Advocacy, Bioethics, and Regulating COVID-19 Vaccines for Children Under 5

While COVID-19 vaccines became available quickly for adults and teens in the U.S., children under 5 years old waited an additional year and a half for vaccine access, even though they were often present in congregate settings like daycares and preschools and had the highest rates of hospitalization and death from COVID-19 of any pediatric age group. This paper argues that the vaccination process for children under 5 years old in the U.S., which may have appeared to be merely composed of linear scientific and regulatory steps, was in fact impacted by formal and informal advocacy informed by competing, and at times, under-acknowledged values. In this conceptual philosophical analysis, we identify a necessary but largely untapped role for bioethics in the domains of community and government advocacy at individual, adjacent, and structural levels and to help clarify and navigate competing values and priorities raised in complex cases of health advocacy.