Review of Moral Principles
All Catholics should be properly catechized on the principles of cooperation with evil as taught by the Roman Catholic Magisterium. You can read my posts on this topic here, or read my booklet Roman Catholic Teaching on Cooperation with Evil here.
There are three fonts of morality. To be moral, an act must have only good in the intention (first font), only good in the moral object (second font), and the reasonably anticipated bad consequences must not morally outweigh the reasonably anticipated good consequences (third font). The moral object is the end, in terms of morality, toward which the knowingly chosen act is inherently ordered. An evil end makes the chosen act intrinsically evil and always immoral.
What happens if your knowingly chosen act is related to the sin of another person? What if your act in some way cooperates with the sinful act of another? The teaching of the Magisterium on this topic is called the principles of cooperation with evil.
Explicit cooperation is intentional (deliberate) cooperation with whatever is sinful in the act of another person; it is always immoral. Formal cooperation occurs when your cooperative act is inherently ordered toward assisting the intrinsically evil act of another person in attaining its evil moral object; it is always immoral. Formal cooperation is itself an intrinsically evil act, as it is ordered toward the evil moral object in the other person’s intrinsically evil act.
Material cooperation, when it is not also explicit cooperation and not also formal cooperation, depends for its morality on an evaluation of the circumstances of your act. Given that the sin of another person is grave, but remote from your own cooperative act, your act can be moral — if the reasonably anticipated good consequences morally outweigh the reasonably anticipated bad consequences of that cooperation.
Background Information on Fetal Cell Lines
In the 1960’s, two abortions occurred for reasons unrelated to research. Cells from these abortions were used to develop two “cell lines”, termed WI-38 and MRC-5. These fetal cells were grown in a container, and as they divide, they are moved to additional containers. The division of these cells continues today, and can continue indefinitely. The cells are sold by companies providing supplies to medical researchers for use in experiments; they are not solely or even primarily used for the development of vaccines.
Morally, the manner in which these cell lines are used affects whether the use is more remotely or less remotely related to the cell line and therefore to its origin in an abortion. Three possible categories of this relation are likely:
1. Some experiments might be done in such a cell line, to obtain a better understanding of the virus and to test various medical theories or treatments, while the development and preparation of the vaccine would not use those cells at all.
2. A vaccine might be developed using such a cell line, for example, by infecting the cells with the virus, and continuing the infection from generation to generation of the line, under various conditions, until the virus is attenuated (reduced in harmfulness). Then many doses of the vaccine would be prepared without use of such a cell line.
3. Finally, the vaccine doses themselves might be grown out in such a cell line. This would be the most direct connection between the cell line and the vaccine.
Concerning case 1, there is no reason for researchers to exclude from their work, seeking an effective Covid-19 treatment or vaccine, information obtained by other researchers using an aborted fetal cell line. The researchers using the information had no control over the conditions of those experiments, and the experiments themselves are only remotely and materially related to the original abortion. Moreover, if one were to attempt to make a vaccine with no information obtained from any such cell line, this would likely be impossible. So many experiments have been done using these lines, first used in the 1960’s, that a vast amount of information, in many different areas of medicine, has at least a remote connection to those lines.
So in the case of #1 above, the relation to the original abortion is so remote, that the moral weight of the circumstances needed to justify use of the information would be met by almost any research with a goal of reducing disease, suffering, or death.
In the second case, #2 above, the use of the cell line is morally objectionable, and those persons who choose to use such a cell line, when some other means would suffice for the same purpose, commit an objective sin. The original abortion was gravely immoral of course, and the original decision to use cells from the aborted fetus for research was also gravely immoral.
The issue today, decades later, is that these cell lines have been used so many times, with so much knowledge built up over the years, that research using those lines has benefits above any new line that has no connection to abortion. And the past cannot be changed. Abandoning this cell line, without an equal or better replacement, might do more harm than good. Research should be done on new cell lines that can utterly replace all lines based on aborted fetal cells. But that will take time.
Now the researchers themselves are in a different situation, many times, than company leaders and administrators. They would often not have responsibility or even the ability to make a decision as to which cell line to use. Given that they do not have any reasonable option — other than to quit or object until they are fired — they may morally use such a cell line, even to the extent of developing a treatment or vaccine using the line. No new abortions occur as a result of such use. And the benefits of the cell line, because of decades of experimentation have given researchers a vast body of knowledge that would not be applicable to other cell lines, morally outweighs the remote connection to a past abortion.
In the third case, #3 above, the use of the cell line is more objectionable than in the other two cases, as each dose of a vaccine would be more or less directly related to the cell line itself. This would not be a case of mere knowledge obtained by experimentation with the cell line. Use or acceptance of such a hypothetical vaccine would require a grave reason. (Fortunately, this case seems to be merely hypothetical.)
