Vaccine guilt began nearly as soon as COVID-19 vaccinations did. The first COVID-19 vaccines were authorized for emergency use in December 2020, and eligibility was narrowly restricted to frontline health care workers, other essential workers and those whose age or medical conditions placed them at greatest risk if they contracted COVID-19. But even among this first at-risk cohort, reports emerged of vaccine recipients feeling vaccine guilt.
With the U.S. now administering millions of doses a day and President Joe Biden vowing to expand eligibility to every adult by May 1, or possibly earlier – and some states reaching this target sooner – one might think vaccine guilt is going away. But it isn’t.
What vaccine guilt is – and isn’t
Vaccine guilt is different from the survivor’s guilt felt by some people who recognize that while they survived the pandemic to get vaccinated, others – perhaps including loved ones – did not.
It is also different from the guilt associated with lying about vaccine eligibility, or otherwise skipping the line – for which culpability, remorse or a guilty conscience would be the most appropriate response.
For some, vaccine guilt is the sense that other groups, such as those working in grocery, caretaking or public transportation jobs not initially included under “essential workers,” should have been prioritized before you. For others it is the wish that particular individuals – like specific family members – could be vaccinated in your place.
Vaccine guilt might be experienced as embarrassment over having the good fortune of a vaccine or shame over feeling undeserving of a coveted dose.
Fundamentally, vaccine allocation is about risk. Early or late vaccination eligibility is not, or at least should not be, an assessment of positive or negative personal worth or social value. Allocation should be about how best to mitigate COVID-19 risks and stem the spread of disease while working toward herd immunity.
Yet vaccine guilt reflects the reality that some risks have been unfairly assessed in vaccine allocation. For example, assessing risk based on age without accounting for disparities in life expectancy between white and Black Americans resulted in fewer Black Americans initially being eligible for vaccination – despite Black Americans experiencing higher rates of COVID-19 cases and fatalities.
Meanwhile some groups and individuals at increased risk for COVID-19 have been largely excluded from vaccine prioritization, such as incarcerated individuals or those with certain disabilities.
Reasons to feel guilty
Despite increased eligibility for vaccination, there remain significant barriers to access for some communities. Many of these barriers are structural and connect to social and economic inequities. Obtaining a vaccination appointment often requires time and access to resources, such as a phone or internet, to search for and book a slot. Speaking a language in which appointment information is available, having reliable transportation to and from the appointment, and being able to get the time off work or caretaking duties creates other barriers for some groups.
Data show that U.S. counties with the lowest share of people living in poverty and less COVID-19 community transmission have been vaccinated at higher rates. These counties also tend to have a higher share of residents with health insurance and fewer high-risk medical conditions than communities with more-vulnerable populations. Similarly, the rate of vaccination in whiter counties is higher than in counties with a higher proportion of racial and ethnic minority residents.
So even if someone follows the rules of vaccination eligibility, it doesn’t mean the rules are necessarily fair or do a good job ensuring those most vulnerable in society are being vaccinated.
What can we do about vaccine guilt?
My scholarship suggests that people have individual responsibilities as members of a society, including for the society’s health care practices. This is because we are interconnected in a shared society in which we rely on, benefit from, and can sometimes cause disadvantage to others.
As such, one good reason to feel vaccine guilt is it helps people recognize their participation in – and sometimes advantage because of – unjust and unfair systems. It can also spur a push for better accountability and equity within one’s social and political organizations in charge of health care systems in general and COVID-19 response specifically.
Although overall rates of vaccination are important and help protect those most medically vulnerable, the goal of herd immunity is not an excuse for unfairness in vaccine rollout. Plus data confirm that equitable vaccination is better for public health. Vaccinating highest-risk communities first reduces more cases, saves more lives and slows the pandemic faster.
So, where does this leave those feeling guilty about an upcoming vaccine appointment?
They should certainly keep the appointment. But perhaps they could consider ways to help others get vaccinated. Helping people who lack internet access to sign up and safely driving someone who lacks transportation to an appointment are two options.
Or people can donate to nonprofit organizations providing vaccination outreach in underserved communities or support community health centers.
People can also lobby political representatives for greater health equity in the first place.
In a country that can afford and produce vaccines in such a scale and timescale, perhaps there is good reason to feel some guilt. Although shots will soon be available to all, the burden of the virus has disproportionately fallen on low-income families and communities of color – the same communities that may face additional barriers to getting vaccinated.
Elizabeth Lanphier is assistant professor on the pediatrics and ethics center faculty at Cincinnati Children’s Hospital Medical Center, part of the University of Cincinnati College of Medicine. This piece originally appeared in The Conversation, a nonprofit news source dedicated to unlocking ideas from academia for the public.