Abortion and the Coronavirus Vaccine

The efforts and sacrifices Americans have made in response to the coronavirus pandemic are, to say the least, real departures from what we would normally do to sustain a thriving society. Controlling the coronavirus has meant giving up many of the things that make life worthwhile. We want grandparents to be able to visit their grandchildren. We don’t want government officials keeping track of our movements and whom we’ve visited, as contact tracing requires. Having to cover our faces in public is a mild inconvenience, though some objections to them may be, as Michael Brendan Dougherty has argued, “deeply rooted in Christian theology.” And no one wants to live in a society where everyone avoids physical proximity with strangers. But when we adopt social distancing we are not choosing to become a society of isolated, atomized individuals; we are rather reaffirming our solidarity with the elderly and vulnerable. We “stand together by standing apart.”

What makes these measures tolerable is not only that they are necessary, but that they are temporary. The harshest lockdown restrictions are already being relaxed as infections seem to have slowed, though other precautions will likely continue to be necessary until a cure or vaccine is developed. Even if we can’t predict exactly when a vaccine will be ready — but assuming that it will be at some point — we can be confident that transformations to our way of life we have accepted to control the virus need not be permanent.

But there are also difficult choices we must make that are not mere temporary departures from our ordinary conduct — there are choices about whether to compromise deeper ethical principles. If we do evil in the fight against Covid-19, we may get a return to normalcy, but we will not be able to simply reverse a lapse into immorality.

We face a choice of this kind with the prospect of using tissues from aborted fetuses to develop cures or vaccines for Covid-19.

President Trump’s decision last summer to ban the National Institutes of Health from funding research involving fetal tissue from elective abortions generated some controversy at the time, as scientists and some bioethicists claimed that it would hold back life-saving research. In April, a number of Democratic lawmakers sent a letter to Health and Human Services Secretary Alex Azar calling for the policy to be suspended for coronavirus research, and one researcher at an NIH lab in Montana sought an exception to the rule in order to test potential coronavirus treatments on a recently developed line of mice containing human fetal tissue.

The restrictions the policy places on fetal tissue research are in fact quite modest. First, while the policy bans using fetal tissue in “intramural” NIH research — that is, work done by scientists employed by the NIH — it leaves the door open to funding “extramural” research, or grants from the NIH to scientists working at universities or private labs, albeit with an additional layer of ethical review. Second, the rule allows research using fetal cell lines established prior to June 5, 2019, when the policy was announced. This means that the policy only restricts work on fetal tissues procured from abortions over the past year — while the most common fetal cell lines used in vaccine development are from the 1960s and ’70s.

Furthermore, some aspects of Covid-19 research aren’t actually likely to benefit from work with fetal tissues. For instance, scientists have had trouble infecting small lab animals with the MERS coronavirus, but in a study last year, mice that contain human-like lungs derived from human fetal tissue had been found to be susceptible to infection. Thus, NIH scientists were interested in using these “humanized” mice to test potential treatments for the new coronavirus. But researchers have found plenty of other animal models for studying the Covid-19 virus. Monkeys, hamsters, and transgenic mice bearing the gene for the human cell receptor targeted by the virus — all can be infected. And of course there are already hundreds of clinical trials in human patients to find out if any repurposed treatments might work against the virus.

Vaccine development has a long history of using human fetal cell lines to grow viruses. And because the administration’s restriction on funding for fetal tissue research still allows funding of research that uses established fetal cell lines, it does not prevent funding for vaccines that rely on fetal cell lines. Scientists don’t need to be granted any exemption from the Trump administration policy to use existing fetal cell lines to develop vaccines for Covid-19. Indeed, the U.S. government’s Biomedical Advance Research Project team working on vaccine development has provided $450 million to Janssen, Johnson & Johnson’s pharmaceutical company, for a vaccine that will be grown in a human fetal cell line.

