Is It Ethical To Lie To Get A Booster Or A Shot For An Under-12 Kid?
This story originally ran on NPR's Goats and Soda blog, which answers frequently asked questions about life during the coronavirus crisis. See an archive of their FAQs here.
Is it OK to lie to get a vaccine? Say, if you want a third shot as a booster because you think it could enhance your protection. Or a shot for an 11-year-old who's... almost 12? Or if you're a teenager who wants a shot but your parent is opposed?
We posed these questions to experts in medical ethics and infectious disease, and their answers were clear for that unauthorized booster or an underage candidate: Don't do it.
It turns out there are plenty of ethical, medical and practical reasons not to lie.
First, the practical: The Food and Drug Administration and the Centers for Disease Control and Prevention have not OK'd additional shots, and lying about a birth date or past vaccination history introduces potential medical problems and billing hassles not only for you but for the medical system, says Nancy Berlinger, a research scholar at the Hastings Center, an independent bioethics research institution in Garrison, New York.
At a minimum, getting an unauthorized shot means you may have to figure out how to deal with it in your personal medical records at some point. "Getting vaccinated is part of your medical history — you would have to reveal it going forward in the interest of your own health," Berlinger says.
It's also unclear who is paying for these unauthorized shots: As STAT has reported, insurance companies have a billing code set for booster shots, but it won't work until the shots are authorized. And it also puts pharmacies and hospitals in the position of playing the truth police: While many have developed policies about boosters, few have the resources to check the accuracy of every single patient's record. Most consent forms ask if you've been vaccinated before. If you say no, you may get away with the lie in the moment, but your insurance company may deny the claim once it realizes you were already fully vaccinated. And the pharmacy or medical facility could be stuck with your bill.
Then there are the potential medical repercussions of getting an unauthorized shot, says Dr. Jill Weatherhead, an assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. The CDC has started tracking unauthorized booster shots, but clinical trials addressing the safety of additional doses are still underway. It's not yet known, for example, whether people will experience more side effects from additional doses, Weatherhead says. Israel, however, is already authorizing third shots for people over 60, and other countries are planning to follow suit. And in the U.S., San Francisco General Hospital has said it will give mRNA shots to people who got the Johnson & Johnson vaccine initially.
"Is it possible you'll need another eventually? Yes," Weatherhead says. "But at this time it's not recommended by the CDC or the FDA to get a second shot. In the meantime, Johnson & Johnson still prevents severe disease, hospitalization and death — it's a huge layer of protection."
Seeking vaccines for kids younger than 12 involves additional unknowns, Weatherhead says, partly because Moderna and Pfizer-BioNTech adjusted the doses in their ongoing trials for younger kids. Even if you have an 11-year-old who could pass for a 12-year-old, weight and size are not the only factors that researchers take into consideration when deciding on appropriate doses.
"It's also how developed the immune system is," Weatherhead explains. The way an 11-year-old metabolizes a vaccine may be very different from the way a 16-year-old does.
"That's why it's important to let [the studies] go to completion — to ensure the safety of the dose," she says.
At the same time, Weatherhead "completely understands the sentiment as a parent," especially since she lives in a state that won't allow her 6-year-old's school to require masks. "You want them to be as protected as possible, and you don't want to send them into a situation that is high risk when you know there's a layer of protection you could give them. But I still recommend waiting until we know it's safe and efficacious, to not jump ahead, so that you know when you do get it it's the best protection we can provide our children."
Berlinger empathizes with parents of young children too. However, she also knows that people tend to cherry-pick data: "We choose data based on the things we want to do," she says. "And this isn't like a 4-year-old going on the subway for free. This has material consequences that could actually affect a child's health."
Now let's look at the ethical debate regarding those unauthorized boosters. At first glance, it might seem simple: If a dose is set to expire, what's the ethical issue with taking it? But if we all did that, it would be part of a pattern that shuts out people in need, Berlinger says.
"Someone in frailer health may not simply be able to go to CVS," she points out. "You shouldn't crowd out people at greater risk than you. Even with adequate vaccine supply, people who are older or in more fragile health may face barriers to vaccine access. The first duty of public health is a duty to plan, so if there is now evidence of which population will benefit from a booster, we must plan for how that population gets access."
Plus, lying about your eligibility to get something that's not intended for you is gaming the system. And that's not a good public health strategy, Berlinger points out. "It's only thinking about oneself, and it doesn't help close the vaccination gap."
"Is it really better to lie to the pharmacist than to have a chat with your doctor about whether a fully vaccinated adult needs a booster now [ahead of evidence and authorization]?" she says. And also: You're angling for a booster without considering which fully vaccinated adults are at the greatest risk and should get boosters first.
At its extreme, gaming the system (which, she points out, is often a tactic only available to the privileged) crowds other people out. "I should not be leaping ahead of my 87-year-old mother," Berlinger says.
On a global level, the World Health Organization this week called for countries to put a moratorium on boosters (which are now being administered in Israel, for example, to adults over age 60).
"The WHO is making a health justice argument: This is a global emergency. We must think globally, which means rich vaccine producers shouldn't get 'thirds' while poor countries are still waiting to eat," Berlinger says.
"If we in this rich country, which most of us were born into by chance, fail to imagine the situation of people in poor countries — fail to imagine their lives as being as real as our lives — that certainly works against progress on health justice," she says.
However, the situation is different for teens whose parents refuse to sign off on the paperwork to get their jab, our experts allow. Currently, most states require parental approval for teens to get vaccinated. That could change once the FDA fully approves the vaccines — and states should consider changing their guidance to allow kids as young as 12 to get vaccinated without parental consent, experts in health law, policy and ethics argue in a new JAMA Pediatrics article.
For now, Weatherhead advises that teens who want to get vaccinated ask their doctor (or another trusted adult) to talk to their parents. And in some situations, such as when a student's college requires vaccination, a student would be justified in not telling a parent that they have been vaccinated, says Berlinger — if the disclosure would be risky in terms of parental consequences or not getting into college.
Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She has written about COVID-19 for many publications, including Medscape, Kaiser Health News, Science News for Students and The Washington Post. More at sheilaeldred.pressfolios.com. On Twitter: @milepostmedia.
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