COVID-19 Vaccines, Aborted Baby Cell-Lines and Catholic Moral Theology - Part H - Reference - Vatican Declarations
I just realised that I don't have the Vatican information in a handy spot for reference.
P^3
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CONGREGATION FOR THE DOCTRINE OF THE FAITH
Note on the morality of using
some anti-Covid-19 vaccines
The question of the use of vaccines, in general, is often at the center of controversy in the forum of public opinion. In recent months, this Congregation has received several requests for guidance regarding the use of vaccines against the SARS-CoV-2 virus that causes Covid-19, which, in the course of research and production, employed cell lines drawn from tissue obtained from two abortions that occurred in the last century. At the same time, diverse and sometimes conflicting pronouncements in the mass media by bishops, Catholic associations, and experts have raised questions about the morality of the use of these vaccines.
There is already an important pronouncement of the Pontifical Academy for Life on this issue, entitled “Moral reflections on vaccines prepared from cells derived from aborted human fetuses” (5 June 2005). Further, this Congregation expressed itself on the matter with the Instruction Dignitas Personae (September 8, 2008, cf. nn. 34 and 35). In 2017, the Pontifical Academy for Life returned to the topic with a Note. These documents already offer some general directive criteria.
Since the first vaccines against Covid-19 are already available for distribution and administration in various countries, this Congregation desires to offer some indications for clarification of this matter. We do not intend to judge the safety and efficacy of these vaccines, although ethically relevant and necessary, as this evaluation is the responsibility of biomedical researchers and drug agencies. Here, our objective is only to consider the moral aspects of the use of the vaccines against Covid-19 that have been developed from cell lines derived from tissues obtained from two fetuses that were not spontaneously aborted.
1. As the Instruction Dignitas Personae states, in cases where cells from aborted fetuses are employed to create cell lines for use in scientific research, “there exist differing degrees of responsibility”[1] of cooperation in evil. For example,“in organizations where cell lines of illicit origin are being utilized, the responsibility of those who make the decision to use them is not the same as that of those who have no voice in such a decision”.[2]
2. In this sense, when ethically irreproachable Covid-19 vaccines are not available (e.g. in countries where vaccines without ethical problems are not made available to physicians and patients, or where their distribution is more difficult due to special storage and transport conditions, or when various types of vaccines are distributed in the same country but health authorities do not allow citizens to choose the vaccine with which to be inoculated) it is morally acceptable to receive Covid-19 vaccines that have used cell lines from aborted fetuses in their research and production process.
3. The fundamental reason for considering the use of these vaccines morally licit is that the kind of cooperation in evil (passive material cooperation) in the procured abortion from which these cell lines originate is, on the part of those making use of the resulting vaccines, remote. The moral duty to avoid such passive material cooperation is not obligatory if there is a grave danger, such as the otherwise uncontainable spread of a serious pathological agent[3]--in this case, the pandemic spread of the SARS-CoV-2 virus that causes Covid-19. It must therefore be considered that, in such a case, all vaccinations recognized as clinically safe and effective can be used in good conscience with the certain knowledge that the use of such vaccines does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive. It should be emphasized, however, that the morally licit use of these types of vaccines, in the particular conditions that make it so, does not in itself constitute a legitimation, even indirect, of the practice of abortion, and necessarily assumes the opposition to this practice by those who make use of these vaccines.
4. In fact, the licit use of such vaccines does not and should not in any way imply that there is a moral endorsement of the use of cell lines proceeding from aborted fetuses.[4] Both pharmaceutical companies and governmental health agencies are therefore encouraged to produce, approve, distribute and offer ethically acceptable vaccines that do not create problems of conscience for either health care providers or the people to be vaccinated.
5. At the same time, practical reason makes evident that vaccination is not, as a rule, a moral obligation and that, therefore, it must be voluntary. In any case, from the ethical point of view, the morality of vaccination depends not only on the duty to protect one's own health, but also on the duty to pursue the common good. In the absence of other means to stop or even prevent the epidemic, the common good may recommend vaccination, especially to protect the weakest and most exposed. Those who, however, for reasons of conscience, refuse vaccines produced with cell lines from aborted fetuses, must do their utmost to avoid, by other prophylactic means and appropriate behavior, becoming vehicles for the transmission of the infectious agent. In particular, they must avoid any risk to the health of those who cannot be vaccinated for medical or other reasons, and who are the most vulnerable.
6. Finally, there is also a moral imperative for the pharmaceutical industry, governments and international organizations to ensure that vaccines, which are effective and safe from a medical point of view, as well as ethically acceptable, are also accessible to the poorest countries in a manner that is not costly for them. The lack of access to vaccines, otherwise, would become another sign of discrimination and injustice that condemns poor countries to continue living in health, economic and social poverty.[5]
The Sovereign Pontiff Francis, at the Audience granted to the undersigned Prefect of the Congregation for the Doctrine of the Faith, on 17 December 2020, examined the present Note and ordered its publication.
Rome, from the Offices of the Congregation for the Doctrine of the Faith, on 21 December 2020, Liturgical Memorial of Saint Peter Canisius.
| Luis F. Card. Ladaria, S.I. | + S.E. Mons. Giacomo Morandi |
| Prefect | Titular Archbishop of Cerveteri |
| Secretary |
[1] Congregation for the Doctrine of the Faith, Instruction Dignitas Personae (8 th December 2008), n. 35; AAS (100), 884.
[3] Cfr. Pontifical Academy for Life, “Moral reflections on vaccines prepared from cells derived from aborted human foetuses”, 5th June 2005.
[4] Congregation for the Doctrine of the Faith, Instruct. Dignitas Personae, n. 35: “When the illicit action is endorsed by the laws which regulate healthcare and scientific research, it is necessary to distance oneself from the evil aspects of that system in order not to give the impression of a certain toleration or tacit acceptance of actions which are gravely unjust. Any appearance of acceptance would in fact contribute to the growing indifference to, if not the approval of, such actions in certain medical and political circles”.
[5] Cfr. Francis, Address to the members of the "Banco Farmaceutico" foundation, 19 September 2020.