What is the current situation regarding development of Covid-19 treatments and vaccines?
Treatments: most experiments regarding treatments for Covid-19 do not use any fetal cell lines. The researchers certainly have some knowledge, applicable to their own research, obtained from experiments done by other persons, which assists them in seeking treatments, vaccines, or simply a better understanding of Covid-19. But this relationship is remote, merely material (not formal), and the moral weight of relieving suffering and reducing disease infections and deaths greatly outweighs this very remote cooperation.
Vaccines: Over 100 vaccine candidates are currently in development against Covid-19. Companies doing this research do not seem to give any moral consideration to the use of a cell line from aborted tissue. The researchers generally have little or no say over which cell lines they use. However, most of the modern means of developing and manufacturing the vaccine doses themselves have little or no relationship to these cell lines.
How likely is it that any successful vaccine might be related to a fetal cell line?
1. Cell lines might be used in experiments whose goal is providing information: highly likely, but very limited. For any vaccine brought to market, the number of research experiments by teams across the globe whose work had some small contribution to that success is vast. Thousands of experiments resulted in information that has some relation to the vaccine. But only a small proportion of these experiments may have used such a cell line.
But even if a fetal cell line were used, in some few experiments, the relationship between the use of the cell line and the eventual goal of a treatment or vaccine is very remote. Then, too, the benefits to human society are of inestimably high moral value. Avoiding such a treatment or vaccine, due to this type of remote relationship to an abortion in the distant past, is not a moral obligation.
2. Cell lines might be used to develop the vaccine itself, such as by growing the virus in the cell line, to produce an attenuated form, or the growing of the virus in the cell line to obtain RNA from which is produced genetically-modified bacteria which express one or another vital protein. In such a case, the use of the cell line goes beyond merely obtaining some information by experiments, but falls short of using the cell line to develop individual vaccine does. This type of use is unlikely, as it does not seem to be the current method for developing a vaccine. (I believe the rabies vaccine was developed in the manner described above, in the 1970’s.)
As for its morality, in the hypothetical case of such a use, the relation to the original abortion is nonetheless remote, and the benefits are of considerable moral weight, so the use would be moral. If it were possible to obtain the same benefits without use of such a cell line, a researcher has a moral obligation to avoid such a use. But given that a vaccine or treatment has that past relationship to such a cell line, persons of good will are not required to reject the vaccine nor to reject a treatment.
3. What if a cell line were used to produce individual vaccine doses? This use is highly unlikely, as this is simply not how vaccine doses are produced today. Given a hypothetical case of such a use, the connection to the past abortion is far less remote than in the first and even second case.
For an ordinary vaccine, whose use is not of urgent need for the survival of hundreds of thousands or even millions of persons, one might morally refuse such a vaccine. And its acceptance would require a careful weighing of the circumstances. However, in the case of Covid-19, the severity of the disease and its harm, as well as the threat of a degree and type of harm not seen since the Spanish Flu, justify even such an extreme case, where each dose is from the cell line itself.
Now I want to stress that no such vaccine candidate is in development and, again, this is not the method used to produce vaccines today. However, even given this worst-possible merely-hypothetical use of aborted fetal cell lines, the acceptance of such a vaccine would not only be moral, but a moral obligation (as I will explain at the end of this article).
Please understand that although abortion is a very grave crime against humanity in the world today, many acts of faithful Christians, who oppose abortion unequivocally, have a remote relation to that sin. Many companies donate money to organizations which perform or promote abortion. The faithful may still use the products or services of those companies. The production and distribution of food and other necessities often involves companies who support abortion and who donate to pro-abortion groups. Public schools and even some Catholic universities teach in favor of abortion and contraception. Very many medical professionals are pro-abortion. Many hospitals perform supposedly “necessary” abortions, which are morally unacceptable under Catholic teaching.
You could not possibly live your life in this sinful world without cooperating with persons or organizations that have at least a remove relationship to abortion or to other grave sins. And this is why the Church has a teaching on material cooperation with evil, a teaching which permits your cooperative act, as long as it is remote to the sin of the other person, and as long as you do not approve of that sin, nor commit that sin yourself.
A proportionate reason is needed to justify your cooperative act, when it is related to the sin of another person. In the case of experiments toward a treatment or vaccine for disease, the gravity of the medical benefits outweighs the bad consequences of the cooperation. And this is particularly true when the abortions in question were two isolated abortions, many years ago, not performed for any reason related to research, and only distantly related to current use of those cell lines.
