Ethical Issues in Smoking and Prioritization of Vaccines for the Prevention of Communicable Respiratory Tract Infections

While vaccination is an aid, at least temporarily, for all emerging infectious diseases, not just COVID-19, fair distribution is an issue. Vaccine distribution to smokers is one such example. The provision of vaccine preference to smokers is consistent with the maximum life-saving principle and is justified on utilitarian grounds. However, the following five possible objections can be presented: (1) self-responsibility for smoking; (2) support from non-smokers; (3) preference for those who maintain social function; (4) identification of smokers and inducement to smoking behavior; (5) consideration for passive smokers. However, arguments against prioritizing vaccination based on self-responsibility downplay the social factors of smoking. (1) Smokers should be provided with treatment, not punishment. (2) To understand non-smokers and enhance social cohesion, communitarian explanations based on the reciprocity of care should be carefully provided to non-smokers. (3) The principle of maintaining social functioning does not supersede the principle of maximum life-saving. (4) Support for smokers should be based on self-reporting. (5) Severe cases of COVID-19 caused by passive smoking are among the most important cases to avoid. The extensive implementation of testing should actively identify victims of passive smoking. This will be evidence of the damage caused by passive smoking.