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Mrs Debra L.Vinnedge Vatican City, June 9 2005 Dear Mrs Debra L.Vinnedge, On June 4, 2003, you wrote to His Eminence Cardinal Joseph Ratzinger, with a copy of this letter forwarded to me, asking to the Sacred Congregation of the Doctrine of Faith a clarification about the liceity of vaccinating children with vaccines prepared using cell lines derived from aborted human fetuses. Your question regarded in particular the right of the parents of these children to oppose such a vaccination when made at school, mandated by law. As there were no formal guidelines by the magisterium concerning that topic, you said that catholic parents were often challenged by State Courts, Health Officials and School Administrators when they filled religious exemptions for their children to this type of vaccination. This Pontifical Academy for Life, carrying out the commission entrusted to us by the Congregation for the Doctrine of Faith, in answer to your request, has proceeded to a careful examination of the question of these "tainted" vaccines, and has produced as a result a study (in Italian) that has been realized with the help of a group of experts. This study has been approved as such by the Congregation and we send you, there enclosed, an English translation of a synthesis of this study. This synthesis can be brought to the knowledge of the interested officials and organisms. A documented paper on the topic will be published in the journal "Medicina e Morale", edited by the Centra di Bioetica della Universita Cattolica in Rome. The study, its synthesis, and the translation of this material took some time. We apologize for the delay. With my best regards, Sincerely yours,
00193 Roma - Via della Conciliazione, 1 - Tel. 06 698.82423 - 06 698.81693 - Fax 06 698.82014 MORAL REFLECTIONS The matter in question regards the lawfulness of production, distribution and use of certain vaccines whose production is connected with acts of procured abortion. It concerns vaccines containing live viruses which have been prepared from human cell lines of foetal origin, using tissues from aborted human foetuses as a source of such cells. The best known, and perhaps the most important due to its vast distribution and its use on an almost universal level, is the vaccine against Rubella (German measles). Rubella and its vaccine Rubella (German measles)1 is a viral illness caused by a Togavirus of the genus Rubivirus and is characterized by a maculopapular rash. It consists of an infection which is common in infancy and has no clinical manifestations in one case out of two, is self-limiting and usually benign. Nonetheless, the German measles virus is one of the most pathological infective agents for the embryo and foetus. When a woman catches the infection during pregnancy, especially during the first trimester, the risk of foetal infection is very high (approximately 95%). The virus replicates itself in the placenta and infects the foetus, causing the constellation of abnormalities denoted by the name of Congenital Rubella Syndrome. For example, the severe epidemic of German measles which affected a huge part of the United States in 1964 thus caused 20,000 cases of congenital rubella2, resulting in 11,250 abortions (spontaneous or surgical), 2,100 neonatal deaths, 11,600 cases of deafness, 3,580 cases of blindness, 1,800 cases of mental retardation. It was this epidemic that pushed for the development and introduction on the market of an effective vaccine against rubella, thus permitting an effective prophylaxis against this infection. The severity of congenital rubella and the handicaps which it causes justify systematic vaccination against such a sickness. It is very difficult, perhaps even impossible, to avoid the infection of a pregnant woman, even if the rubella infection of a person in contact with this woman is diagnosed from the first day of the eruption of the rash. Therefore, one tries to prevent transmission by suppressing the reservoir of infection among children who have not been vaccinated, by means of early immunization of all children (universal vaccination). Universal vaccination has resulted in a considerable fall in the incidence of congenital rubella, with a general incidence reduced to less than 5 cases per 100,000 livebirths. Nevertheless, this progress remains fragile. In the United States, for example, after an overwhelming reduction in the number of cases of congenital rubella to only a few cases annually, i.e. less than 0.1 per 100,000 live births, a new epidemic wave came on in 1991, with an incidence that rose to 0.8/100,000. Such waves of resurgence of German measles were also seen in 1997 and in the year 2000. These periodic episodes of resurgence make it evident that there is a persistent circulation of the virus among young adults, which is the consequence of insufficient vaccination coverage. The latter situation allows a significant proportion of vulnerable subjects to persist, who are a source of periodic epidemics which put women in the fertile age group who have not been immunized at risk. Therefore, the reduction to the point of eliminating congenital rubella is considered a priority in public health care. Vaccines currently produced using human cell lines that come from aborted foetuses To date, there are two human diploid cell lines which were originally prepared from tissues of aborted foetuses (in 1964 and 1970) and are used for the preparation of vaccines based on live attenuated virus: the first one is the WI-38 line (Winstar Institute 38), with human diploid lung fibroblasts, coming from a female foetus that was aborted because the family felt they had too many children (G. Sven et al., 1969). It was prepared and developed by Leonard Hayflick in 1964 (L. Hayflick, 1965; G. Sven et al., 1969)3 and bears the ATCC number CCL-75. WI-38 has been used for the preparation of the historical vaccine RA 27/3 against rubella (S.A. Plotkin et al, 1965)4. The second human cell line is MRC-5 (Medical Research Council 5) (human, lung, embryonic) (ATCC number CCL-171), with human lung fibroblasts coming from a 14 week male foetus aborted for "psychiatric reasons" from a 27 year old woman in the UK. MRC-5 was prepared and developed by J.P. Jacobs in 1966 (J.P. Jacobs et al, 1970)5. Other human cell lines have been developed for pharmaceutical needs, but are not involved in the vaccines actually available6. The vaccines that are incriminated today as using human cell lines from aborted foetuses, WI-38 and MRC-5, are the following:7 A) Live vaccines against rubella8:
B) Other vaccines, also prepared using human cell lines from aborted foetuses:
The position of the ethical problem related to these vaccines From the point of view of prevention of viral diseases such as German measles, mumps, measles, chicken pox and hepatitis A, it is clear that the making of effective vaccines against diseases such as these, as well as their use in the fight against these infections, up to the point of eradication, by means of an obligatory vaccination of all the population at risk, undoubtedly represents a "milestone" in the secular fight of man against infective and contagious diseases. However, as the same vaccines are prepared from viruses taken from the tissues of foetuses that had been infected and voluntarily aborted, and the viruses were subsequently attenuated and cultivated from human cell lines which come likewise from procured abortions, they do not cease to pose ethical problems. The need to articulate a moral reflection on the matter in question arises mainly from the connection which exists between the vaccines mentioned above and the procured abortions from which biological material necessary for their preparation was obtained. If someone rejects every form of voluntary abortion of human foetuses, would such a person not contradict himself/herself by allowing the use of these vaccines of live attenuated viruses on their children? Would it not be a matter of true (and illicit) cooperation in evil, even though this evil was carried out forty years ago? Before proceeding to consider this specific case, we need to recall briefly the
principles assumed in classical moral doctrine with regard to the problem of
cooperation in evil 9, a problem which arises every time that a moral agent
perceives the existence of a link between his own acts and a morally evil action
