How important should personal responsibility be in triage criteria? Because persons who choose not to be vaccinated are failing to perform their social commitments during a pandemic, the ethical principle of fairness requires that they bear equitable consequences. These effects might include a reduced priority for treatment, increased employer and government obligations, and entry limits to numerous entertainment places.

Individuals who choose not to be vaccinated increase the likelihood that the COVID-19 virus will mutate and spread, putting the entire population at risk, particularly those who cannot be vaccinated for medical reasons, children for whom vaccines have yet to be approved, and older adults and immunocompromised people for whom the vaccine is less effective. When willfully unvaccinated persons seek medical treatment for COVID-19 (94% of COVID-19 patients in U.S. intensive care units), they use resources that might otherwise be used for non–COVID-related diseases.

A strategy for balancing resource allocation between patients who refuse immunization and those who require the same health care services is required. An ethical alternative would be to prioritize voluntarily unvaccinated persons for admittance and utilization of other health care resources. Current in-hospital triage approaches are easily adaptable to do this. This significant shift in practice may persuade more individuals to get vaccinated.