The ethics of using fetal cell lines in vaccine development is a complex and controversial subject. There are just a few cell lines derived from abortion that are used in vaccine research, and they are decades old. So contemporary vaccine development that relies on these cells is remote in time from the abortion. Nevertheless, many Americans who are opposed to abortion are rightly repelled by the prospect of a vaccine developed from an aborted fetus, however long ago. There are good reasons to try to provide Americans with a vaccine that will be free of any connection with abortion.

As Christopher Tollefsen recently argued, the use of fetal tissue in medical research “predicates the health of some on the deliberate destruction of the lives and health of others.” And so, even though thousands of lives may be saved, by developing a vaccine using fetal cells procured from elective abortions, we would be contradicting “the fundamental commitments of medicine.”

This is not a contradiction based on a cost-benefit analysis, or thinking about the issue in a consequentialist or utilitarian way. Using fetal cells derived from abortion will not mean that more lives have been destroyed than a vaccine would save, nor would development of such a vaccine cause further abortions, since there is no need to procure fetal tissue from new abortions. The contradiction is more fundamental: Saving some human lives only by having killed others undermines the moral meaning of medicine.

Consider an analogy: Should we use organs from executed prisoners for transplantation? No, we should not. Even doctors who believe that capital punishment is legitimate should not collect organs from the condemned for transplantation, because such participation in deliberate killing is contrary to the aims and purpose of medicine.

Of course, we cannot forget that a vaccine for the coronavirus will save many thousands of lives, so that forgoing the use of a vaccine because of its connection with abortion would have grave consequences. As Tollefsen points out, in light of the remoteness of the act of abortion from the development of vaccines with these established cell lines, “the use of these cells cannot be ruled out as unethical ‘as a matter of principle.’” Likewise, in a 2005 statement on the use of the rubella vaccine (which is prepared using human fetal cell lines), the Vatican’s Pontifical Academy for Life advised that it may be acceptable to use such a vaccine if no alternatives are available, provided one puts “pressure on the political authorities and health systems so that other vaccines without moral problems become available.”

The chief moral concern with using these fetal cell lines to develop a vaccine is not, then, that doing so will incentivize or otherwise cause abortions, but that benefiting from abortion, even remotely, could be understood to imply the moral approval for the practice. Of course, this implicit approval would not matter for people who do explicitly approve of abortion, including many scientists and doctors working on vaccine development and many Americans who would eventually receive a vaccine. But the development and certainly the use of the coronavirus vaccine will involve more than just the researchers. Between government funding and the need for the entire population to eventually be vaccinated, the coronavirus vaccine is a matter of vital public concern. How the United States delivers a vaccine will send a message about the values of the entire country.

Many of the leading vaccine candidates do not rely on fetal cell lines. The mRNA vaccine under development by the National Institutes of Health together with the biotech company Moderna does not require the cultivation of viruses in fetal cells, and it is showing promise in clinical trials. Other companies like Inovio, Sanofi, and the Shenzhen Geno-Immune Medical Institute also have vaccines in clinical trials that do not rely on human fetal cell lines.

It’s unlikely that pro-life scruples played much of a role in any of these pharmaceutical companies’ decisions not to use fetal cell lines as part of their vaccine development strategies; rather, they are simply pursuing strategies that they believe are likely to result in a successful vaccine. But at this point it is too early to say whether one of these fetal cell–free vaccine candidates or one of their ethically suspect competitors will be the first proven safe and effective in clinical trials.

What then, if anything, should be done to encourage the development of vaccines that do not require the use of ethically problematic cell lines?

We can consider three options the U.S. government might pursue to deal with the moral and practical challenges of delivering a coronavirus vaccine.

First, the government could simply abandon funding vaccine research that involves human fetal cell lines. Perhaps if none of the fetal cell–free vaccine candidates work, then the government could resume working with candidates that use fetal cells as a matter of necessity. This would be a dramatic change of course, and with contracts already signed, it seems highly unlikely. It could also very well set back the availability of a vaccine by months or even years at the cost of thousands of lives — an unacceptable price to pay.