carried out by others. The first fundamental distinction to be made is that between formal and material cooperation. Formal cooperation is carried out when the moral agent cooperates with the immoral action of another person, sharing in the latter's evil intention. On the other hand, when a moral agent cooperates with the immoral action of another person, without sharing his/her evil intention, it is a case of material cooperation. Material cooperation can be further divided into categories of immediate (direct) and mediate (indirect), depending on whether the cooperation is in the execution of the sinful action per se, or whether the agent acts by fulfilling the conditions - either by providing instruments or products - which make it possible to commit the immoral act. Furthermore, forms of proximate cooperation and remote cooperation can be distinguished, in relation to the "distance" (be it in terms of temporal space or material connection) between the act of cooperation and the sinful act committed by someone else. Immediate material cooperation is always proximate, while mediate material cooperation can be either proximate or remote. Formal cooperation is always morally illicit because it represents a form of direct and intentional participation in the sinful action of another person.10 Material cooperation can sometimes be illicit (depending on the conditions of the "double effect" or "indirect voluntary" action), but when immediate material cooperation concerns grave attacks on human life, it is always to be considered illicit, given the precious nature of the value in question11. A further distinction made in classical morality is that between active (or positive) cooperation in evil and passive (or negative) cooperation in evil, the former referring to the performance of an act of cooperation in a sinful action that is carried out by another person, while the latter refers to the omission of an act of denunciation or impediment of a sinful action carried out by another person, insomuch as there was a moral duty to do that which was omitted12. Passive cooperation can also be formal or material, immediate or mediate, proximate or remote. Obviously, every type of formal passive cooperation is to be considered illicit, but even passive material cooperation should generally be avoided, although it is admitted (by many authors) that there is not a rigorous obligation to avoid it in a case in which it would be greatly difficult to do so. Application to the use of vaccines prepared from cells coming from embryos or foetuses aborted voluntarily In the specific case under examination, there are three categories of people who are involved in the cooperation in evil, evil which is obviously represented by the action of a voluntary abortion performed by others: a) those who prepare the vaccines using human cell lines coming from voluntary abortions; b) those who participate in the mass marketing of such vaccines; c) those who need to use them for health reasons. Firstly, one must consider morally illicit every form of formal cooperation (sharing the evil intention) in the action of those who have performed a voluntary abortion, which in turn has allowed the retrieval of foetal tissues, required for the preparation of vaccines. Therefore, whoever - regardless of the category to which he belongs — cooperates in some way, sharing its intention, to the performance of a voluntary abortion with the aim of producing the above-mentioned vaccines, participates, in actuality, in the same moral evil as the person who has performed that abortion. Such participation would also take place in the case where someone, sharing the intention of the abortion, refrains from denouncing or criticizing this illicit action, although having the moral duty to do so (passive formal cooperation). In a case where there is no such formal sharing of the immoral intention of the person who has performed the abortion, any form of cooperation would be material, with the following specifications. As regards the preparation, distribution and marketing of vaccines produced as a result of the use of biological material whose origin is connected with cells coming from foetuses voluntarily aborted, such a process is stated, as a matter of principle, morally illicit, because it could contribute in encouraging the performance of other voluntary abortions, with the purpose of the production of such vaccines. Nevertheless, it should be recognized that, within the chain of production-distribution-marketing, the various cooperating agents can have different moral responsibilities. However, there is another aspect to be considered, and that is the form of passive material cooperation which would be carried out by the producers of these vaccines, if they do not denounce and reject publicly the original immoral act (the voluntary abortion), and if they do not dedicate themselves together to research and promote alternative ways, exempt from moral evil, for the production of vaccines for the same infections. Such passive material cooperation, if it should occur, is equally illicit. As regards those who need to use such vaccines for reasons of health, it must be emphasized that, apart from every form of formal cooperation, in general, doctors or parents who resort to the use of these vaccines for their children, in spite of knowing their origin (voluntary abortion), carry out a form of very remote mediate material cooperation, and thus very mild, in the performance of the original act of abortion, and a mediate material cooperation, with regard to the marketing of cells coming from abortions, and immediate, with regard to the marketing of vaccines produced with such cells. The cooperation is therefore more intense on the part of the authorities and national health systems that accept the use of the vaccines. However, in this situation, the aspect of passive cooperation is that which stands out most. It is up to the faithful and citizens of upright conscience (fathers of families, doctors, etc.) to oppose, even by making an objection of conscience, the ever more widespread attacks against life and the "culture of death" which underlies them. From this point of view, the use of vaccines whose production is connected with procured abortion constitutes at least a mediate remote passive material cooperation to the abortion, and an immediate passive material cooperation with regard to their marketing. Furthermore, on a cultural level, the use of such vaccines contributes in the creation of a generalized social consensus to the operation of the pharmaceutical industries which produce them in an immoral way. Therefore, doctors and fathers of families have a duty to take recourse to alternative vaccines13 (if they exist), putting pressure on the political authorities and health systems so that other vaccines without moral problems become available. They should take recourse, if necessary, to the use of conscientious objection14 with regard to the use of vaccines produced by means of cell lines of aborted human foetal origin. Equally, they should oppose by all means (in writing, through the various associations, mass media, etc.) the vaccines which do not yet have morally acceptable alternatives, creating pressure so that alternative vaccines are prepared, which are not connected with the abortion of a human foetus, and requesting rigorous legal control of the pharmaceutical industry producers. As regards the diseases against which there are no alternative vaccines which are available and ethically acceptable, it is right to abstain from using these vaccines if it can be done without causing children, and indirectly the population as a whole, to undergo significant risks to their health. However, if the latter are exposed to considerable dangers to their health, vaccines with moral problems pertaining to them may also be used on a temporary basis. The moral reason is that the duty to avoid passive material cooperation is not obligatory if there is grave inconvenience. Moreover, we find, in such a case, a proportional reason, in order to accept the use of these vaccines in the presence of the danger of favouring the spread of the pathological agent, due to the lack of vaccination of children. This is particularly true in the case of vaccination against German measles15. In any case, there remains a moral duty to continue to fight and to employ every lawful means in order to make life difficult for the pharmaceutical industries which act unscrupulously and unethically. However, the burden of this important battle cannot and must not fall on innocent children and on the health situation of the population - especially with regard to pregnant women. To summarize, it must be confirmed that:
References
|
Immunization Action Coalition
1573
Selby AvenueSt.
