Were Moderna & Pfizer’s HEK-293 Tests Immoral?

Much of the Catholic discussion around the ethics of vaccines has focused on the remote connection with abortion. There has been an implicit assumption that all testing on HEK-293 is unethical. But as not all remote cooperation with evil is immoral. Thus, we need to ask if the tests Moderna and Pfizer did on HEK-293 were immoral on the part of the companies & scientists. I don’t think there is a clear definitive answer but I will give principles to judge it.

To analyze this I will explain relevant moral principles then analyze the tests using the same principles in the same order.

Moral Principles of Double-Effect & Remote Cooperation / Appropriation

Remote cooperation is an extension of the principle of double-effect. To understand it, we need to understand the three parts of any moral action. Then we can look at where double-effect fits into moral action.

Three Parts of the Moral Act

The three parts of any action are the object, the end, and the circumstances. The first two must always be 100% good or neutral but, in modern society, circumstances almost always have some imperfection if pushed.

• The object is what we choose in choosing the action. It answers questions like what or how. For example, my object right now is writing a blog post on my computer. In Veritatis Splendor 78, John Paul II said: “The morality of the human act depends primarily and fundamentally on the ‘object’ rationally chosen by the deliberate will.”
• The end is the goal one is seeking in an action. It answers questions like why or for what end. For example, my end right now is explaining Catholic moral theology to fellow Catholics.
• Circumstances are a little more complicated as they tend not to be as monolithic. They include questions, like when, where, with what tools, under what direction, etc. (I’m writing this in my room in my community house, using the laptop assigned to me, after finishing a part of my doctoral thesis with permission from my superiors to write such things online, etc.) Certain circumstances can be sufficient to make an act immoral, but most don’t corrupt the whole act. Often circumstances are imperfect but the act is still clearly good. For example, I know this laptop almost definitely has rare earth metal from illicit sources in it, but given every other aspect of the act is good, this does not corrupt the whole act. If super minor imperfections like that corrupted an act, there would be no way to act morally while living in modern society.

Double Effect

Let’s explore the standards for the principle of double effect to be applicable.

• The object and end still need to be good. Let’s use as an example the actions of police in a hostage situation. The end is the safety of innocent humans, and different actions could have different objects.
• There must be no way to achieve the good without also having the evil or a similarly evil result. We must prefer such options without an evil result. For example in a hostage situation, We need to prefer options like getting the hostage-taker to surrender via negotiation or finding a safe way to arrest him over gunshots.
• The evil result cannot directly be a means to the good, but must be an undesired side effect. Here we need often be careful about the object as an object is not a physical action. Pulling the trigger of a gun is not a proper object: an object is the choice of the rational will. Taking the hostage situation, if other options have been exhausted, shooting the hostage-taker has the object of removing an imminent deadly threat against an innocent person.
• The good effect must be equal or greater than the evil effect. This is a question of proportionate that needs to be judged prudentially for specific acts.

Remote Cooperation or Appropriation

A few notes about these:

• The difference between these two is whether it refers to an already completed act or not. Cooperation refers to contributing something, even in the most infinitesimal way, to a current or future evil act. Appropriation – less morally significant – refers to taking something from an already completed moral act. We should still avoid appropriation if all things are equal but the moral duty to do so is very minor, so can be overcome for relatively small reasons.
• They need to follow all the rules of double-effect above.
• When looking at it, we need to examine both the degree of evil of the act and the moral distance. For example, the CIA torturing people is far more morally horrendous than lying to get out of work for the day to go fishing, but me paying taxes that eventually through a byzantine path fund that CIA torture is far less of a moral issue than inviting a friend out fishing knowing he will lie to his boss to get out of work that day.

Applying Principles to Moderna and Pfizer Vaccine Tests

Let’s apply these principles to the testing on HEK-293 done by Moderna and Pfizer for their COVID vaccines. I will follow the same order of bullet points, point by point.

Three Parts of the Moral Act

• The object would be testing a drug’s effects at a cellular level.
• The end would be to determine effectiveness, to ensure it’s safe for humans, and to fulfill regulatory requirements. (There may be more.) Ultimately, this was all directed towards providing a safe vaccine for public use to prevent COVID.
• There are a variety of circumstances, the most important one is appropriation or cooperation with abortion in using HEK-293.

Double Effect

• The object and end are clearly good.
• Whether there would be a way to achieve the good gets into a slightly complex question. I am unsure of the exact details. It seems that HEK-293 was the first standardized model for how CVOID-19 interacted on the cell-level in humans. It seems likely it was the only sufficiently developed model at the time of the first test. This seems less clear by the time each did their second test using HEK-293. Obviously, these companies have the funds to create other models. However, that would take time, so a side effect would then be that the vaccines would be delayed by several weeks or months. If HEK-293 was the only option then available, the earlier end to the pandemic offered by using it rather than creating another model seems proportionate. If other options for the tests without such remote cooperation or abortion were available, then it would be unethical for scientists to use the less ethical option.
• Four points about how the good effect is not the direct result of the evil of abortion.
  • HEK-293 were removed after the abortion so the taking of HEK-293 was not the means of killing the baby.
  • If HEK-293 was from a miscarriage instead of an aborted baby (possible but unlikely), the tests on it would operate the same, and there would likely be no moral evil to speak of.
  • The continued existence of HEK-293 is further removed and not directly causal in any abortion.
  • The tests themselves are not dependant on HEK-293 and could be done with other cells if available.
• As noted two bullet-points above, we need to look at this rather remote cooperation or appropriation as a negative aspect compared to the great good of hastening the end of the pandemic.

Remote Cooperation or Appropriation

• We need to legitimately ask if using HEK-293 is cooperation or appropriation. It would be cooperation if its use contributed to future abortions. A big question here is how immortal are immortalized cell lines like it. As far as I can tell, this is still an open scientific question. Continuing to use it now likely means others will continue to use it later, but will that use necessitate the taking of future cells from an aborted baby to replace it, it’s not 100% clear. It may actually be either, but when unsure and dealing with human life morally, we should work on the assumption fo the stricter stance so we likely want to assume cooperation even if likely appropriation.
• We have noted all the points of double-effect for such cooperation or appropriation.
• Abortion is clearly a serious grave evil, but the connection even for these researchers is quite remote. I have covered this a few times before, most notably in my recent piece. Obviously, the connection for us is a whole other level of remoteness: these four tests (2 per company) contributed to the approval of billions of doses of vaccines.

Conclusion

In the end, it’s not 100% clear whether these tests were ethical or not. If all models for COVID’s interactions on the cellular level involved fetal cell lines, the good of getting the vaccine out faster probably was sufficient to justify the remote cooperation in such tests. However, it seems less certain there were no other options in the second test each company did that involved HEK-293. When it is is not even clear if the scientist doing a test did something immoral, it should crystal clear that the connection once we get to each of us vaccinating is far from sufficient to corrupt the virtuous act of vaccination.