No country is safe if only its own citizens are inoculated; the question of equitable distribution of a vaccine is as much a global concern as it is local
The vaccine against the novel coronavirus SARS-CoV-2, the virus that causes COVID-19, could come out in a few months. But once it does, how will it be distributed?
There are many aspects to the distribution of a vaccine, including economic, demographic, logistic, legal, socio-political, etc. There is the ethical aspect as well, which demands an equitable policy of distribution.
Not all countries are in the race to make a vaccine, and these countries will have to depend on the policies of countries that have been successful in coming up with one.
We also know that the pandemic is a global phenomenon, and any piecemeal or local management would not suffice. It is, therefore, imperative that a global policy of distribution be in place so that all countries can receive the benefit almost simultaneously.
No country is safe if only its own citizens are inoculated. So, the question of an ethical and equitable distribution of the vaccine is as much a global concern as it is local.
Addressing the global issue first, where the question pops up: Is there a moral obligation on the part of a country to help the distant needy by supplying the vaccine while people at home wait for it? Isn’t there an obligation to cater to the requirements of one’s own people first? Or is this protectionism, and if it is, what’s wrong with it?
Who decides how much of the vaccine produced should go to other countries and at what cost? Do agencies funding the research or the researchers or government authorities or citizens decide on a global policy of distribution?
It is a known fact that when a quantity of an export increases, the cost of resource in the exporting country also increases. Should citizens of that country bear the burden of the extra cost when their tax payers’ money has already been used up in research? Don’t they all deserve to get the vaccine, before any surplus is sent to another country?
But, is that the right humanitarian stand to take? If the vaccine is exported to another country, would the exporting country be justified in charging a higher price for the vaccine than its actual cost?
Research on modalities of transporting the vaccine reveals numerous logistic problems that add to its cost and may also result in the vaccine losing its potency due to delays in transportation. The cost of the vaccine and its possible loss will have to be borne by someone. In the distributive hierarchy, it is always the last receiver that has to bear the cost — likely to be the more vulnerable and needy people of the society.
How do we circumvent the human and economic cost of this eventuality? This brings us to the other question about the modalities of distributing a scarce resource locally. What ethical principles should guide the local distribution of the vaccine? Should it be determined by need, affordability, vulnerability or some other criterion or a combination of all?
It may be argued that healthcare workers fighting the pandemic at the forefront are most vulnerable to contracting the disease and hence they need to get it first. Alternatively, one could argue that the elderly with comorbidities need the vaccine first. But then, the elderly are not fighting the virus at the forefront, so they may not be at a greater risk.
Again, one could argue that those in 18-50 age group, who have to step out of their homes for a living and who are more exposed to the virus, would need the vaccine first. So, do they deserve the vaccine first while the health workers get the protective gear and the elderly stays at home?
There is also the cost issue: Should open market forces determine the cost of the vaccine and affordability? In that case, the section of society most vulnerable to the disease would get left out.
To make sure that that does not happen, the government would need to intervene to regulate and cap the price to avoid profiteering, which would again be a matter of local / national policy.
Here too the question is: What is an equitable principle that treats all stakeholders fairly?
These are not easy questions to answer. In fact, they become all the more difficult when the race is against time.
We need to put our heads together to figure out a local as well as a global policy of distribution that looks into the benefits as well as the burdens of this much-valued resource in the most equitable manner. For this, it is important that we garner public opinion about how this task is to be accomplished and the war against COVID-19 won.
In my opinion, there appears to be no single ethical principle that can guide an equitable policy on distribution. Several factors such as the population size, demographics, indigenous production capacities, short- and long-term needs, affordability and vulnerability will have to be kept in mind to arrive at a policy that would need to be reviewed and reframed.
In this respect, putting up challenging questions so that we can get reasonable answers is of foremost importance. My attempt here has been just that.
Shashi Motilal is professor, department of philosophy, University of Delhi
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth
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