Paul MN 55104
E-mail: admin@immunize.org Web:
http://www.immunize.org/
Tel: (651) 647-9009Fax:
(651) 647-9131
Source: https://www.immunize.org/talking-about-vaccines/vaticandocument.htm
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Note on Italian vaccine issue
The Pontifical Academy for Life issued a document commenting on the Italian vaccine issue, in collaboration with the "Ufficio per la Pastorale della Salute" of Italian Bishops' Conference and the "Association of Italian Catholic Doctors", on July 31, 2017.
Clarifications on the medical and scientific nature of vaccination:
The lack of vaccinations of the population indicates a serious health risk of diffusing dangerous and often lethal diseases and infections that had been eradicated in the past, such as measles, rubella, and chickenpox. As noted by the Italian National Health Institute, since 2013 there has been a progressive trend in decreasing vaccination coverage. Vaccination coverage data for measles and rubella decreased from 90.4% in 2013 to 85.3% in 2015, contrary to WHO indications that recommend 95% vaccination coverage to eliminate virus circulation.
In the past, vaccines had been prepared using cells from aborted human fetuses, however currently used cell lines are very distant from the original abortions. The vaccines being referred to, the ones most commonly used in Italy, are those against rubella, chickenpox, polio, and hepatitis A. It should be noted that today it is no longer necessary to obtain cells from new voluntary abortions, and that the cell lines on which the vaccines are based in are derived solely from two fetuses originally aborted in the 1960’s. From the clinical point of view, it should also be reiterated that treatment with vaccines, despite the very rare side effects (the events that occur most commonly are mild and due to an immune response to the vaccine itself), is safe and effective. No correlation exists between the administration of the vaccine and the onset of Autism.
Reflections on the ethical nature of vaccines:
In 2005 the Pontifical Academy for Life published a document entitled: "Moral reflections about vaccines prepared from cells of aborted human fetuses" which, in the light of medical advances and current conditions of vaccine preparation, could soon be revised and updated.
Especially in consideration of the fact that the cell lines currently used are very distant from the original abortions and no longer imply that bond of moral cooperation indispensable for an ethically negative evaluation of their use.
On the other hand, the moral obligation to guarantee the vaccination coverage necessary for the safety of others is no less urgent, especially the safety more vulnerable subjects such as pregnant women and those affected by immunodeficiency who cannot be vaccinated against these diseases.
As for the question of the vaccines that used or may have used cells coming from voluntarily aborted fetuses in their preparation, it must be specified that the "wrong" in the moral sense lies in the actions, not in the vaccines or the material itself.
The technical characteristics of the production of the vaccines most commonly used in childhood lead us to exclude that there is a morally relevant cooperation between those who use these vaccines today and the practice of voluntary abortion. Hence, we believe that all clinically recommended vaccinations can be used with a clear conscience and that the use of such vaccines does not signify some sort of cooperation with voluntary abortion. While the commitment to ensuring that every vaccine has no connection in its preparation to any material of originating from an abortion, the moral responsibility to vaccinate is reiterated in order to avoid serious health risks for children and the general population.
Rome, 31 July 2017
Pontifical Academy for Life - National Office for Health Pastoral Care (CEI) - Association of Italian Catholic Doctors
Source; http://www.academyforlife.va/content/pav/en/the-academy/activity-academy/note-vaccini.html
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Vaccines: Making responsible decisions (La Civilita Cattholica)
Carlo Casalone, SJ / Church Thought / Published Date:8 March 2021/Last Updated Date:19 March 2021
“Arabian smallpox maliciously undermines man at the threshold of life and preys on the human species almost destroying it in its birth. This very sad thought is exacerbated by the repeated heavy losses of life caused by the disease and should persuade everyone to embrace with great enthusiasm and receive with equal gratitude the inoculation vaccine, a method that is as simple as it is effective in curbing the poisonous force of the disease.”
These words are from the Edict on Vaccination, June 20, 1820,[1] issued immediately after an epidemic of smallpox in the Papal States by the Secretary of State, Cardinal Ercole Consalvi, on behalf of Pope Pius VII. It provided, in case of epidemics, organizational measures of public health (quarantine, isolation) and the practice of vaccination (administration, records, certificates, supply), making it mandatory and free.
The British physician Edward Jenner (1749-1823) had confirmed, in 1798, the safety and efficacy of the procedure that used cowpox to treat the more serious smallpox. Those who came into contact with the bovine form of smallpox did not contract smallpox, obtaining what we now call immunization. It was thus possible to abandon the previous ancient use, from the Middle East, which for the same purpose, but with much greater risks, used material from infected humans. After about 20 years of practice, Jenner concluded that vaccination “produces a short benign disease without danger, does not cause the contagion of smallpox amongst people living together and at the same time provides a defense against smallpox no less than inoculation with the products of true (human) smallpox.”[2]
The measure of Pius VII, however, was not very successful. Therefore, his successor, Leo XII, removed the obligation, “given the futility of insisting,” as noted by Fr. Enrico Baragli, when reviewing in this magazine the well-known film, Nell’anno del Signore (In the Year of the Lord) and pointing out various historical inaccuracies: the responsibility for this choice to reject the vaccine was “neither that of popes nor of their governments, but was the result of popular prejudices, including those of doctors themselves, as well as of parish priests. The latter considered it ‘troublesome, difficult and odious to compile quarterly lists of births, and especially to expose the reasons for the failure to vaccinate, given the resentment that results.’”[3] Even in those times there was resistance and opposition to the use of vaccines.
