Transmission blocking vaccines (TBV) is a way of combating infections (like malaria) by reducing the chances of infections in a community over time. Since it only blocks transmissions, individuals do not directly benefit from the vaccine but incur all the risks and complications. Assuming it is deployed in a low resource setting where infections are endemic, is it ethically justifiable? I think the most salient issue here is one concerning dignity. In this paper, I want to focus on two sub-issues: first, the issue of people being used as a means to an end (viz. reducing malaria in the community); and second, the issue of exposing people to risks that are contrary to their individual interests. I will set aside the question of rightness or wrongness within the standards of a strict normative ethics and rely rather on commonsense morality as an ethical justification. By “commonsense morality” I mean the justifications that go into things in the socio-political realm, like laws or policies, which mostly match our intuitions. It is hard to say if the ethical justifications in these cases are strictly (for instance) utilitarian or Kantian, and it is even difficult to say if one particular normative ethical theory should or ought to be deployed for a particular scenario; although, whether they are explicit or not, normative theories are often evoked through notions such as “individual rights” or “greater good.” With this in mind, I will seek to establish a justification through commonsense morality, and this will mean using parallel reasoning to point to cases which seem analogous and use the same justification to come to their conclusions. More specifically, I aim to establish a parallel between TBV and wartime conscription, and a parallel between TBV and taxation. Although the analogies do not map on neatly, I argue that each parallel highlights an avenue of justification that can be applied to the TBV case. In effect, if commonsense morality used to justify wartime conscription and taxation are acceptable, then the same justification used for TBV must also be acceptable.

I take the motivation behind objecting to TBV and related resistant attitudes to be based on the thought that TBV ignores or (worse) consciously violates individual dignity. The idea of “dignity” — roughly alongside ideas of “respect” or “integrity” — captures something like the Kantian notions that persons are intrinsically valuable and should never be used instrumentally for an end. For instance, a moral reasoner concerned solely with the best consequence might push a very fat man in front of a runaway trolley to save a bus load of school children; of course, the moral reasoner might fully understand the intrinsic value of the fat man, but the moral reasoner who is concerned with the best consequence might think the right thing to do in the given circumstance is to use the fat man as an instrument for saving the children. Those concerned with dignity may resist this moral reasoning and argue that the dignity of the fat man must not be violated in order to save some measly lot of school children. Similarly, in the case of TBV, the dignity of the individuals being vaccinated might be violated since they are an instrument for the end of reducing malaria in their community.

How exactly is the dignity of the vaccinated individual (or potential vaccinatee) being violated in the TBV case? First, the mere fact that they are being thought of as instrumental to a certain end rather than ends in themselves is problematic. There is something dehumanizing about being thought of as a mere instrument to a particular end — I can only gesture towards it here. We can take extreme examples to push the point (slavery, exploitation, coercion, etc.), but I think less obvious examples do a better job of outlining the contrast between the instrumental and intrinsic value of persons. Consider the example of employment. Typically there is some mutual agreement between employer and employee: the employee offers certain skills that the employer needs and the employer offers some compensation for the employee’s services. In this professional context, the employee has instrumental value to the employer. Now imagine the fatuously “by-the-books” employer who treats the employee only as an instrument: not allowing time off for the employee’s child emergency, getting furious at the employee for coming in 30 seconds late, and filing complaints for the smallest misdemeanors. We feel some sort of repugnance towards the employer’s behavior because the employer callously ignores the fact that the employee is more than just an instrument – after all, the employee is a person, demanding some level of dignity which the employer fails to respect. Similarly, TBV might carry the same attitude towards the vaccinated individual as the bad employer has towards his employee.

Second, exposing people to risks that are contrary to their interests may violate dignity. Some may say that any actions that are contrary to a person’s interests may violate dignity (e.g. giving a million dollars to an ascetic monk), but potential risks or harms provide further (a fortiori) reasons to think that dignity has been violated. The worry stems from the fact that TBV does not have direct benefit to the individual, and individuals generally do not take on risks that do not provide a direct benefit. This is not to profess that people are egoistic or to cast doubt on genuine cases of charity, but one may reasonable object to incurring risks for the benefit of the community at large. For instance, imagine we asked every citizen to pay a dollar to an initiative to provide everybody with hand sanitizer so we might prevent the transmission of the cold. I might reasonably object to giving my dollar — perhaps I am very poor, or I believe my immune system to be immaculate, or I believe my dollar would be better spent elsewhere. Now, we can up the ante by switching “a dollar” to “potential risks,” and we can see that I might have even stronger reasons to object to incurring a risk that does not directly benefit me. Again, the general worry to TBV is a violation of dignity, and any justification for TBV must overcome these worries.