In addition, the harm done by Covid-19 and the benefits of finding treatments and/or a vaccine, is of immense moral weight. Over 4 million cases of Covid-19 have been reported, with many millions of additional cases possibly unreported. Over 300,000 deaths have occurred, with many more deaths from certain nations (such as China, North Korea, Iran, etc.) possibly going unreported or under-reported. And for those who recover from Covid-19, continuing serious health problems are possible, including lung fibrosis, neurological problems, and problems with heart, lungs, kidneys, liver, and blood vessel linings.
So the claim that Catholics must refuse a Covid-19 vaccine, despite the vast benefits, due to a very remote relation to a couple of abortions in the 1960s, abortions which would have occurred in any case, is absurd. It is a severe misrepresentation of Church teaching on morality.
And the Church has approved of the use of these types of vaccine, developed from aborted fetal cell lines, especially when the disease prevented is very harmful. The CDF Instruction Dignitas Personae discusses the use of ‘biological material’ meaning a cell line originating from an aborted fetus.
“Grave reasons may be morally proportionate to justify the use of such “biological material”. Thus, for example, danger to the health of children could permit parents to use a vaccine which was developed using cell lines of illicit origin, while keeping in mind that everyone has the duty to make known their disagreement and to ask that their healthcare system make other types of vaccines available. Moreover, in organizations where cell lines of illicit origin are being utilized, the responsibility of those who make the decision to use them is not the same as that of those who have no voice in such a decision.”
The National Catholic Bioethics Center has a good discussion of Church teaching on this topic: FAQ on the Use of Vaccines. That discussion is on the topic of vaccines and fetal cell lines in general. And they approve of the acceptance of a vaccine by Catholics, despite this remote material cooperation.
But the harm done by Covid-19 to the infected and to society is much more severe than for other diseases, which means that accepting a Covid-19 vaccine is certainly moral, even in the worst case of a close relation between the doses of the vaccine and the cell line — a worst case which is merely hypothetical.
Is it a Grave Sin to Refuse a Covid-19 Vaccine?
Given the case of a vaccine proven to be safe and effective against Covid-19: Yes. It is an objectively grave sin to refuse to be vaccinated against Covid-19, unless one has a particularly grave reason which is proportionate to the gravity of the harm avoided and the benefits obtained by accepting the vaccine.
There are three fonts of morality: intention, object, circumstances. An act — such as refusing a vaccine — can be a grave sin, even when it has a good intention, and is not intrinsically evil, if the reasonably anticipated bad consequences morally and gravely outweigh the reasonably anticipated good consequences. Refusing to accept a Covid-19 vaccine has very serious bad consequences, as follows:
A. Infectivity – you are likely to be infected and you are likely to infect others
Covid-19 is a highly infectious disease, with an R0 (basic reproduction number) of between 2 and 3. This means that, on average, an infected person will infect two or three other persons, and they each will infect 2 or 3 other persons, and so on.
Morally, if you refuse a vaccine, your chances of contracting the disease are high, as the virus is widespread in society (over 4 million cases so far) and it is very infectious. And your chances of infecting other persons, directly or indirectly, are also high. Even if you only infect one person, instead of the average 2 or 3, that person might infect 2 or 3 persons, and so on. Therefore, you are endangering the health of other persons.
B. Incubation Period
The time from infection to symptoms is 5.1 days. You are infectious for a period of time prior to knowing that you are infectious. So this makes it difficult to avoid infecting others. MedMastery explains that 44% of transmission of Covid-19 from one person to another occurs before the infector has symptoms. This means that the person who makes you sick with Covid-19 is often not yet symptomatic. You often get the disease from someone who has no symptoms.
Morally, this means that you cannot easily reduce the grave bad consequences by avoiding persons who appear ill, nor by avoiding infecting others once you know you are ill. Infectivity largely occurs from a person without symptoms. So you are likely to become ill, and you are likely to pass on that illness to others. Then you are also indirectly morally responsible when they pass on the illness to still other persons.
C. Suffering and Death
Covid-19 is said to produce only mild cases in 80% of persons. This claim is based on a Chinese study in which the patients were categorized as mild, severe, or critical. Many of the “mild” patients had pneumonia as well as other symptoms that any ordinary not-completely-insane person would not call “mild”. A more reasonable categorization has four types of Covid-19: mild, moderate, severe, critical. The degree of suffering in the mild and moderate categories can be significant.
The Covid-19 virus, called SARS-CoV-2, can infect any cell with an ACE2 receptor on its surface. 83% of the ACE2 in the human body is in the lungs. So Covid-19 can severely afflict the lungs, possibly causing lung fibrosis, the development of fibrous tissue, which does not expand and contract easily as lungs ought to do. This can result in painful breathing, reducing oxygenation, and eventual death even months later. This was seen in past cases of SARS and is likely in Covid-19 as well.
