Vaccination, Risk, and Beneficence

Abstract Should health authorities exclude vaccines with a small risk of severe side effects during a deadly pandemic, even if this is expected to lead to more harm due to delayed vaccination and prolonged social distancing measures? This question was at the centre of controversy amid the COVID-19 pandemic, where countries excluded vaccines with harmful side effects for some or all groups. Through this case study, I test the normative force and empirical applicability of principles for vaccine allocation and argue for the superiority of a Principle of Sufficient Benefit, according to which health authorities should only offer vaccines that sufficiently improve the recipient’s prospects. I present multiple challenges to the principle: that it is self-defeating, leads to unfair and societally worse outcomes, and prevents people from doing their duties. Given the force of these objections, I conclude that the most satisfactory justification for excluding riskier vaccines fails. In the final section, I argue that compensating people for receiving vaccines with higher risks is a way of retaining the force of the Principle of Sufficient Benefit while accounting for the possibly unfair and harmful consequences that result from putting the recipients first.