To answer these worries, and to reiterate a caveat, I think justifications for TBV need to appeal to commonsense morality. Any justification appealing to a comprehensive moral doctrine is problematic in the context of public health. We cannot be strictly utilitarian or Kantian in our solutions, rather our commonsense morality must be sensitive to how certain features of these theories may apply to specific cases and reflect our intuitions. With this in mind, I think there are cases where we are posed with similar worries of violating individual dignity where we have come to acceptable conclusions. We can look at these cases and extrapolate the moral justifications, and then we may apply them to TBV.

The first parallel I want to draw with TBV is with mandatory conscription in wartime. Mandatory conscription faces similar worries of treating citizens as mere instruments for a war. For instance, citizens are treated as mere soldiers and are expected to ignore their other individual interests, projects, and goals. The justification, I think, offered in accordance with commonsense morality is that the ends are very great (e.g. protecting a great number of lives, liberties, and so forth). Once we reach a certain threshold of good as an end, we may be justified in violating individual dignity and use persons as mere instruments. Imagine a moral reasoner pushing a fat man in front of a runaway trolley because this time the trolley was going to hit and trigger an atomic bomb which would kill millions if detonated. The intuition behind our commonsense morality seems to align with the moral reasoner this time. Similarly, in the case of TBV, the good end of preventing the spread of malaria may be sufficiently good enough to meet the threshold to justifiably override individual dignity. It remains an open question what exactly this threshold of good is, but the morbidity and mortality of malaria seems to push intuitions that this threshold of good is met; or, at the very least, the threat of malaria (given the empirical data) is on par with the threats of wartime.

Insofar as the second worry relating to dignity — namely exposing people to risks that are contrary to their interests — I think here the mandatory conscription parallel fails. Usually our commonsense morality accepts the justification of the reasonable pacifist. There might be some TBV equivalent of a pacifist in that an individual may reasonably refuse to incur the risks associated with TBV. We need something other than the mandatory conscription example to meet this worry.

A second parallel between TBV and taxation may meet the worry of imposing risk to an individual without a direct benefit. Generally speaking, taxes are collected to fund public goods, and public goods are usually thought of as a shared interest for everybody in that society. Healthcare, for instance, might be funded publically with the thought that everybody has an interest in being treated when they are sick. This might raise a similar worry with individual dignity: what if the aims of taxation are not my aims? If nobody has a claim on me to give a dollar so everybody has hand sanitizer, why should there be claims put on me to pay taxes that go into (say) building parks that I will never visit and fund children’s programs I will never be a part of? I think the justification for taxation encroaching on individual dignity is complex. Again, I can only provide a partial answer, but I think an essential part of it is that the indirect benefits are sufficiently great and inextricably tied to more direct benefits for the individual. Taxation is essential to a functioning society, and a functioning society provides goods that are inextricable to direct benefits. For instance, a functioning society provides the conditions for a job, a family, and other essential benefits which are contingent on the more indirect benefits. A pension plan might be a very good thing in itself, but it also sets the stage for more direct benefits, like the relief of knowing one’s parents will be provided for. On this picture, “indirect benefits” is misleading since they are essentially tethered to more direct benefits (it might be more appropriate to call “indirect benefits” something like “downstream benefits” or “diachronic benefits”). We can draw a parallel to the case of TBV in that the indirect benefits of ridding malaria is inextricably connected to more direct benefits (e.g. social order, economic benefits, national pride). This justifies the incurring of potential risks.

I have framed the issue of TBV as one of dignity, and I raised two specific worries of using persons instrumentally and of posing risks on an individual for ends contrary to their interests. I have argued that our commonsense morality overcomes the first worry in cases of mandatory conscription by pointing to a sufficiently great end; insofar as the second worry, I looked at the parallel between TBV and taxation, and I argued that we justify risks without direct benefit to the individual by pointing to the indirect benefit and its ties to the individual’s more direct benefits. I conclude that since we accept (prima facie) the justification for mandatory conscription and taxation, we can accept similar justifications for TBV. Opponents may question the disanalogy to some extent, but there is a feature of the disanalogy that actually strengthens my conclusion: namely, there is some duty not to infect others that seems to provide added justifications for TBV.