It is ethically irresponsible that in the midst of the pandemic we are unable to increase the vaccination rate, says medical ethicist Annelien Bredenoord. According to her, Minister De Jonge makes a wrong assessment of the risks with his injection stop.
It was a ‘fearful government’ that just before Easter took the decision to introduce another injection stop, says medical ethicist Annelien Bredenoord, and exactly the wrong thing has been achieved. ‘Because the government did not want to take any risks, more risk has actually arisen. The risk of more infections and more sickness than was necessary. And the risk of an even longer lockdown with all the resulting social damage. ‘
Bredenoord, professor of Ethics of Biomedical Innovations at UMC Utrecht and senator for D66, is annoyed by the slow vaccination rate, the increasing stocks of vaccines that are kept as a precaution and the time-consuming advice that is required before a decision is made. She can understand that the vaccination with AstraZeneca was temporarily halted in mid-March due to a mysterious side effect – after all, there was little information at the time. But the second stop was a bad idea, she says. ‘It can no longer be ethically justified that we are still unable to increase the vaccination rate in the middle of a pandemic.’
Why was quitting a bad idea?
‘The government is there for the sake of public health. The minister should not have thought: what if that one vaccinated person gets an adverse reaction? No, he should have thought: what if all those others get sick? By shutting down vaccinations, you harm public health, a government has to look at group level. ‘
As an ethicist, how do you view that decision?
‘Ethics is about making choices and those choices are always about essential matters, about things that we find valuable. What you choose then always gets a bit tricky. You have to dare to accept that: ethics is not for scared people, I always say. I get the idea that the government was afraid to choose the wrong thing, afraid to compromise safety, that it wanted to cover all risks. But let’s not forget that all of life carries risks, even in our modern high-tech society. The minister should not give the impression that those risks do not exist. By dealing with this so anxiously, you create a feeling of insecurity, and you suggest that we live on a risk-free planet.
‘Risk is the probability of an event multiplied by its seriousness. And you always have to compare that with the status quo. We are in the middle of a pandemic, the number of hospital admissions is increasing. So you have to compare the risk of a rare side effect with the risk that many more people will become seriously ill with all the social damage that entails. And the latter risk is so much greater. ‘
The EMA announced on Wednesday how great the risk is of the side effect of the AstraZeneca vaccine: one in 150 thousand. What can an individual do with it? Is that a lot or a little?
‘The way in which a risk is presented determines how we view it. This is made very clear by research in medical sociology. When we tell patients that nine out of ten people get out of an operation well, they say: we will. If we say that one in ten will not make it, they are more likely to give up. While it concerns exactly the same numbers.
‘It shows that we all have difficulty dealing with risks and statistics. Virologist Marion Koopmans tweeted a link this weekend to a website that calculates the risk of death for numerous events. If we base ourselves on the Dutch figures, the risk of the side effect from the AstraZeneca vaccine appears to fall roughly between the chance of being bitten to death by a dog and the chance of death from a lightning strike. That can help put your fear in perspective, but in the end the perception of a risk is never absolute, always personal. ‘
Don’t people who still have doubts have the right to determine their own vaccine of choice? After all, there is the right to self-determination, you can choose what you do and do not want for medical treatment.
‘There is a difference between a positive and a negative right of self-determination. That negative right says that you can decide for yourself that you do not want something. That is an extremely strong right, it actually always applies, even now, you cannot be obliged to get vaccinated. The positive right of self-determination determines whether and to what extent we are entitled to something, to a vaccine of our choice in this case. But to realize that positive right, you always need help or a push from someone else. Think of the right to education or to healthcare. Then it is about what society must and can offer. And that is where it pinches at the moment, because there is a scarcity of vaccines, which makes it impossible to achieve that right now. ‘
Can’t we come up with a practical solution? Open up a phone number and anyone who wants AstraZeneca can sign up.
‘No, then you just give the idea that the vaccine is not safe. Then you are going to make it the pariah of the vaccines, like: whoever wants to have it. Why would you choose this if there is no reason to do so? It is also impossible to let people at the counter choose which injection they want. It is certainly not going well with the vaccination rate anyway. ‘
Are you annoyed?
‘The pace is already low, then we have a much too conservative stock policy and we will also temporarily stop injecting. It is no longer possible to explain why we are so behind, and the government can no longer maintain that it cannot be done any faster. The injection sites and hospitals have been saying for weeks that they can help fill the empty time slots. And why should the Health Council be asked for advice on every decision if knowledge about the vaccination strategy can come abroad? See how things are going in Great Britain, ask experts there for advice, they have already vaccinated ten times as many people. Look around you, be creative, we are not on an island. ‘