Other cells that have ACE2 receptors, and which can be infected by SARS-CoV-2 include the heart, kidney, intestines, and blood vessel linings. Some cells in the nervous system have ACE2, as do some reproductive cells. This implies that cases of Covid-19 can vary greatly in types of harm, the suffering to the patient, and the health consequences months or years after recovery. In some cases, young adults with initially mild or moderate symptoms can suddenly show severe complications, such as thrombosis (blood clots) in the brain or lungs.
Currently, in the world, the ratio of reported deaths to reported cases is 6.67%; in the U.S., the ratio has been at about 5.9% for several days. This is a high death rate for this type of disease, as it is highly infectious. If ten percent of the world population (7.7 billion) contract Covid, and 5% die, that is 38.5 million deaths. And the suffering endured by those who become ill and recover may continue for many years. There are all manner of severe possible complications to this disease.
Morally, you are risking severe suffering, possible future disability or reduced ability, and death for yourself. And the chances are high that you will infect others, directly and indirectly, resulting in this type of grave harm to other persons. What grave reason can you give to morally outweigh these grave bad consequences?
Refusing the vaccine does nothing to prevent abortion. Refusing the vaccine might possibly avoid an negative consequences that can occur from any vaccine, such as the risk of a bad reaction. You might suffer somewhat, if that reaction occurs. The vaccine might present a small risk of death from a particularly bad (and certainly very unusual) reaction to the vaccination. But the suffering and risk of death to yourself and others if you are not vaccinated is certainly far greater.
Therefore, the risk of bad consequences has grave moral weight to yourself and others, and there are no equally weighty good consequences to be obtained, nor bad consequences to be avoided by refusing the vaccine. The connection to a past abortion, from which a line of research cells were obtained is remote material cooperation, and so it is moral to accept the vaccine. The weight of this remote material cooperation is very much outweighed by the grave risks and great harm to individuals and to society of Covid-19.
And the harm of the disease, which is reduced greatly by a vaccine, includes harm to the Church. A vaccine allows the Churches to reopen and the parishes and priests to resume a near-normal spiritual life. The moral weight of this benefit alone outweighs remote material cooperation with a past abortion from the 1960’s.
Then the harm of the disease also includes harm to the economy, to jobs, family life, education of children and an orderly society. And all this is added to the harm of the disease directly to the health of millions, if not billions of persons.
So refusing the Covid-19 vaccine, in most cases, would be gravely immoral. The harm done by this refusal, harm to the Church, society, and to the health of many persons, is of immense moral weight. The faithful are morally obligated to accept a Covid-19 vaccine — once it is tested and found to be safe and effective — and they sin gravely if they refuse the vaccine, unless they have a grave reason.
What grave reason could justify refusal of the vaccine? A person who is gravely ill, who might die from a bad reaction to the vaccine, and who is unlikely to infect others (e.g. if their family members already had Covid-19 and are now immune), could morally refuse the vaccine. But for the most part, not only are all adults morally required to accept a Covid-19 vaccine, but they would sin gravely if they refuse it.
Worse still is the sin of those persons who publicly oppose any Covid-19 vaccine, discouraging a large number of persons from receiving it. The effect of this public discouragement of vaccination is that many persons might refuse the vaccine, resulting in many cases of Covid-19 that otherwise would have been avoided, and certainly resulting in much suffering and some unnecessary deaths. These persons are indirectly responsible for that harm and for those deaths.
Ronald L. Conte Jr.
See my previous post below:
I’m working on an article, to be posted here when completed [now posted above], on whether a faithful Catholic is morally obligated to refuse a Covid-19 vaccine, or free to accept or reject it, or morally obligated to accept the vaccine.
I will say, though, at this point, it is absolutely clear that the benefits of an FDA-approved vaccine, which has met the usual conditions of safety and efficacy, far outweigh the remote material cooperation with the use of a cell line from an aborted fetus. So the claim is false, as stated in “the Appeal,” that “it is morally unacceptable to develop or use vaccines derived from material from aborted fetuses.”  It is not “morally unacceptable”, but rather moral or immoral based on the proportionality of the circumstances under the principles of material cooperation with evil. And already sufficient harm from the virus and therefore great benefit from a vaccine clearly outweighs this material cooperation (with a past abortion) which cooperation is, in most or all real cases today, very remote.
So the real question is whether we are morally obligated to accept the vaccine, so as to protect the lives of persons who might suffer greatly and/or die if we, due to a refusal of the vaccine, become ill and then transmit the disease to other persons.
Also noteworthy, in evaluating the circumstances, is the likelihood that any vaccine will be in short supply relative to demand (and thus it is very unlikely that anyone be forced to accept it).
 APPEAL FOR THE CHURCH AND THE WORLD to Catholics and all people of good will; Link