More COVID-19 Vaccine Ethics

At the direction of Bishop Daly, the Diocese of Spokane has provided general guidance on the morality of accepting a vaccination for COVID-19 and links to relevant Church and bioethical sources on this page. As described in Bishop Daly's letter on COVID-19 vaccines and on the main diocesan vaccine resource page, the Church's practical moral guidance can be summarized in three points:

1. We may morally accept currently available COVID-19 vaccines.
2. We are not obligated to take a vaccine.
3. We should advocate for more ethical research and pharmaceutical development. 

On this page, our Diocesan Bioethicist, Fr. Kyle Ratuiste, responds to some more in depth ethical questions that have been raised by the COVID-19 vaccines. He provides some additional relevant scientific context on vaccine development and outlines the way longstanding Catholic moral principles have informed the Church's guidance regarding these vaccines. 

Readers may also be interested in the following resources:

• "Answers to Key Ethical Questions About COVID-19 Vaccines" by the USCCB's Secretariat of Pro-Life Activities. [Link]
• Another FAQ-style article by Catholic physician Dr. Thomas McGovern.[Link]
• An extenive (and growing) list of articles on bioethical topics related to COVID-19, including vaccines, by Fr. Matthew P. Schneider, LC. [Link]
• Coronavirus resources provided by the Catholic Medical Association. [Link]

Multiple organizations proposing COVID-19 vaccines have used abortion*-derived cell lines in the overall process of bringing their candidates to mass distribution. People rightfully wonder whether they can accept a vaccine if it has a connection with the evil of abortion.

It is important to note that the moral concerns raised by these vaccines are not caused by any connection to current abortions. It is not as if these vaccines depend on a constant stream of abortions to provide raw “biological material.” If that were the case, this would be an entirely different conversation!

Instead, the moral concern arises from the origin of the cell lines used by these vaccines. When scientists produce a cell line, they essentially take a cell from an organism and manipulate it so that it produces more copies of itself indefinitely. The cells from the cell line can be used for science experiments and the production of things that grow in cells (e.g., proteins and viruses). Once a cell line is created, scientists do not need to go back to the original organism to collect more cells; the cells reproduce on their own so long as they are cared for properly. Common cell lines employed in research and bioindustry have been in use for decades.

An abortion-derived cell line is a cell line in which the starting cells were taken from the body of an aborted baby. As such, these cell lines are often described as “ethically tainted,” “ethically problematic,” etc. This is the case for a line called HEK293, which was established in 1973.** HEK293 is the most common ethically problematic cell line used in the pursuit of COVID-19 vaccines. Another problematic cell line connected to some COVID-19 vaccines is called PER.C6. However, there are other cell lines that are not ethically problematic because they are either of non-human origin (e.g., monkeys, hamsters, insects) or they originated from humans without the use of abortion.

Cell lines, whether ethically problematic or not, have been used in various activities involved in the effort to make COVID-19 vaccines. The Charlotte Lozier Institute provides a helpful summary that shows how various cell lines have been employed in these different activities: click here.

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*This may be getting too much into the semantics, but the term “abortion” by itself can simply refer to a miscarriage (i.e., a “spontaneous abortion”). For the sake of this FAQ, “abortion” is being used to refer to the intrinsically evil intentional destruction of unborn human life (i.e., “procured abortion” or “direct abortion”).

**There is some debate as to whether the source cells for HEK293 came from a miscarriage rather than a procured abortion. If they came from a miscarriage, the moral issue stemming from abortion disappears. However, the general consensus is that HEK293 cells came from a single abortion that took place in 1972 or 1973. This analysis treats HEK293 as an are abortion-derived cell line.

Not all vaccines are created equally. By having a clear understanding of the different activities that go into making vaccines, we can identify which ones have closer connections to abortion than others. When accepting a vaccine, we should choose the one with the least connection to abortion as possible.

The Charlotte Lozier Institute identifies three categories of activity in which cell lines may be used by vaccine manufacturers:

1. Design and development: “conceptualization, preparatory experiments, and specification for how vaccine will be constructed and produced.”
2. Production: “process used to manufacture final vaccine to be given to people.”
3. Confirmatory Lab Tests on Products: “tests to analyze quality, nucleic acid or protein sequence, protein conformation, antibody reactivity, etc. of final vaccine product.”