The strategic role of vaccines in the current pandemic
Today, the situation has changed considerably. The causes that have determined the spread of the contagion and the propagation of Covid-19 in the globalized world are numerous, as are the consequences that must be re-examined if the human family is to recover from the damage that the crisis has partly caused, partly revealed.[4] Vaccines are not a panacea, but they play a crucial and urgent role in this process: they have undergone an enormous evolution in the last two centuries, proving highly effective for many diseases. It is estimated that about 25 million deaths have been prevented between 2010 and 2020, at a very low cost compared to other health strategies.[5] However, from a biotechnological, medical and social point of view they are not just simple tools due to how they are perceived and culturally represented.
Their story is marked not only by success, but also by failure , which have contributed to a recent resurgence of what is called “vaccine hesitation.”[6] This is a well-known phenomenon, spanning a spectrum from mild hesitancy to outright refusal (anti-vaxers). Didier Fassin, a world-renowned physician and anthropologist, has been interested in public health and social justice. He recollects how the field of medicine is fertile ground for the development of “conspiracy” theories, since vaccination is a practice based on a well accredited scientific truth today, and on a high ethical principle, such as that required of those who take care of sick and fragile people. To think that science could be used for occult and malicious purposes and that medicine operates in contrast with its fundamental axiom: primum non nocere (first, do no harm) therefore strikes at the heart of truth and moral principles.
Like the plague in the 14th century, cholera in the 19th century, and HIV/AIDS since the 1980s, Covid-19 has caused an epidemic of conspiracy theories. Its sinister shadow even reaches vaccines. While one must rule out intentional planning of such goals, one must nevertheless acknowledge that accidental side-effects have fueled suspicion of and opposition to vaccines. The spread of hepatitis C, linked to improper use of syringes during the anti-trypanosomiasis (sleeping sickness) vaccination campaign in Cameroon, is one example.[7] The conversation on vaccines must therefore take into account these multiple dimensions if it is to lead to actions based on responsible choices.
Remote and recent interventions of the Holy See
A statement repeated several times by Pope Francis invites us to take into account different implications of the issue. Following the line set out by many of his predecessors – Pius VII, Leo XII, Gregory XVI, Pius IX – he affirms that vaccinating against Covid-19 is an “ethical option” and warns against “suicidal denialism.”[8]
An ethical action is the result not only of correct information, but also of a critical examination of suspicions and fears. For this to happen, it is necessary to distance oneself from emotional reactions: to recognize them, understand them and examine where they lead, so as not to follow them if they are misleading or “disordered,” to use the language of discernment. They must therefore be responsibly assessed, in the context of the good of other people.
The pope pointed out clearly that vaccination involves aspects that concern others: “You are gambling with your health, with your life, but you are also gambling with the lives of others.” Moreover, if one takes a broader view, the common good and justice are also in question: “If there is the possibility of curing a disease with a drug, it should be available to everyone, otherwise it creates injustice”[9]; “pharmaceutical marginality” must be avoided.[10] “Social and economic differences on the global level risk dictating the order of distribution of anti-Covid vaccines, with the poor always at the end of the line and the right to universal health care affirmed in principle, but stripped of real effect.”[11] In order to clarify this complex matter and to give answers to those who ask questions about the safety, effects and lawfulness of vaccines, the Holy See has recently published two Notes that address the various aspects.
Vaccines and abortion
The first, Note on the Morality of the Use of Certain Anti-Covid-19 Vaccines, comes from the Congregation for the Doctrine of the Faith (CDF) and examines a very specific problem, but one that has been discussed for some time, especially within the ecclesial community: the use of vaccines produced using cell lines extracted from the tissues of voluntarily aborted fetuses.[12] This problem has also been raised by some vaccines administered to children: first of all, the rubella vaccine, but also those against hepatitis A and rabies. In particular, there is concern about a cell line (HEK293) obtained in 1973 from the kidney tissue procured as the result of an abortion that occurred in Holland.
Neither the identity of the parents nor the precise reasons for the termination of the pregnancy are known, although they appear to have no connection with the objective of preparing cell lines for laboratories.[13] Some Covid vaccines use such biological material in one or more phases of their preparation. Those already approved in the U.S. and Europe, manufactured by Pfizer-BioNTech and Moderna with messenger RNA technology, do not use such cell lines for production, but only for some verification tests.[14]
The CDF Note reiterates what has already been stated in a previous Instruction, where it was first specified that you cannot justify voluntary abortion, even for public health reasons: both the extraction of cell lines to prepare vaccines and their distribution and marketing are, in principle, morally illicit. The Instruction noted, however, that “within this general picture there exist differing degrees of responsibility. Grave reasons may be morally proportionate to justify the use of such ‘biological material.’”[15]
With reference to the current situation, the CDF explains the reasons and conditions under which “it is morally acceptable to use Covid-19 vaccines that have employed cell lines from aborted fetuses in their research and production process” (Note, No. 2). The argument used to support this position is that it differentiates between ways of cooperating with a morally illicit action performed by others. The principle is of great interest because it is a conceptual tool that the tradition of moral theology has developed to address the complexity of human decision-making, which never occurs in an abstract space, but is always intertwined with the actions of other subjects and in composite circumstances.[16]
In our case, consideration must be given to the fact that cooperation with cell lines from the 1973 abortion is material, passive and remote (see Note 1, No. 3). These are terms that designate well-defined conditions. First, cooperation is material when one does not share the intention of the person who performed the principal action, in this case, the presumably deliberate killing of an innocent person. Secondly, it is passive. In fact, you do not actively participate in the conduct of the act, which is also impossible, since the event happened in the distant past, and – an important aspect to remember, because sometimes it is misunderstood – it does not require the procuring of other abortions: for the preparation of vaccines, cells already available in laboratories from the 1970s and 1980s are used. Third, therefore, the action that is performed is remote, that is, it is distant in time and peripheral to the core of meaning of the behavior to which it refers. These criteria can help to locate and differentiate the responsibilities of other subjects involved in the process required by the research and preparation of vaccines.