The second option would be for the government to take a neutral stance on the use of established fetal cell lines in vaccine development. This is more or less the status quo, where the government is seeking to bring a vaccine to market as soon as possible, regardless of whether it uses fetal cell lines or not. Perhaps this approach will lead to a fetal cell–free vaccine, in which case pro-life Americans will face no concerns about its use. But even if this happens, the government’s indifference between vaccine candidates that rely on fetal cell lines and those that do not will be an implicit public statement that the government approves of and is comfortable benefiting from abortion.

The third option would be to attempt to accommodate the views of those who object to the production of vaccines using fetal cell lines by committing to the development of a fetal cell–free vaccine, while continuing to support other promising candidates in order to make a vaccine available as soon as possible. If a vaccine that relies on fetal cells is the first to prove its safety and efficacy in clinical trials, then it can be made available, but the government will continue to support the development of promising fetal cell–free vaccine candidates. Since there may be shortages in the first few months after a vaccine is approved, continuing to pursue alternatives may be an effective way of ensuring that everyone has access to a vaccine as soon as possible.

Prioritizing the development of a fetal cell–free vaccine would acknowledge the importance of the deeply held moral objections to abortion held by many Americans — without delaying the urgently needed development of a Covid-19 vaccine. Accommodating the views of pro-life Americans will be important even from a public health perspective: even if a convincing argument can be made that a vaccine that relies on human fetal cells should be used if it is the only one available, such arguments might have trouble actually convincing many pro-life Americans. The country’s response to the coronavirus is already all too polarized, with nearly thirty percent of Americans saying they are not likely to use a vaccine if it were available.

How much this vaccine hesitancy has to do with pro-life concerns, as opposed to concerns about vaccine safety, or with belief in outlandish conspiracy theories, is unclear, but anything the government can do to mitigate such concerns could help to improve the number of Americans willing to receive a vaccine when one finally becomes available. Actually making an effort to produce a morally acceptable vaccine would go a long way in showing pro-life Americans that their views are being respected, and may well make them more willing to accept even a vaccine that does rely on morally problematic sources, since they will know that their government is still working on making a morally acceptable vaccine available as soon as possible.

If the government takes this approach, it will be important to be explicit about the moral meaning of its purposes, both to reassure pro-life Americans that the government is doing what it can to accommodate their views, but also to publicly stake out a position about the morality of abortion and its relation to the biomedical research enterprise.

Carrying out this kind of communication to the public would be best left to respectable figures in medicine, ethics, and religion, rather than members of the administration, who are bound to be unduly polarizing in the current political climate. One of the provisions of the president’s policy on fetal tissue research was the establishment of an ethics advisory board to review grant proposals for research involving human fetal tissue. In February, the government sent out a call for nominations to the board, and an NIH representative has confirmed by email that it is currently considering nominations. Explaining to the public the moral controversies surrounding fetal tissue and vaccines, and the government’s approach to accommodating the different values at stake, would be a worthy task for such a body.

There has been entirely too much focus on symbolism and public relations during this pandemic. Whether one wears a mask or not has become a symbol of one’s political affiliation, rather than a means of preventing transmission of the virus. Politicians have been more concerned with reassuring the public and casting blame than with taking actions to improve the situation.

But symbolism, and sending a public message about the kind of society we are, matters too. The Covid-19 pandemic and how we respond to it will be remembered for generations. If we sacrifice the elderly to increase consumer spending in one of the richest societies in human history, we might improve our economic situation over the next few years, but how will such a tradeoff be remembered? Likewise, if the cure for Covid-19 relies on human fetal cells, the nobility of the biomedical research community’s conquest of this plague will be forever shadowed by its complicity in evil.

By doing everything possible to not only develop a vaccine, but develop one that is not predicated on the sacrifice of the unborn, we can show that science can always be done in accordance with moral principles.