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With promising news surrounding the development of different Covid-19 vaccines, many are looking forward to the day when the coronavirus can be effectively eliminated.
However, there is likely to be a shortage of an effective vaccine initially, so the question arises: Should international distributors prioritize some countries to receive the first batch?
Some countries may respond with “vaccine nationalism,” which occurs when countries prioritize their own citizens first.
Even if we accept that countries have primary obligations to their own citizens and can legitimately weigh more the interests of their people, vaccine nationalism should not be absolute.
Unless a country can be hermetically isolated from the rest of the world, outright vaccine nationalism will backfire in promoting a country’s own interests.
As we often hear during this crisis, a global pandemic knows no borders and no country is safe unless the virus is contained everywhere.
More specifically, countries have global responsibilities.
Any attempt at vaccine nationalism that ignores those responsibilities will be hard to justify.
The question therefore remains: What constitutes a fair international distribution of vaccines?
This is not about science or public health, but about justice: what is the fairest way to distribute a scarce and valuable resource between countries?
DISTRIBUTION PROVIDED
The values of equality, solidarity and international cooperation could suggest that any vaccine should first be made available as widely as possible, in all countries of the world.
The World Health Organization has proposed one such distributional model: initially, providing each country with a supply of vaccines proportional to its population.
In a range of distribution, all countries of the world could first receive sufficient doses for 3% of their population, regardless of mortality rates, the spread of disease or other factors.
So Singapore, with a population of around 5.6 million, could receive around 170,000 vaccines in the first instance, while Britain would receive around two million for its 66.6 million inhabitants.
This is not a strictly equitable distribution between countries, since large countries would receive more doses of vaccines, but it is the same in that each country receives the same amount per capita.
The proportional distribution approach can be seen as demonstrating the same moral concern for people in all countries, since all factors about your country except population, including its infrastructure, economic development and political system, are irrelevant to distribution initial vaccination.
THE FAIR PRIORITY MODEL
An alternative is to prioritize certain countries over others.
The journal Science recently published an article, of which we are among the co-authors, that offers precisely that alternative: the fair priority model.
The model has three general principles: benefit people and limit harm; prioritize the disadvantaged; and equal moral concern.
Together, these principles suggest an approach during the first phase of international distribution: Prioritize those countries where people have the most urgent need for a vaccine.
Although there is a variety of economic and social damages from a widespread Covid-19 outbreak, the most substantial damage is death.
Therefore, countries where vaccines would save the most years of life should be prioritized at first.
Once deaths are relatively under control, other less urgent considerations, such as economic damage, will be taken into account.
Therefore, our model envisions a fair distribution in terms of three phases: saving lives, reducing economic and social deprivation, and helping countries to fully function again.
This not only maximizes the benefits of a vaccine, but also prioritizes the disadvantaged by targeting first those countries that have been made worse by the virus, and demonstrates equal moral concern by treating the value of a life equally, no matter where that person is. lives in the world.
Which countries would get the vaccine first in this model?
This will depend on a detailed analysis of the impact in terms of years of life saved in the distribution.
If current trends persist, countries like the United States and Brazil could end up taking precedence over Singapore, as they have recorded higher per capita deaths and therefore would likely save many more lives by receiving a given stretch of vaccines.
However, by the time a vaccine is ready, the situation could change.
If Singapore suffers from a severe increase in per capita deaths, it is likely, under the fair priority model, to receive higher priority.
COMMITMENTS
No matter what approach is taken, there will be trade-offs in our values.
The proportional distribution approach is possibly in line with the solidarity norm, emphasizing that we are all affected by Covid-19 and that any effective vaccine must be shared with everyone.
But it does so at the expense of the interests of those most in need of the vaccine.
Some countries are experiencing far worse outbreaks than others, and therefore their populations would benefit far more from a potentially life-saving vaccine than others.
The fair priority model puts people’s interests front and center.
Doing so could be seen as an objectionable punishment for countries like Singapore that effectively kept death rates low, but with high economic and social costs, while wrongly rewarding countries like the United States and Brazil for their drastic domestic failures.
However, we must keep in mind that vaccine distribution is not about punishment and reward, it is about alleviating the damaging effects of Covid-19.
Even if we could somehow determine and measure collective responsibility for the spread of the virus, in urgent circumstances, we should allocate resources based on who needs them most, not who might deserve them most.
By way of comparison, it would be inappropriate for an emergency department to prioritize treating an accident victim who caused his own injury over one who was injured by a third party.
Furthermore, it is only in the first phase of distribution under the fair priority model that saving lives is the most urgent consideration.
In the second phase of our model, which we can reasonably expect to follow quickly behind the first phase once the most severe mortality rates are controlled, the fair distribution will also be sensitive to the economic and social costs of the pandemic in different countries. . .
The very substantial economic disruption from Covid-19 in Singapore may give you substantial priority in the second phase.
Whether our proposed fair priority model is adopted or a different approach is taken, determining a fair distribution system cannot wait until a vaccine is shown to be effective.
Distributive systems need to be established and operational well in advance so that they can be implemented without delay when the time comes.
Stakeholders around the world need to consider and discuss the fairest and most equitable distribution model.
• Dr. G. Owen Schaefer is Assistant Professor at the Center for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore.
• Professor Tan Kok-Chor is a professor of philosophy at the University of Pennsylvania.
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