Personal responsibility
As we can see, our moral evaluation of voluntary abortion remains negative and it is necessary to avoid any perception of complicity with it (thus avoiding causing scandal), when one engages in the search for ways of production that employ other biological material. But, in the absence of alternatives and because of the gravity of the situation, the use of these vaccines is considered legitimate. And in the current circumstances, it can certainly happen that there is no real possibility of choosing an alternative vaccine, both because of the scarcity of available doses and because of the constraints imposed by health systems.
In fact, we must remember that the lengthy time required for vaccinations entails an increase in the probability that more contagious variants will develop, which are more lethal and/or more resistant to the available vaccines. The more time we give the virus to replicate, the greater the likelihood of mutation. It is true that Sars.Cov.2 is more stable than other viruses (such as influenza), at least from the point of view of antigens: being equipped with a good molecular “proofreading” device, copying errors are reduced. The variants known so far – such as the British, Brazilian and South African – seem sensitive to current vaccines. However, we cannot exclude the possibility of resistant forms taking hold.
Therefore, as the U.S. bishops also point out, in the same way that the use of the rubella vaccine is acceptable, so too, “because of the lack of alternatives and the serious risk to public health, it would be permissible to accept the AstraZeneca vaccine.”[17] And the Latin American bishops reiterate: “Vaccination cannot be considered to be in cooperation with evil (for example, abortion), but a direct act of care for life.”[18] So let us see how the importance of circumstances is brought to bear in evaluating the good to be done. Also because what is at stake is not only personal health, but also the health of others and the common good.
Therefore, there is a very real responsibility for everyone to get vaccinated: what is at stake is the protection not only of one’s own health, but also of public health. In fact, vaccination, on the one hand, reduces the exposure of people who, for medical reasons, cannot receive it (for example, immuno-compromised people) and who will be protected by the vaccination coverage of others (and by the achievement of herd immunity); on the other hand, it limits the number of sick people and hospitalizations, reducing the overload in health systems, which are already struggling to provide the necessary care to patients with other diseases. We have seen how in various countries treatment has had to be rationed due to lack of resources. The refusal of the vaccine, therefore, means risking the fundamental safety of others, both personally and socially.[19]
The first steps of the vaccine pathway: research and testing
The second Note, Vaccine for All. 20 Points for a More Just and Healthy World[20], this time from the Vatican Covid-19 Commission and the Pontifical Academy for Life, focuses on aspects that concern the broader context of public health, also on a global level. The text analyzes the entire life cycle of the vaccine and, in addition to the issues already mentioned regarding production and administration, examines the ethical implications of each step. The principles it refers to are those of the Church’s social doctrine (starting with human dignity, justice, solidarity and subsidiarity), and the values shared with emergency medicine practitioners.[21]
The very short time taken to develop several vaccines is an exceptional achievement, fruit of the worldwide commitment of researchers and both public and private institutions, the availability of advanced knowledge in the field of infectious diseases and oncology, the economic effort and the simplification of administrative procedures, with the elimination of bureaucratic inefficiencies. It has also been possible to carry out research and development in parallel phases that normally occur in sequence, without departing from scientific requirements.
Given the rapidity of these steps, some question the efficacy and, above all, the safety of the new vaccines. But the fact that the regulatory authorities who routinely approve the use of drugs have been authorizing these products, guarantees the use of the standards that are applied to every new drug prior to its approval.
There is no doubt that the situation in which we find ourselves sees vital issues at stake. In addition, the political and public pressure to speed up procedures is very high. But there has been no shortage of examples of how the balance between risks and benefits has been carefully assessed: for example, the examination of some data that did not seem convincing has led to the suspension of some trials and new controls. It will be important to integrate the data not yet collected, monitoring the long-term effects of vaccines, as is usually done in the surveillance phase following the diffusion of a drug. Certainly, given the global dimensions of the pandemic, coordination and mutual recognition between the national authorities approving the product in order to share results and eliminate delays, could be of great help (see Note 2, No. 10).
Economic dimension and commercial exploitation
Regarding the economics of vaccines, we have witnessed a substantial mobilization of resources, with extensive funding available both through the investment of public resources (either research grants or prior purchase of doses) and through donations from private entities, distributing the risk of research among different bodies.
Note 2 supports the commitment to make the vaccine a “public good,” as stated by several politicians and scientists.[22] This implies that the vaccine is not subject to free competition, but that the price is agreed and fixed with criteria that allow a distribution based on actual needs, according to criteria of equity and universality. Since the vaccine is not “an existing natural resource (such as air or oceans), nor a discovery (such as the genome or other biological structures), but an invention produced by human ingenuity, it is possible to subject it to economic consideration, which allows the recovery of the research costs and risks companies have taken on. Nonetheless, given its function, it is appropriate to consider the vaccine as a good to which everyone should have access, without discrimination” (Note 2, No. 7).
To ensure universal access and equitable distribution, it has also been proposed to remove patents, although this measure could reduce the speed of research and the number of companies involved. However, it is possible to imagine forms of limitation and the granting of regulated licenses at the international level, also introducing financial instruments for the recovery of resources invested (for example, vaccine bonds). The Covax global program, whose partners include the World Health Organization (WHO), has the objective of allowing all countries to access a vaccine, avoiding the dominance of the richest ones. The priority should be “to vaccinate some people in all countries rather than all people in some countries.”[23] This objective requires international agreements between different parties and transparent and collaborative procedures, avoiding antagonism and competition that lead to “vaccine nationalism.”[24]
As has been seen with the Pfizer-BioNtech vaccine, the goal is difficult to achieve, given the scope of interests involved and the multiplicity and size of the actors involved. We have noted how arduous it is to proceed with collaboration and subsidiarity in the vaccine production phase (see Note 2, No. 9). It too requires a stronger understanding and synergy between states, pharmaceutical companies and other organizations, so that the vaccine can also be produced in the territories where it is to be distributed. This would make it possible to increase the availability of doses – and therefore the speed of administration – as well as making the most of local resources. However, there is considerable resistance to this, perhaps linked to patent management.
