortions happened long ago?
Aren’t we — as respected pastor and author John Piper puts it — “desecrating the bodies of unborn victims and treating those children as though they can be killed and their tissue harvested for our benefit”? Piper states the position of many Christians plainly: “We should not do evil that good may come.”
But is that in fact what we are doing? Are those of us who take vaccines “doing evil” by using products tainted by long-ago abortions — abortions performed without complicity from the scientists who created the cell lines?
That vaccines have saved millions upon millions of lives is irrefutable. But can good ever come from something that is rooted in great evil?
These are enormously difficult, complex questions; questions that don’t have tidy answers.
Similar questions proliferated in the aftermath of the Second World War, when the awful scale of Nazi medical experimentation on concentration camp prisoners became apparent. It’s not controversial to argue that these experiments, indescribable in their brutality, should never have happened. But happen they did; and while most of the Nazi’s morally-repugnant studies were horribly flawed and scientifically useless, some of the knowledge they generated — around hypothermia, for example — wasn’t so easily discarded. It wasn’t “un-knowable”.
Which posed an awful dilemma: what to do with that knowledge? Would use of that data give tacit approval to the naked evil that was done in those experiments? If good could be done — if lives could be saved — was it ethically permissible to use it, while universally condemning the manner in which it was obtained? Was it possible to rescue good from the ashes of evil, in a way that didn’t make us make us complicit in the past, but rather honoured the lives of those who were brutalized and murdered?
The Nazi-era atrocities are an extreme example; but they’re far from the only instance of egregious scientific misbehaviour. There’s scarcely a corner of the scientific world that hasn’t been contaminated by unethical and immoral activity.
Consider, for instance, the knowledge derived from America’s Tuskegee syphilis study, in which syphilis-infected black men were knowingly deprived of penicillin so that researchers could study the natural history of untreated disease; or the data extracted from New Zealand’s repugnant cervical cancer “study” that left women untreated for years so that researchers could learn how cervical cancer progressed; or the insights gained by Swedish experiments that fed copious amounts of sweets to the mentally handicapped to explore the link between sugar and dental decay.
These are just three examples. There are many more — all of them generating knowledge obtained by despicable means, yet much of that knowledge used nonetheless as foundational to how we treat people today.
Navigating this morass requires the wisdom of Solomon, to put it mildly. Which brings me to the Christian approach to these ethical dilemmas; or, rather, to what the Christian approach should be. Christians, after all, have the Bible to guide them.
Most Christians are intimately familiar with the life and times of King David, a giant of a figure in Scripture and a man much loved by God. Yet he was merely a man, deeply flawed like the rest of us.
During his kingship David had an illicit affair with Bathsheba — another man’s wife — and impregnated her. To cover up his transgression he murdered her husband Uriah by sending him to the front lines of battle where he was certain to be killed; then he took Bathsheba to be his wife.
Great evil, indisputably; but David thought he’d escaped scot free. God saw what he had done, however, and punished David with the death of the son he had conceived with Bathsheba.
Yet following that child’s death, God permitted David and Bathsheba to remain married. Together they had another son — the aforementioned Solomon. And from that lineage, twenty-seven generations later, Jesus Christ was born. The Saviour Himself, around whom the entire Christian faith is built, is fruit of a family tree undeniably rooted in evil.
Can great evil be turned to great good? By God’s towering example, the answer is a thunderous yes.
I don’t aim by this essay to impugn the intentions of those who refuse vaccines because of their link to abortions. Far from it. Their motives are beyond reproach.
But we must beware the “righteousness fallacy” — otherwise known as the fallacy of good intentions — which holds that one is correct simply because their intentions are pure.
Without question, we must condemn the evil of the past; we must continue to push for change; we must hold the feet of scientists and doctors to the cleansing fire of unassailable ethics.
But in the meantime the pandemic marathon is far from over. Many more will die. And we remain far behind the virus. To catch up, and then to win the race, we must consider the greater good: we must get vaccinated.
It’s time to put an end to the crippling isolation and ever-present fear of death being endured by our parents and grandparents; to the grievous harm being inflicted on our children’s education and future; to the terrible carnage laying waste to the livelihoods and mental health of millions.
So please: when the vaccine is available and when it’s your turn, line up to be immunized.
Let’s not pave the road to continued misery with good intentions.
Instead, let’s turn on the afterburners — and let’s win this race.