US Vaccine Priority Allocation Generally Aligns With Church Teaching

However, some states have shifted from the CDC’s national guidelines due to local epidemiology and demand.

Elton Jackson, 80, looks on as he receives his COVID-19 vaccine, administered by Kathryne Acuna, director of Ambulatory Clinical Services at Kaiser Permanente, on Feb. 5, the opening day of a large-scale vaccination site at a parking structure at Cal Poly Pomona University in Pomona, California. The elderly are among those given priority during the vaccine rollout across the country.
Elton Jackson, 80, looks on as he receives his COVID-19 vaccine, administered by Kathryne Acuna, director of Ambulatory Clinical Services at Kaiser Permanente, on Feb. 5, the opening day of a large-scale vaccination site at a parking structure at Cal Poly Pomona University in Pomona, California. The elderly are among those given priority during the vaccine rollout across the country. (photo: FREDERIC J. BROWN / AFP via Getty Images)

As President Joe Biden announced last week that the federal government may provide enough COVID-19 vaccines to fully vaccinate 300 million Americans by the end of summer, the fact that those most at risk of dying and essential workers have had first priority for limited supplies is compatible with Catholic teaching, according to doctors and ethicists. 

Progress in vaccinating populations has varied by state. While in Florida vaccination is open to those over the age of 65, Minnesota has set up a lottery that registered more than 200,000 seniors for a chance to be vaccinated with the limited vaccine supply. And Oregon is vaccinating teachers before the elderly in hopes of resuming in-person learning this school year. Other states have prioritized those over age 75.

States sometimes have shifted from Centers for Disease Control (CDC) guidelines according to local epidemiology and demand — for example, reallocating surplus doses initially assigned to nursing homes — causing in some cases competition among groups for scarce vaccines. But while individual states may have made different decisions on how to distribute vaccines, their shared objectives of caring for the vulnerable and promoting the common good are in line with principles of Catholic social teaching. 

“The goal has to be for the good of the community as a whole, and it shouldn’t be looking at any particular group over another — but rather who is most in need,” said Edward Furton, an ethicist at the Philadelphia-based National Catholic Bioethics Center, which promotes human dignity in health care and the life sciences in light of Catholic teaching.

In early February, the CDC reported that 33.9 million vaccine doses had been administered. The daily total of new COVID-19 cases fell more than 62% from a post-holiday high of 314,093 on Jan. 8 to 116,915 on Feb 2. 

Vaccine allocation is the type of pragmatic matter that the Church would more often leave to medical experts, Furton said. “The Church is concerned for moral good and human persons, so that comes first. I would think that the health-care experts should be the ones who lead the way in this area and that the Church should only raise concerns if there are obvious injustices.” 

Last year the U.S. bishops and Vatican leaders issued statements on the morality of vaccines that use aborted fetal cell lines in some aspects of the production process. But several Church leaders also have expressed views on allocation, which one doctor called “the largest logistical challenge the U.S. has faced in modern history.” Pope Francis has called for caring for the vulnerable and sharing vaccines internationally, a call that was echoed in a Dec. 29 document released by the Vatican COVID-19 Commission and  the Pontifical Academy for Life.


CDC Guidelines

The CDC’s Advisory Committee on Immunization Practice guidelines on phased vaccine allocation for state, federal and local jurisdictions give first priority to long-term-care-facility residents and health-care personnel, followed by persons 75 and older and frontline essential workers. 

Frontline essential workers include first responders, educators and manufacturing, postal and grocery-store workers who are considered to be at a substantially higher exposure risk to the Sars-CoV-2 virus that causes the COVID-19 disease.

In the next phase of allocation are those who are age 65-74 and persons under 65 with high-risk medical conditions as well as other essential workers. After these groups are people ages 16-64 without high-risk medical conditions. 

In January, the Trump administration began allocating vaccines to states based on how quickly they could administer the shots and the size of their populations over age 65 rather than on the overall size of their population, The Hill reported.

