by Mark Christopher Navin, PhD; Michael Redinger, MD, MA

Some leading COVID-19 vaccine candidates—including those being developed by Oxford University/AstraZeneca and Moderna—use fetal cell lines derived from abortions. Other candidate COVID-19 vaccines do not, for example those being developed by Sanofi Pasteur and GlaxoSmithKline. We do not know which, if any, of the candidate COVID-19 vaccines will be successful. Prominent Catholic and pro-life voices in the US and elsewhere have objected to the development of vaccines with materials derived from aborted fetuses, but few people outside of these circles seem to think the abortion issue is relevant to decisions about how to fund and develop vaccines. And some bioethicists have suggested that even Catholics have no real reason to be concerned about the relationship between abortion and vaccines. 

But we think even people who are untroubled by abortion should be concerned.

To be clear: We hope an effective COVID-19 will soon be developed and widely distributed, even if it uses material derived from fetal cells. Pro-life people would have good reasons to accept such a vaccine, as we discuss below. However, they also have reasons to support the development and distribution of a COVID-19 vaccine that does not use materials derived from aborted materials, even if a COVID-19 vaccine that uses material derived from abortions is developed first. We think everyone should want there to be such alternative vaccines for every vaccine-preventable disease, for practical, ethical, and legal reasons.

First, it’s important to avoid oversimplifying Catholic and pro-life positions on abortion and vaccination, as some bioethicists have done. In particular, the Roman Catholic Church, both at the Vatican and in the US Conference of Catholic Bishops, embraces an uncomfortable compromise on this issue: It supports immunization as a means to promote the common good, but teaches that Catholics must avoid vaccines connected to abortion when alternative vaccines exist. The Catholic Church also teaches that individuals have a moral right to object to vaccines connected to abortion, and that government and industry should develop alternative vaccines.

Of course, most people in the US are not Roman Catholics, and many Roman Catholics are not too concernedabout their Church’s teaching on life issues. More to the point, we should not build public health policy around the teachings of a single religion.  

Nonetheless, we should not be too quick to dismiss concerns about the relationship between vaccination and abortion. In particular, we think there are three kinds of reasons why even people who are entirely untroubled about abortion should support the development and distribution of alternative vaccines.

There are practical reasons: Public health advocates should want as many groups as possible to promote COVID-19 vaccination. Widespread vaccine uptake is essential for developing herd immunity, but the Roman Catholic Church and pro-life organizations can provide full and univocal support only for vaccines that are not connected to abortion. For example, the Catholic Church now teaches that individuals have a moral right to decline vaccines connected to abortion. When alternative vaccines are available, the Church can teach that people have a moral obligation to vaccinate. We should not assume Catholics act in lockstep with Church teaching, but the Church certainly has some influence on some people’s vaccination decisions, and vaccination advocates will need all the help they can get to overcome vaccine hesitancy, especially regarding COVID-19 vaccine. 

There are ethical reasons: Pro-life people may agree to receive vaccines connected to abortion, but then experience moral conflict about that choice. Some may instead decide to refuse vaccines for reasons of conscience. Also, someday soon a person’s ability to travel, work, or go to school may depend on them being vaccinated against COVID-19 or demonstrating immunity to SARS-CoV-2. And even if COVID-19 vaccination or immunity testing were not legally mandated, there may be unjust social stigma or discrimination targeted at those who refuse COVID-19 vaccine.

Admittedly, vaccine refusal due to concerns about abortion appears to be relatively uncommon, but it is a realphenomenon. And crises of conscience matter morally even if they are not frequent. Furthermore, the fact that US public health policy has recently become politically contentious, and the fact that the abortion issue is one of the central fault lines in contemporary US politics, make it reasonable to suppose that abortion-related vaccine hesitancy and refusal are only likely to increase in the future. 

There are legal reasons: COVID-19 vaccine mandates are likely to be more burdensome than existing school and daycare immunization requirements. If the only available COVID-19 vaccine were one connected to abortion, then COVID-19 vaccine mandates would significantly constrain the religious liberty of people who object to vaccines for religious reasons. However, religious liberty laws, especially state and federal Religious Freedom Restoration Acts(RFRAs), require the government to use the least restrictive means to promote compelling government interests whenever the state’s activity impedes religious liberty. If it is possible to develop and distribute an alternative vaccine—one that promotes public health goals without compromising religious liberty—then mandates for an abortion-related vaccine could be found illegal. Court cases, including Jacobson v. MA (1905) and others have long upheld the constitutionality of vaccine mandates, but they cannot defend vaccine mandates against the charge that they violate state or federal RFRA laws.  

Vaccine advocates should worry about a vaccine-oriented version of Burwell v Hobby Lobby, which found that the HHS contraceptive mandate violated the federal RFRA, because HHS could have chosen to provide contraceptive coverage directly, rather than require corporations with religious objections to purchase insurance that includes contraceptive coverage. Advocates of public health should worry that COVID-19 vaccine mandates—and vaccine mandates, more generally—may be vulnerable to legal challenges on religious liberty grounds.

A COVID-19 vaccine that is connected to abortion is more likely to be refused or to generate hesitancy than will an alternative vaccine. If an alternative vaccine is not made available, then laws that require COVID-19 vaccination may cause conflicts of conscience or violate religious liberty. Even people who do not object to abortion should want to avoid these bad outcomes, and should therefore support the funding, development, and availability of alternative vaccines, for COVID-19 and other vaccine-preventable diseases.