Being able to distinguish between these different kinds of activity is important because it allows us to establish an ethical ranking system for vaccines if they use an abortion-derived cell line at any point in the process. The Church teaches that if we do not have access to a vaccine that is completely free of connection to abortion, we ought to choose vaccines less connected to abortion over those that are more connected if we can. The National Catholic Bioethics Center outlines such a ranking system as part of their assessment of COVID-19 vaccines [click here, go to page 5].

Some people seem to fall into thinking that some vaccines are more closely connected to abortion than they actually are or that all of these vaccines are equally bad. This confusion may arise from the fact that the ethically significant terms that describe “producing” or “making” a vaccine can be used in two ways – one more specific and one more broad.

Taking a cue from the Charlotte Lozier Institute as above, “production” can be used in the more specific and technical way to refer to the process by which the vaccine is physically made. Using this definition, we can say that the Pfizer vaccine does not use abortion-derived cell lines in its production, because it relies on a cell-less production method. On the other hand, the vaccine candidate by AstraZeneca and the University of Oxford uses cells to grow their main vaccine ingredient, and these cells come from the ethically problematic cell line HEK293.

If we were to use “production” in the more general and colloquial way to mean the overall process of developing a vaccine and bringing it to mass distribution, then we would say the Pfizer vaccine used an abortion-derived cell line in its “production” (in the general sense) because HEK293 cells were used in a confirmatory lab test on the main vaccine ingredient to confirm that it worked. I think it is natural for people to ask about how a vaccine is “produced” in this general sense because it answers the question: “How did this vaccine come about?” For the sake of clarity, I reserve the term “production” for the specific and technical sense as used by the Charlotte Lozier Institute. To capture the more general sense, I opt to use “making/ to make” as shorthand to mean the overall process of developing, producing, and testing a vaccine candidate in the pursuit of bringing it to mass distribution.

It is important to use these terms clearly. Confusing them can lead us to false moral conclusions such as "The Pfizer and AstraZeneca vaccines are both produced (general sense) using HEK293, therefore they are equally ethically problematic." However, the reality is that the AstraZeneca vaccine is far more connected to abortion  because the it uses HEK293 in all stages of making it - development, production (technical sense), and testing. On the other hand, the Pfizer vaccine only used HEK293 as part of confirmatory lab testing with no bearing on the actual production of vaccine doses that people will eventually receive. While this limited use of HEK293 by Pfizer is ethically problematic for the company, Catholic teaching indicates that if choosing between these two options, we should opt for the Pfizer vaccine because it less reliant on abortion-derived cell lines than the alternative.

Current as of January 29, 2021

At this time in the United States, the only available COVID-19 vaccines are those produced by Pfizer/BioNTech and Moderna. They are ethically equivalent. Unfortunately, they are not entirely free of connection to abortion because the cell line HEK293 was used in a confirmatory lab test upon the main vaccine component. There is also some debate about the degree to which HEK293 was used to derive the underlying scientific knowledge necessary to develop the vaccine and may be used as part of quality control processes. Significantly, neither company used ethically problematic cells in the production of their vaccines because they use a cell-free production method to "print" their main ingredient on the molecular level. 

Individuals following Catholic teaching can accept either the Pfizer or Moderna vaccines in good conscience. The diocese strongly encourages people who receive these vaccines to voice their moral objection to the ongoing use of abortion-derived cell lines while acknowledging the progress made in eliminating these problematic materials from essential production activities. Click here for more information and a model letter that can be used to contact these companies.

Official Church documents and statements apply moral reasoning that use the principle of cooperation with evil to make this conclusion. For example, the recent Note by the Congregation for the Doctrine of the Faith (CDF) that specifically addresses the COVID-19 vaccine states,

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--in this case, the pandemic spread of the SARS-CoV-2 virus that causes Covid-19. 

