Vaccine Ethics

There is no starker example of inequity in the world than the rollout of the COVID vaccine.  It was easy to predict.  Richer nations were always going to be vaccinated first. Was there ever a chance to make vaccine access more equitable?  How much will this unequal access affect the further evolution of the pandemic and the death toll?

The development of the COVID vaccine itself has been an amazing and inspirational case of international cooperation and organizational efficiency.  The vaccines currently being distributed across the world – Moderna, Pfizer, Astrazeneca, Sputnik and Sinovac – were developed in a space of time previously considered impossible for vaccines.  The world can truly be proud of this accomplishment.  As in all things, the motivations were a mix of noble, intellectual and monetary ambitions, but the overall result is simply wonderful and incredible.

In early-2020, at the start of the pandemic, efforts to coordinate international cooperation on testing, treatment and vaccine research, and ultimately develop vaccines were initiated by the G-20 through the Access to COVID-19 Tools Accelerator and a Call to Action was published by the World Health Organization (WHO).  One of the 3 pillars of this effort was COVAX, a public/private cooperation to ensure distribution of COVID vaccine to low and middle income countries.

The USA, under the Trump administration, had severed ties and support with the WHO and stated in September, 2020 that it would not support COVAX.  Thus, the USA did not participate in this effort until early this year (2021), when the new Biden administration rejoined the WHO and committed support and funding to COVAX.  The USA has now made a larger funding commitment to COVAX than any other country ($4B), which is certainly the way it should be, considering that the USA is the wealthiest country in the world.

As of the middle of April, 2021, COVAX had only delivered 39 million vaccines doses, falling short of its goal of distributing 100 million by the end of March.  It is likely that the rate of distribution will increase dramatically once the USA and the EU have reduced their caseloads and hospitalizations to a ‘manageable’ level. Hopefully this will occur by mid-summer.  Moderna has now committed to providing 500 million doses to developing countries starting in the 4^th quarter of this year.

The Biden administration has focused most of its effort on vaccinating US citizens, but has just announced that it will send all of its Astrazeneca inventory, some 60 million doses, to low and middle income countries in the next several months.

China and Russia have developed vaccines and have negotiated distribution deals with some developing nations independently.  There is speculation among western nations that China and Russia will use these relationships in a quid pro quo manner to obtain special status in trade or military alliances. 

The moral and ethical questions regarding vaccine distribution are challenging.  Every country’s government is by its definition responsible first and foremost for the welfare of its own citizens.  Its generosity toward other nations and the world in general is secondary, though where that line is drawn varies significantly in different nations.  This difference in perspective from an individual’s decision to share with or help others is part of the moral dilemma that society faces – the moral man, immoral society dichotomy.

The failure of the wealthier countries to share the vaccine with developing nations is certainly distressing, but it is not surprising.  There is some logic to it.  One could perhaps use the analogy of the airplane instruction for people to put their own oxygen masks on before assisting others. This may sound paternalistic, but it reflects the difficult decision-making process in the real world.

This analogy breaks down somewhat as vaccine distribution is not a binary decision.  Perhaps a greater amount of vaccine distribution to developing nations could have been done without much adverse effect on the USA and the EU.  But an argument can be made that the overall effort to stop the contagion is more likely to be successful if the wealthier countries get their outbreaks under control as quickly as possible and then focus on providing aid to other nations. 

Observing the current state of the COVID pandemic, it is clear that certain developing countries are indeed struggling and in desperate need of the vaccine, particularly Latin American countries.  If one measures the relative mortality impact by the statistic deaths/million, then Brazil (1901), Peru (1853) and possibly Mexico (1670, but likely inaccurate) have had worse fatality rates than the USA (1776).

The highest deaths/million are generally in the developed nations, extending from the USA to the EU, especially the eastern European countries.  African countries have so far evaded the worst of the pandemic, a mystery that has baffled epidemiologists.  South Africa (908) and Tunisia (907), the worst hit, are still only at half the USA fatality rate. Most African nations are below 100!  A delay in vaccine distribution to those countries could allow the contagion to take root, but at this point there does not seem to be a desperate need.

And Asian countries have generally been quite resilient and effective in their management of the contagion, with no countries in the top 100 for fatality rate!  India and the Philippines are both at 157, though India is currently experiencing a very dramatic and tragic outbreak.

In my assessment, even if the vaccine distribution is currently unfair and monopolized by the wealthier nations, the long-term consequences may not be that catastrophic.  One might even be able to successfully argue that the current distribution of vaccine will result in saving the most lives across the world.  This is, of course, not out of design.  The wealthy nations would be hoarding and selfishly focusing on their own needs even if the contagion were rampant in other parts of the world.  But fortunately, that is not the case!