Access and administration
Characteristics of each vaccine will impact access as storage conditions (e.g. temperature control) are harder to attain in less well-equipped countries. Again, only a willingness to collaborate will effectively overcome barriers. Paths that contribute to the more stable construction of an international solidarity that overcomes the inequalities and limitations in health protection that many countries still suffer from need also to be established.
As for the order of administration, there is widespread agreement (at least in theory) on the priority to be given to professional groups that perform tasks of prime concern. Frontline health workers receive priority, as do other categories of people more exposed to transmission of infection with public services of greater importance (such as schools and police). The most vulnerable, among whom there is a higher rate of mortality and sickness, are also given priority (such as the elderly and those with particular illnesses). However, these criteria do not allow for a response to all situations that arise. Gray areas remain where more analytical population stratification will be necessary (see Note 2, No. 11).
Note 2 does not mention the possible compulsory aspect of vaccination. In this regard, we are in agreement with the document of the Italian National Committee for Bioethics, which supports in principle the voluntary approach to vaccination.[25] It is in fact desirable that health treatments are administered according to the free choice of the subject and not by imposition, which is one of the factors that increases vaccination hesitation. However, it is ethically and legally legitimate to make vaccination compulsory for particular occupational groups more exposed to infection or transmission of the virus, or on the basis of maintaining a safe workplace. The same would apply if adherence were not achieved in such a way as to obtain a sufficient reduction in the circulation of the virus and the indirect protection of groups that cannot vaccinate themselves, or that would not allow the resumption of the work and social activities on which a balanced human coexistence is based.
For effective communication
From the above, the importance of communication is clear. It must be complete, transparent, understandable and up-to-date. Here again, the task is demanding, both for the type of data that science provides (always revisable and subject to a thorough validation process), and for the fact that communication cannot be reduced to information. Regarding vaccines, there is a distorted perception of risk compared to the objective assessment of the danger, given the clearly favorable and well-documented benefits and risks. Certainly the fact that the people to be treated are healthy can affect matters, but this reason is not sufficient to explain the phenomenon of resistance, since interventions in which this relationship is much less favorable are much more socially accepted.
These notions were already clear to Cardinal Consalvi, as we have seen, but today are emphasized by other factors. On the one hand, greater importance is given to the patient in his or her relationship with the doctor, which is certainly legitimate but not always easy to calibrate. On the other hand, there is a generalized crisis of trust in human relationships, both personally and in structured and institutional forms. Pope Francis puts it very simply: “I do not know why someone says: ‘no, the vaccine is dangerous.’ If the doctors present it to you as something that can go well, that has no special dangers, why not take it?”[26] A simple argument, but full of wisdom. In fact, researchers note that the perception of risk is a predominantly unconscious cognitive process, affected not only by the probability of damage that you can suffer by exposing yourself to a danger, but also, and above all, by an emotional component, consisting of a set of feelings, such as fear, resentment and anger. While the probability of damage in the face of danger can be calculated objectively – and this is the task of experts, as the pope says – the emotional component depends on a multiplicity of variables.[27]
Therefore, it is not enough to field logical arguments and scientific data on a biomedical and statistical level: it is necessary to involve the emotional and relational levels, in which behaviors are rooted. Moreover, a widespread climate of mutual trust is of great importance, which is the result of serious and honest attitudes in the habitual fabric of social coexistence. There is even a specific area of health communications that examines these multiple elements in their various dimensions.[28]
From competition to collaboration
Note 2 concludes with some recommendations for specifications that can mobilize both civil and ecclesial institutions and networks to contribute correct information, responsible behavior and equitable and universal access to the vaccine. It recalls the importance of the decisions that are taken at this juncture: although they concern immediate goals and cures, they may have important effects for a more just society, one that proceeds in a more inclusive and integrated manner. This is recalled in the encyclical, Fratelli Tutti, and also in the introductory paragraph to Note 2: “If responses are limited solely to the organizational and operational level, without the re-examination of the causes of the current difficulties that can dispose us toward a real conversion, we will never have those societal and world-wide transformations that we so urgently need.”[29]
DOI: La Civiltà Cattolica, En. Ed. Vol. 5, no. 3 art. 11, 1020: 10.32009/22072446.0321.11
[1]. E. Consalvi, “Editto sulla vaccinazione”, June 20, 1820, in Efemeridi letterarie di Roma 8 (1822) 102 (see www.brunacci.it/1822—l–editto-del-consalvi-sulla-vaccinazione-obbligatoria.html).
[2]. Quoted in G. Icardi – S. Schenone, “Aspetti della comunicazione nella storia delle vaccinazioni”, in D. Fiacchini et al. (eds), Comunicare i vaccini per la salute pubblica, Milan, Edra, 2018, 11.
[3]. E. Baragli, “Nell’anno del Signore”, in Civ. Catt. 1970 I 271.
[4]. See, for example, E. Morin, Cambiamo strada. Le 15 lezioni del coronavirus, Milan, Cortina, 2020; C. Giaccardi – M. Magatti, Nella fine è l’inizio. In che mondo vivremo, Bologna, il Mulino, 2020; G. Giraud, “Starting anew after the Covid-19 emergency,” in Civ. Catt. English Edition, in laciviltacattolica.com/starting-anew-after-the-covid-19-emergency/
[5]. Cf. R. Rappuoli – A. Santoni – A. Mantovani, “Vaccines: An achievement of civilization, a human right, our health insurance for the future”, in Journal of Experimental Medicine, vol. 216/1, 2019, 7, in https://doi.org/10.1084/jem.20182160
[6]. Cf. G. Icardi – S. Schenone, “Aspetti della comunicazione nella storia delle vaccinazioni”, op. cit.; European Center for Disease Prevention and Control, Catalogue of interventions addressing vaccine hesitancy (www.ecdc.europa.eu/catalogue), April 25, 2017; H. Y. Lawrence, Vaccine Rhetorics, Columbus, The Ohio State University Press, 2020.
