Moral Guidance on the Testing, Procurement and Distribution of the COVID-19 Vaccine in the Philippines
Dear brothers and sisters in Christ:
For many months now, the whole world has been struggling with a global pandemic of historic proportions. COVID-19 has already afflicted more than thirty million people around the globe, and tragically, has claimed the lives of over a million, including several thousand Filipinos. It has also locked down our societies and disrupted the livelihoods of billions. With hope in the merciful providence of God our Father, we are now waiting for a vaccine that will help us to end the scourge of this worldwide disease.
Over the past century, vaccines have saved the lives of countless people. However, like all other medical interventions, they have to be developed and used according to sound moral and scientific principles that both affirm the dignity of the human person, especially those who are poor and vulnerable, beloved by the Lord, and promote the common good. This is especially important here in the Philippines where our recent experience with the dengue vaccine that triggered the hospitalizations of thousands of young students has reduced our people’s confidence in the safety and efficacy of vaccines.
Testing Candidate COVID-19 Vaccines in the Philippines
We understand that the national government has agreed to allow candidate COVID-19 vaccines to be tested in our country. Clinical research is morally good, and we commend our fellow Filipinos who have volunteered to be vaccinated with these candidate vaccines. They are heroes who are helping all of us to win the fight against COVID-19. As the Catechism of the Catholic Church affirms: “Scientific, medical, or psychological experiments on human individuals or groups can contribute to healing the sick and the advancement of public health” (§2292).
However, we remind our public health authorities and the pharmaceutical companies involved that that these COVID-19 vaccine Phase III clinical trials must be conducted adhering to the highest ethical standards and best scientific practices. Full transparency is critical at every step of the development and distribution of a candidate vaccine to ensure the safety and effectiveness of every approved vaccine in an immunization campaign. This will help bolster public confidence in the initiatives of medical and governmental authorities.
Before any Phase III clinical trial begins, the results of all earlier Phase I and II trials must be evaluated by designated ethics and expert panels and approved by our national regulatory agencies. The data should be made publicly available so that other scientists and medical professionals can confirm the safety and efficacy of the candidate vaccine.
During the clinical trial, the risks and benefits of being injected by the candidate vaccine must be appropriately communicated to all participants so that they can give informed consent. As the Catechism teaches: “Experimentation on human beings does not conform to the dignity of the person if it takes place without the informed consent of the subject or those who legitimately speak for him” (§2295). This includes informing all participants of any adverse reactions observed in earlier clinical trials of the candidate vaccine and the possibility of still unknown acute reactions, including severe illness and even death.
Further, financial compensation for participation in the clinical trial should not be excessive to avoid the risk of exploiting the poor who would not be free to turn down the payment. This concern is particularly pressing in the Philippines because the barangays reporting the highest caseloads of COVID-19 are often barangays populated by the urban poor. Finally, every participant in these clinical trials must be guaranteed the highest possible standard of care if they experience any adverse reactions. In the case of unforeseen permanent bodily damage, or even death, compensation to the participant or family would be just.
At the conclusion of the protocol, the findings of the Phase III clinical trial must be made public, regardless of outcome. It is our prayer that the clinical trials conducted in our country will benefit the global effort to end the pandemic.
Procuring COVID-19 Vaccines for the Philippines
We hope that at least one of the many candidate COVID-19 vaccines being developed and tested around the world will be found to be safe and effective. If several vaccines are available, we advise the national government to procure vaccines with the following considerations.
If several vaccines are available, we urge the national government to prioritize vaccines that were developed without the use of morally controversial cell lines derived from the remains of an aborted child. As the Pontifical Academy of Life at the Vatican has explained, “there is a grave responsibility to use alternative vaccines and to make a conscientious objection with regard to those which have moral problems.” We must reject any vaccine made from aborted fetal cells.
If several vaccines are available, we urge the national government to prioritize vaccines developed by pharmaceutical companies that are making their vaccines available as cheaply as possible, usually at cost. Not only will these vaccines be more economical for our country but prioritizing them would encourage other global firms to contribute better to the common good by extending their corporate social responsibility programs. Pope Francis has encouraged us to favor industries that contribute to “the inclusion of the excluded, the promotion of the least, the common good or the care of creation.”
Allocating COVID-19 Vaccines in the Philippines
Initial supplies of a COVID-19 vaccine will be very limited. The World Health Organization (WHO) anticipates that nations that are participating in its COVAX vaccine allocation mechanism – the Philippines is one of these countries – will receive an initial allocation of vaccines equal to 3% of their populations. This means that we will receive vaccines enough to immunize only 3.3 million of the 110 million Filipinos who live in our archipelago. Who should be inoculated first?
The goal of a vaccination campaign should be to reduce mortality and to protect the health care infrastructure of our country. This best protects both the individual good of each citizen and the common good of the country. Therefore, vaccines should be allocated to prioritize those members of our communities who are most at risk for infection and for severe disease. As Pope Francis has explained, we must “plan the treatment of viruses by prioritizing those who are most in need.”
First, all medical front liners who are at high risk for infection because of their vocation as healthcare professionals should receive top priority for vaccinations. We need healthy doctors and nurses to treat our sick so that our people can heal.
Second, adults who are at high risk for severe disease because of their age or underlying medical conditions should be next to receive a vaccine. We especially need to shield our senior citizens who face the highest risk of death from COVID-19.
Third, essential workers whose roles are inherently risky because of necessary interactions with the public and are also important for the common good should be next. This tier would include teachers, grocery story workers, public transportation workers, police, firefighters, and national security personnel, among others.
Finally, the rest of the population would be inoculated, prioritizing those individuals who are living in dense urban areas where they are vulnerable to the virus. Note that these proposed tiers correspond closely with the recommendations of many international organizations including the WHO.
We propose this allocation plan for the COVID-19 vaccine that prioritizes those who are at most risk for infection or for severe disease because of our concern that in the Philippines, vaccines may be allocated first to those who are wealthy, powerful, and influential. This would not efficiently mitigate deaths in our communities and would delay the end of the pandemic in our country. This would be a great moral and social tragedy.
Finally, we urge our national government to provide the COVID-19 vaccine to everyone without cost to the individual. Otherwise it will not be available to the poor. Pope Francis has said, “It would be sad if, for the vaccine for Covid-19, priority were to be given to the richest!” As the pope has said many times, “The preferential option for the poor is at the center of the Gospel. And the first to do this was Jesus. […] Since He was rich, He made Himself poor to enrich us. He made Himself one of us and for this reason, at the center of the Gospel, there is this option, at the center of Jesus’ proclamation.”
In closing, we commend all who are working tirelessly to end this pandemic, all our medical health professionals, our front liners, our public health authorities, and our scientists, to our Mother, Our Lady, Health of the Sick and St. Joseph, Patron of the Dying. We ask them to intercede for us before their beloved Son, Our Lord, the Divine Physician, that we may be healed in both body and spirit. To Him, be the glory forever! Amen! (Rev. 11:36)
From the Episcopal Commission for Seminaries and the Episcopal Commission for Bio Ethics of the Catholic Bishops’ Conference of the Philippines, October 1, 2020
Archbishop of Lingayen-Dagupan
Episcopal Commission for Seminaries
Archbishop of Tuguegarao
Episcopal Commission for Bioethics
+PABLO VIRGILIO DAVID
Bishop of Kalookan
Acting President, CBCP
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