Bioethics Forum Essay
Volunteering for a Covid Vaccine Trial: Fulfilling Hindu Obligations or Fostering Pharmaceutical Company Profits?
When I learned about the invitation to enroll in Moderna’s phase 3 clinical trial of mRNA-1273, its investigational vaccine against Covid-19, I jumped at the opportunity. Not only did enrolling in the study satisfy my altruistic goals, but it also seemed to harmonize with my Hindu beliefs, my Hindu dharma, obligations of giving or donation for the greater good. During this global crisis, offering my body in a clinical trial, I believe, may hasten the development of a potentially life-saving vaccine. And, in the Hindu context, offerings of this sort, whether they are one’s body or ones wealth, are regarded as daana, charities or donations that are expressions of the virtue of generosity, a benevolent deed for the betterment of others and of society.
As grateful as I have been for this opportunity to help others and to act “dharmically,” I remain troubled by the fact that Moderna is going to profit from my altruism and my religious obligations. While this is not unusual, the current context is undeniably exceptional: the number of people in the world who have contracted Covid-19 is approaching 22 million. These people span economic, political, and racial divides. Should the investigational vaccines from Moderna and other drug companies prove to be effective, would they be affordable to those from impoverished countries (or even the impoverished in wealthy countries)? Likely no.
In contrast, the Serum Institute of India, which is working with Oxford-AstraZeneca on its investigational vaccine, intends to sell it for cost. Since it would be manufactured in India, where production costs are significantly lower than in the United States, it would be available and affordable to many more people. In fact, the Serum Institute recently agreed to a partnership with Gavi, the vaccine alliance, and with the Bill and Melinda Gates Foundation to manufacture 100 million doses of the Covid-19 vaccine for India and other low and middle- income countries and to sell doses at around 225 rupees, or $3. I was not able to volunteer for the Oxford-AstraZeneca trial because it was not recruiting volunteers in Cleveland, where I live, until early September, after I had enrolled in the Moderna trial. Of course, the Oxford-AstraZeneca would be sold for profit here in the U. S., where there are no price controls on vaccines.
I am torn between wanting to fulfill altruistic and religious obligations and knowing that if mRNA-1273 is approved in the U.S., my daana is more likely to line the pockets of Moderna and its shareholders and to assist the privileged than to prevent Covid-19 in the vast majority of the people of the world.
In Krishna’s soliloquy to Arjuna, documented in the Bhagavad Gita, Krishna advises that it is always preferable to act nishkamakarma, without desire for the fruits of action, a deontological ethics akin to Kant’s categorical imperative. Should I, as a Hindu, as a Hindu bioethicist, and as an altruist, act nishkamakarma, in spite of the anticipated profits that Moderna will make?
I received my first experimental Covid-19 vaccine dose from Moderna on August 10 and my second on September 9. Though I cannot be certain, given the side effects I experienced, I am fairly confident that I received the experimental vaccine and not the placebo. I am also fairly confident that I volunteered nishkamakarma and am fulfilling my dharma. As much as I dislike contributing to the coffers of the pharmaceutical industry, I dislike even more the suffering of so many people in the world. Hopefully, my daana will have a positive outcome and save lives.
Deepak Sarma, PhD, is a professor in the department of religious studies and a professor of bioethics at Case Western Reserve University. Twitter: @dsarma