The principle of cooperation with evil has been in use in Catholic moral theology for centuries. It essentially recognizes that by living in a complex, interconnected, and fallen world, our actions have the potential to contribute to (i.e., cooperate with) the evil actions of others. This moral principle allows us to identify different kinds and degrees of cooperating with evil and to recognize which are morally acceptable and which are not. One kind of cooperation involves rendering assistance because we want the evil thing to happen. This is called formal cooperation with evil, and it is always wrong. On the other hand, there comes a point in which the contribution of our actions to another's evil action is so minuscule and so remote that our cooperation becomes morally acceptable. 

Catholic moralists use the concept of proportionality when applying the principle of cooperation. The basic moral question can be framed this way: Assuming that we are not engaging in formal cooperation, does the good that we are attempting to do outweigh the gravity of our cooperation in a morally proportionate way? When considering COVID-19 vaccines, the CDF essentially answers in the affirmative when it declares, "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--in this case, the pandemic spread of the SARS-CoV-2 virus that causes Covid-19." Here, the Church says that the good of curtailing the "grave danger" of the pandemic is a proportional reason that outweighs the significance of the very remote cooperation with evil tied to accepting a vaccine made with abortion-derived cell lines. Notably, this comparison is made between the good that is pursued by being vaccinated and the remoteness of the cooperation rather than the abortion itself. 

This article provides another even further in depth examination of the principle of cooperation with evil and how it applies to the question of COVID-19 vaccines.

Moral relativism denies the existence of objective and universal moral truths. The Catholic moral tradition rejects moral relativism and teaches that there are objective moral truths. Among these truths is the fact that certain actions are always and everywhere wrong, such as murder and abortion. We call these actions intrinsically evil. At the same time, our moral tradition recognizes that not everything is so definitive as a universal moral prohibition. This is where the finer points of Catholic moral theology come into play.

Even though we say there are intrinsically evil actions, there are no such things as intrinsically good actions. This is because every action consists of three parts: the object (what is being done), the end (why it is being done), and the circumstance (how it is done and in what context). If any of these three parts do not pass ethical muster, then the whole action is considered bad. In other words, it is possible to do a seemingly good thing for a bad reason or in a bad way, and this would make the whole action bad. For instance, a seemingly good action with the object of visiting your next-door neighbor could be rendered bad if you did so with the end of using the visit to engage in the sin of gossip. Alternatively, a bad circumstance can render this action bad; for example, if the neighbor you choose to visit is infectious with COVID and you take no precautions against the potential spread of the virus. How then are we to determine the right thing to do if doing the right thing is not always cut and dry?

Let’s continue to play with the example of visiting your neighbor, who is infectious with COVID. To recap: visiting your neighbor (the object) is normally a good thing to do, but the recklessness of visiting a COVID positive person without appropriate precautions and justification (the circumstance) renders this specific act bad. However, the presence of your neighbor’s COVID in the circumstance of the act does not make this kind of action always and everywhere bad. If that were the case, it would be impossible to render care to a COVID-positive person in a morally upright way. However, we immediately recognize this as a ridiculous conclusion because we know that there are circumstances when the action of being with someone with COVID is not only ethically permissible, but even morally praiseworthy; the actions of health care workers treating COVID patients readily comes to mind. How do we, as people wishing to approach ethical decision making with the mind of the Church, account for these different ethical assessments? In situations where we assume that both the object and the end are good, we must evaluate the ethical uprightness of the circumstance.

By examining the differences in circumstances, we can explain the immorality of recklessly visiting a friend with COVID and the morality of carefully visiting that same friend while taking appropriate infection control precautions. In the first scenario, there is no attempt to avoid the harm that could transpire from contracting the virus yourself and potentially spreading it to others. In the second scenario, you take reasonable steps to eliminate the potential harm of contracting the virus. These differences exist in the “how” of visiting your friend; this is part of the circumstance of the action.