[7]. Cf. M. W. Sonderup et al., “Hepatitis C in sub-Saharan Africa: the current status and recommendations for achieving elimination by 2030”, in The Lancet 2 (2017) 910-919.
[8] . Francis, Intervista al Tg5, January 11, 2020, see www.ansa.it/sito/notizie/cronaca/2021/01/09/il-papa-vaccino-contro-il-covid
[9] . Id., Speech to the Members of the “Banco Farmaceutico” Foundation, September 19, 2020, in www.vatican.va
[10]. Ibid.
[11]. Id., Message for the 55th Day of Social Communications, January 23, 2021.
[12]. Cf. Congregation for the Doctrine of the Faith, Note on the Morality of the Use of Certain Anti-Covid-19 Vaccines, December 21, 2020. That text cites two earlier Notes published by the Pontifical Academy for Life in 2005 and 2017.
[13]. Cf. J. Suaudeau, Vaccines against SARS-Cov-2, 17 and 19, in www.fiamc.org/bioethics/vaccins-against-sars-cov-2
[14]. See D. Prentice, “Update: Covid-19 Vaccine Candidates and Abortion-Derived Cell Lines” (https://lozierinstitute.org/update-covid-19-vaccine-candidates-and-abortion-derived-cell-lines), January 4, 2021; United States Conference of Catholic Bishops – Committee on Doctrine and Committee on Pro-Life Activities, Moral Considerations Regarding the New Covid-19 Vaccines, December 11, 2020, 4f. Vaccines using these cells for preparation include one from Oxford University and AstraZeneca, as well as Sputnik 5, under development in Russia (produced by the Gamaleja National Center for Epidemiology and Microbiology). The vaccine of Janssen and Johnson & Johnson (which, however, is at a less advanced stage) uses a cell line (PER.C6) from retinal cells of a 1985 abortion.
[15]. Congregation for the Doctrine of the Faith, Dignitas personae. On some questions of bioethics, June 20, 2008, No. 35.
[16]. Cf. K. Demmer, Interpretare e agire. Fondamenti della morale cristiana, Milan, Paulines, 1989, 188-193.
[17]. United States Conference of Catholic Bishops – Committee on Doctrine and Committee on Pro-Life Activities, Moral Considerations Regarding the New Covid-19 Vaccines, op. cit., 6.
[18]. Celam, Vacunas con fetos abortados, October 21, 2020 (https://prensacelam.org/2020/10/21/opinion-vacunas-con-fetos-abortados). Cf. Bishops’ Conference of England and Wales – Department of Social Justice, Covid-19 and Vaccination, December 3, 2020 (www.cbcew.org.uk/home/our-work/health-social-care/coronavirus-guidelines/update-on-covid-19-and-vaccination).
[19]. Cf. R. Pegoraro, “Vacciniamoci per salvarci insieme,” in Avvenire, January 14, 2021, 15.
[20]. Cf. Vatican Commission Covid-19 – Pontifical Academy for Life, Vaccine for All. 20 Points for a More Just and Healthy World, December 29, 2020 (www.press.vatican.va/bollettino/pubblico/2020/12/29); henceforth Note 2.
[21]. See Nuffield Council for Bioethics, Fair and equitable access to COVID-19 treatments and vaccines, London, May 29, 2020, 3: equal respect for people, based on recognition of dignity and human rights; reduction of suffering; and fairness, which includes non-discrimination and balanced distribution of burdens and benefits.
[22]. See U. Von der Leyen, Statement, at http://ec.europa.eu/commission/presscorner/detail/ov/SPEECH_20_2258/; R. Speranza, “Covid-19 vaccine must be a global public good, a right for all”, May 19, 2020, at www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4783/; National Committee for Bioethics, Vaccines and Covid-19: Ethical Issues for Research, Cost, and Distribution, November 27, 2020; M. Yunus – C. Donaldson – J.-L. Perron, “COVID-19 Vaccines. A Global Common Good”, in The Lancet (www.thelancet.com/healthy-longevity), October 2020.
[23]. Note 2, No. 12. See T. Ghebreyesus, Address to the press conference on Covid-19, August 18, 2020.
[24]. Note 2, No. 8. See T. Ghebreyesus, Address to the press conference on Covid-19, September 4, 2020; Council of Europe – Committee on Bioethics, Covid-19 and vaccines: Ensuring equitable access to vaccination during the current and future epidemics, January 22, 2021; Accademia Nazionale dei Lincei, Accesso equo ai vaccini, June 1, 2020, 2; R. Lafont Rapnouil, “La guerre du vaccin aura-t-elle lieu?”, in
https://esprit.presse.fr/actualites/manuel-lafont-rapnouil/la-guerre-du-vaccin-aurat-elle-lieu-43076
[25]. See Comitato Nazionale per la Bioetica, I vaccini e Covid-19: aspetti etici per la ricerca, il costo e la distribuzione, op. cit., 10f.
[26]. Francis, Intervista al Tg5, op. cit.
[27]. Cf. D. Fiacchini – N. Damiani – V. Di Buono, “Percezione del rischio nella pratica vaccinale”, in D. Fiacchini et al. (eds), Communicating Vaccines for Public Health, op. cit., 21f; R. Brotherton, Menti sospettose. Perché siamo tutti complottisti, Turin, Bollati Boringhieri, 2017.
[28]. Cf. D. Fiacchini et al, Comunicare i vaccini per la salute pubblica, op. cit., 32-36.
[29]. Note 2, Introduction; cf. Francis, Fratelli tutti, No. 7.
Source: https://www.laciviltacattolica.com/vaccines-making-responsible-decisions/
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