The Biden administration has also encouraged states to vaccinate all those over 65, even though there has been increased competition for scarce vaccines. Biden has also said he will devote more attention and resources to racial equity in vaccine distribution. 

Though states’ protocols differ, they probably align with Church teaching, said Dr. Timothy Flanigan, a Brown University professor of medicine and infectious diseases who is also a permanent deacon in the Diocese of Providence, Rhode Island. “Individuals that are knowledgeable and of goodwill and following the same ethical principles can come up with divergent approaches to exactly how to vaccinate and which groups to prioritize.” 

New vaccines from other companies will increase manufacturing capability and alleviate scarcity, Deacon Flanigan said. Even if there are disagreements about distribution, he said, “we need to move in a very, very timely fashion, even if there’s some disagreement as to how you distribute it and among which categories.” 

The protocols show a sensitivity and awareness that the elderly are most vulnerable, Deacon Flanigan said, “including those in congregate-care facilities who are at very high risk of illness and death; and therefore these groups have received by and large a high priority, which I definitely would applaud.”

At a March for Life vigil Mass last month, Archbishop Joseph Naumann of Kansas City, Kansas, said, “In a culture where euthanasia and assisted suicide have gained traction, it has been heartening that our COVID protocols are not based on a biased quality-of-life ethic,” which would restrict care for the elderly and disabled based on an assumption about their “quality of life.” Archbishop Naumann chairs the U.S. Conference of Catholic Bishops’ Pro-Life Committee.


Little Sisters of the Poor Perspective

In their nearly 30 homes for the elderly poor across the country, the Little Sisters of the Poor are in the middle of the vaccination process, said Sister Constance Veit, who manages community communications. 

“I think we would all agree that it is only just that the elderly in congregate living settings, and their caregivers, would be among the first to be vaccinated,” she said. “After all, COVID deaths in nursing homes represent a disproportionate number of the total COVID deaths.”

Along with caring for those most at risk, health-care and frontline workers also need protection even if they’re healthy because their work is riskier, Furton said. 

Some nursing-home staff are resisting vaccination, which is especially a concern because they work with high-risk residents, Furton said. “There is a greater moral obligation to receive the vaccine if you are likely to transmit the illness to others who will suffer badly because of it.”

Also deserving priority for vaccines are racial and ethnic communities affected by health disparities that have suffered more severely from COVID-19, said Brian Kane, senior director of ethics at the St. Louis-based Catholic Health Association. Reaching some communities — especially rural ones — is challenging because some vaccines must be kept at subzero temperatures, he said. 


International Equity

Vaccine equity across national lines is another issue that Pope Francis and the Pontifical Academy for Life have emphasized: Rather than attempting to own vaccines more quickly, states with more resources should share them with those with more need. 

In his urbi et orbi message on Christmas Day, the Holy Father said, “I ask everyone — government leaders, businesses, international organizations — to foster cooperation and not competition, and to seek a solution for everyone: vaccines for all, especially for the most vulnerable and needy of all regions of the planet. Before all others: the most vulnerable and needy!”

Profit tends to drive distribution of new technology, Deacon Flanigan said. “Therefore, there are issues of equity and justice, and I’m grateful to the Holy Father for pointing this out; and I’m also grateful to sensitivity of the global community, as to the need to make these vaccines available throughout the world as quickly as possible.” 

Countries can donate vaccines out of generosity, but there probably isn’t a moral obligation to do it, Furton said. A nation’s first obligation is to care for its own citizens, he said.

Still, sharing vaccines globally should be a standard practice, Kane said. “Diseases don’t stop at borders,” he said. “There are vulnerable [people] in the United States; there are also vulnerable globally.” 

Vaccine-prioritization issues in the United States may be resolved as the supply increases, but Catholic social teaching is at the heart of the allocation priorities, which involve balancing intrinsic human dignity, the common good and justice, Kane said. 

“It’s a conversation that has its roots in those principles,” he said. ”We shouldn’t just see this as a crisis conversation. This is something that is part of the teaching of the Church.”