However, can we also imagine a scenario in which you could morally visit your neighbor in the absence of suitable infection control measures? This is where proportionality comes into play: examining the balance of harms and benefits. The operative question is this: Is there a proportionate reason to justify entering this situation that has a certain harm or evil associated with it? Is there a good to be gained or an evil to be avoided that is proportionately greater than the bad circumstance that would normally disincline you from pursuing this proposed course of action? In the case of the COVID positive neighbor, the immediate “bad thing” is endangering your own health by exposing yourself to an infectious pathogen. Unless you accept reasonable precautions such as self-quarantine, there is the additional harm of potentially exposing others to the virus yourself and exacerbating the pandemic. Alleviating loneliness by having a multi-hour board game night with your neighbor would not seem to provide a morally proportionate reason. A “COVID party” would not be morally justifiable. However, if your neighbor is suffering from an emergent mental health crisis in which you have reason to believe that he may harm himself without prompt intervention, then it would seem clear that going to your friend would be morally justifiable. By visiting your neighbor under these conditions, you would be attempting to avoid the evil of him inflicting bodily harm and even death upon himself. This would be proportionately greater than the fact that you would expose yourself to COVID. Also, if you were resolved to self-quarantine after this exceptional visit, this would mitigate any further harms that may be imposed on others by the spread of the virus. Here, we see how an honest application of proportionality allows us to recognize one action as morally inadmissible and the other as morally acceptable.

All this talk of proportionality and moral justification can only apply for actions that already have a morally good (or at least neutral) object. If the object of an action is bad, then no amount of reasons can justify it. In fact, this is the basis of the concept of intrinsically evil actions: there are some actions that by virtue of their nature are always and everywhere evil.

The Catholic Church has been around for a long time and, as such, has seen a lot of life and the fallen human condition. Therefore, it is not unsurprising that our 2,000-year-old moral tradition has developed principles and guidelines for pursuing virtue in morally complex situations, especially when we consider that we live in a morally complex and interconnected world with people who are not always pursuing what is good. The principle of cooperation with evil, which illuminates the present conversation about COVID-19 vaccines (see Question #3 above), is one fruit of our moral tradition. Rationalization involves coming up with fanciful and convenient reasons to justify something that is demonstrably wrong. This is not the case when someone seeks to use long-standing Catholic moral principles to discern the right thing to do in new and uncertain situations.
 

The moral dictum “the ends do not justify the means” can be a powerful bulwark against the allure of using manifestly evil, that is intrinsically evil, acts to pursue a seemingly greater good. Since abortion is intrinsically evil, it would seem to follow that we cannot justify using a vaccine that was made using abortion-derived cell lines. However, a closer examination of the “ends” and “means” in the case of COVID-19 vaccines shows us otherwise.

In the response to the previous question, we outlined the three parts of a human act: the object, the end, and the circumstance. The idea of the “end” corresponds with the end of a human act, and the “means” corresponds with the object. Therefore, to identify the relevant end and means of the COVID-19 vaccine question, we must ask ourselves: What am I hoping to accomplish (the end) and what am I considering doing to make it so (the object/means)? Answering this question, we recognize that our proposed end is something to the effect of preserving my own health, protecting my neighbor, and contributing to the end of the pandemic. To achieve that, we are considering choosing accepting a vaccine as our means. However, accepting a vaccine is not manifestly evil. Therefore, it is not morally illuminating to invoke “the ends do not justify the means” because it presumes that the means being denied is already intrinsically evil.

Nevertheless, this ethical phrase allows us to reassert unequivocally the immoral status of abortion. Truly, one of the ethical side effects of the ongoing use of abortion-derived cell lines and their implementation to create lifesaving medicines is that these good effects can be seen as implicit justifications for abortion. The (faulty) reasoning would go: Even though Catholics say abortion is always and everywhere wrong, clearly the benefits that we derive from it must mean that it is actually okay or even morally praiseworthy! Since we already know that abortion is intrinsically evil, we can resolutely say that even the loftiest ends of advancing human health cannot justify abortion as a means to pursue those ends.

There are two additional things worth noting about the connection of abortion to the decision to accept an abortion-associated vaccine. First, we emphatically are not choosing the original abortion as our moral object (means). Instead, we are choosing accepting a vaccine as our moral object, and the vaccine’s remote connection to abortion falls under the circumstance of the act. Second, even though people may attempt to use contemporary benefits to justify the historic abortions from which various cell lines have been derived, we must acknowledge that the precise ends that we are considering today by pursuing vaccination could in no way have been in the mind of the original abortionists. Today, we may be considering accepting a COVID-19 vaccine to promote personal and public health, but the original abortionist and even those who first created the cell line would have had different ends in mind. This divergence of ends between us and those who perpetrated the original evil serves as further evidence of our moral distance from those original immoral activities.

I think the ethical worry that is raised by this question can be phrased something like this: If I take a vaccine made using abortion-derived cell lines, doesn’t that mean that I would automatically intend for that abortion to have taken place so that I could have the vaccine? If so, would I not be committing an immoral endorsement of the grave evil of abortion? This is an understandable, visceral moral concern. Nevertheless, experience reaffirms that it is possible to acknowledge and to even delight in the good that may have arisen from a past evil without endorsing or willing that past evil. Also, the moral category of appropriation of evil can provide us greater clarity and guidance on the question of COVID-19 vaccines with some connection to abortion.

Consider a couple that adopts a baby girl who was conceived by rape. It would be preposterous to say that whenever they delight in their daughter and the gift of her life that they thereby simultaneously intend or desire the rape of the child’s birth mother. On the contrary, it is more plausible to believe that their moral abhorrence at that instigating violent and evil act may have further engaged the virtues of charity and justice that permitted them to accept this child into their family with heroic generosity, thereby affirming her inherent dignity.

When we consider the dynamic of repentance and conversion, we see multiple instances in which we confront our limited ability to change the past and must content ourselves to humbly surrendering ourselves to God who in his loving omnipotence draws good even from evil. A man may have recognized that his ability to have a successful career with which to support his family was dependent upon a fateful deception during the application process. Rightly, he ought to repent of his lie and regret it, but it would be unreasonable to demand that he thereby renounce his livelihood and ability to provide for his family. A woman may have conceived a child out of wedlock. When she goes to the Sacrament of Reconciliation she can confess the sin of fornication with sorrow, manifest a firm purpose of amendment, and expect to receive absolution. She should never hear the insinuation that she should “cancel” her pregnancy and child because the event that gave rise to them morally should not have happened in the first place.

While we have a limited ability to rectify the past, there are instances in which we can either rightly or wrongly choose to associate ourselves with the past or present evil actions of others. The moral concept of appropriation of evil comes into play here. For example, if someone takes advantage of the fruits of an evil action is such a way that this person endorses the past evil or becomes desensitized to it, then we can say this person engaged in immoral appropriation. Conversely, it is possible for people to squarely acknowledge the wrongness of an evil action, resolutely set themselves against it, and morally appropriate the fruits that may have arisen from it. As with the principle of cooperation with evil (see Question #3 above), one’s degree of proximity to the evil act of another is morally relevant. Also, as with cooperation, appropriation requires a morally proportionate reason to justify it.

When we consider accepting a vaccine made with abortion-derived cell lines, we recognize that doing so involves some kind of appropriation of the abortion that was the source of this cell line that was used in some capacity to make the vaccine at hand. The question then is whether this is a morally justifiable appropriation or not. From the perspective of virtue ethics, which pays special attention to the impact of actions on one’s moral character, we can reframe this question as asking whether our association with this past evil harms our moral character so that we are less virtuous and more vicious.

We examine our moral proximity to the original abortion and recognize that what may initially appear as a direct appropriation of abortion is really a chain of multiple appropriations. There are at least four recognizable steps of appropriation: (1) appropriating the work (i.e., the vaccine) of a pharmaceutical company that (2) appropriated the activity of the vendor of the cell line that (3) appropriated the work of those who produced the cell line who (4) appropriated the original abortion to derive raw “biological materials” for the basis of the cell line. There are likely far more steps in this chain of appropriation that can be considered; for instance, the pharmaceutical company using research that used technologies derived from abortion-derived cell lines purchased from a vendor, etc. A similar observation can be made about the degrees of remoteness seen in potential cooperation with abortion, although it is more difficult to conceptualize how one can meaningfully contribute to (i.e., cooperate with) a past and concluded action. We then can ask ourselves whether it is likely that this remote degree of association with abortion can have meaningful impact on our moral character. It may be illuminating to consider other activities that involve appropriation of and/or cooperation with abortion. Fr. Matthew P. Schneider, LC provides an illuminating article that identifies twelve seemingly morally inconsequential activities that are more closely associated with evil than COVID-19 vaccines.

We also assess our potential for being desensitized to the evil of abortion or even beginning to tacitly approve of it. Such an outcome is very dangerous to our moral character. The USCCB chairmen of the Committee on Doctrine and Committee on Pro-Life Activities are adamant in signaling this caution when they say, “We should be on guard so that the new COVID-19 vaccines do not desensitize us or weaken our determination to oppose the evil of abortion itself and the subsequent use of fetal cells in research” (see here, page 7). A connected concern is whether our use of an abortion-associated vaccine will serve as a source of scandal. The moral concept of scandal refers to the idea that an action, even if it is in itself morally good or neutral, may lead others to commit evil. This can happen if the action encourages someone to commit sin themselves or if the action causes them to believe that an action is good or acceptable when in fact it is evil. It is unlikely that receiving an abortion-associated vaccine would convince someone to receive an abortion. However, doing so may give the appearance of reinforcing the systemic ethical problem of widespread reliance on abortion-derived materials in research and medicine. For the sake of our moral character, recognizing and reinforcing the gravity of the intrinsic evil of abortion is essential for justifiable appropriation. Furthermore, we can voice our moral objection to the ongoing use of abortion-derived cell lines and even “put our money where our mouth is” by financially supporting research endeavors that can help fix our ethically problematic reliance on these cells. (For more information on, click here.)

Lastly, we ask whether there is a proportionate reason to engage in this appropriation. We should not associate ourselves with the evil actions of others frivolously. Again, as when using proportionality with the principle of cooperation with evil, we are comparing the good we are hoping to achieve against the characteristics of the immediate instance of appropriation that is before us. We can conclude that the aim of promoting personal and public health during a pandemic serves as an adequate proportionate reason to justify the limited and remote appropriation entailed by accepting such a vaccine. Additionally, by reasserting our will against the abortion and publicly advocating for ethical research we further minimize the moral harms this appropriation may cause to us and the broader society.
 

This is an interesting question to try to answer because it presumes something that is not true about the Pfizer and Moderna vaccines, which have been the first vaccines approved for distribution. The idea of a vaccine being physically “tainted” with DNA comes from fact that the most common way to produce a vaccine has been to grow the main ingredient of the vaccine in cell cultures. (For more information on how vaccines are produced, click here.) Because cells are living things with their own DNA, it is possible for fragments of their DNA to end up in the final vaccine product. The amount of residual DNA is minimal and does not pose a safety concern. The thing about the Pfizer and Moderna vaccines is that they are not produced using any cells at all. They rely on a different technology platform that basically uses precise biochemistry to “print” the main ingredient of the vaccine (a mRNA molecule) on the molecular level. Therefore, it is impossible for these vaccines to be “tainted” by any DNA whatsoever – human or animal, fetal or otherwise.

However, it seems to be the case that people have referred to fetal DNA primarily as a physical signal of an underlying moral issue, namely the connection of a vaccine to abortion. In other words, saying that a vaccine is “tainted with fetal DNA” seems to be shorthand for “something totally morally unacceptable happened and the vaccine should be rejected.” As much rhetorical force or emotional appeal this may have, it does not contribute much to sober ethical reasoning. This is because appealing to contamination by fetal DNA opens the door to additional questions that distract from the main moral issue. For instance, if a vaccine was purified so thoroughly that it was not tainted by fetal DNA even though it used cells derived from abortion, does this then make it ethically clean? I think the clear answer would be “no.” Also, if a vaccine was “tainted with fetal DNA,” but the cell line used originated by the body of a child that was naturally miscarried, does this mean that a moral issue is present? You may insist that there is a moral issue here, but at this point it would not be based in the matter of abortion.

Nevertheless, other vaccine candidates do use abortion-derived cell lines in the production of their vaccine. This would cause them to be liable to the charge of being tainted by fetal DNA as outlined above. However, the ethical assessment of these vaccines should be based on their moral connection to the past abortion rather than any notion of physical contamination. Namely, by using abortion-derived cells to produce the material that will be given to people, this vaccine has a more intimate connection to abortion than another vaccine that may have only used an ethically problematic cell line for a confirmatory test.