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On the Ethics of Vaccine Nationalism: The Case for the Fair Priority for Residents Framework

Published online by Cambridge University Press:  29 October 2021

Ezekiel J. Emanuel ,
Allen Buchanan ,
Shuk Ying Chan ,
Cécile Fabre ,
Daniel Halliday ,
R. J. Leland ,
Florencia Luna ,
Matthew S. McCoy ,
Ole F. Norheim  and
G. Owen Schaefer
...Show all authors
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Abstract

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents (FPR) framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: (1) having developed a vaccine, (2) raising taxes to pay for vaccine research and purchase, (3) wanting to eliminate economic and social burdens, and (4) being ineffective in combating COVID-19 through public health interventions.

Keywords

fair priorityCOVID-19vaccinesnationalismcosmopolitanismmortality
Type
Feature
Information
Ethics & International Affairs , Volume 35 , Issue 4 , Winter 2021 , pp. 543 - 562
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Carnegie Council for Ethics in International Affairs

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References

NOTES

1 “COVAX Announces Additional Deals to Access Promising COVID-19 Vaccine Candidates; Plans Global Rollout Starting Q1 2021,” World Health Organization, December 18, 2020, www.who.int/news/item/18-12-2020-covax-announces-additional-deals-to-access-promising-covid-19-vaccine-candidates-plans-global-rollout-starting-q1-2021.

2 “The Race for Global COVID-19 Vaccine Equity,” Launch & Scale Speedometer, Duke Global Health Innovation Center, launchandscalefaster.org/COVID-19.

3 Sandrine Rastello and Kait Bolongaro, “Canada Has Reserved More Vaccine Doses per Person than Anywhere,” Bloomberg, December 7, 2020, www.bloomberg.com/news/articles/2020-12-07/canada-has-reserved-more-vaccine-doses-per-person-than-anywhere.

4 Tedros Adhanom Ghebreyesus, “WHO Director-General's Opening Remarks at 148th Session of the Executive Board,” World Health Organization” (remarks, January 18, 2021), World Health Organization, www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-148th-session-of-the-executive-board.

5 “Coronavirus: EU Demands UK-Made AstraZeneca Vaccine Doses,” BBC News, January 27, 2021, www.bbc.com/news/world-europe-55822602.

6 Emanuel, Ezekiel J., Persad, Govind, Kern, Adam, Buchanan, Allen, Fabre, Cécile, Halliday, Daniel, Heath, Joseph, Herzog, Lisa, Leland, R. J., Lemango, Ephrem T., Luna, Florencia, McCoy, Matthew S., Norheim, Ole F., Otterseng, Trygve, Schaefer, Owen, Tan, Kok-Chor, Wellman, Christopher Heath, Wolff, Jonathan, and Richardson, Henry S., “An Ethical Framework for Global Vaccine Allocation,” Science 369, no. 6509 (September 11, 2020), pp. 1309–12Google Scholar.

7 Singer, Peter, One World: The Ethics of Globalization, 2nd ed. (New Haven, Conn.: Yale University Press, 2004)Google Scholar; and Caney, Simon, Justice beyond Borders: A Global Political Theory (Oxford: Oxford University Press, 2005)CrossRefGoogle Scholar.

8 Carens, Joseph H., The Ethics of Immigration (Oxford: Oxford University Press, 2015)Google Scholar.

9 Tan, Kok-Chor, Justice without Borders: Cosmopolitanism, Nationalism, and Patriotism (New York: Cambridge University Press, 2004)CrossRefGoogle Scholar.

10 Herlitz, Anders, Lederman, Zohar, Miller, Jennifer, Fleurbaey, Marc, Venkatapuram, Sridhar, Atuire, Caesar, Eckenwiler, Lisa, and Hassoun, Nicole, “Just Allocation of COVID-19 Vaccines,” BMJ Global Health 6, no. 2 (2021)CrossRefGoogle ScholarPubMed.

11 Miller, David, National Responsibility and Global Justice (Oxford: Oxford University Press, 2007)CrossRefGoogle Scholar; and Moore, Margaret, The Ethics of Nationalism (Oxford: Oxford University Press, 2001)CrossRefGoogle Scholar.

12 Singer, Peter, Famine, Affluence, and Morality (Oxford: Oxford University Press, 2016)Google Scholar.

13 Blake, Michael, “Distributive Justice, State Coercion, and Autonomy,” Philosophy & Public Affairs 30, no. 3 (Summer 2001), pp. 257–96CrossRefGoogle Scholar; and Nagel, Thomas, “The Problem of Global Justice,” Philosophy & Public Affairs 33, no. 2 (Spring 2005), pp. 113–47CrossRefGoogle Scholar.

14 Francesco Guarascio, “Exclusive-WHO Vaccine Scheme Risks Failure, Leaving Poor Countries with No COVID Shots until 2024,” Reuters, December 16, 2020, www.reuters.com/article/health-coronavirus-who-vaccines-exclusiv-idUSKBN28Q1LF; and Alana Wise, “Biden to Announce $4 Billion for Global COVID-19 Vaccine Effort,” NPR, February 18, 2021, www.npr.org/2021/02/18/969145224/biden-to-announce-4-billion-for-global-covid-19-vaccine-effort.

15 Emanuel et al., “An Ethical Framework for Global Vaccine Allocation.” In this article, we argue that a view of this type would provide the most permissive reasonable standard of domestic prioritization.

16 Ed Silverman, “Most Americans Say They Should Be Vaccinated before the U.S. Donates Covid-19 Shots Elsewhere,” STAT, April 21, 2021, www.statnews.com/pharmalot/2021/04/21/covid19-vaccines-global-donations-america/.

17 Kyle Ferguson and Arthur Caplan, “Love Thy Neighbour? Allocating Vaccines in a World of Competing Obligations,” BMJ Journal of Medical Ethics (December 2020), pp. 1–4.

18 Lie, Reider K. and Miller, Franklin G., “Allocating a COVID-19 Vaccine: Balancing National and International Responsibilities,” Milbank Quarterly 99, no. 2 (June 2021), pp. 450–66CrossRefGoogle ScholarPubMed.

19 Jecker, Nancy S., Wightman, Aaron G., and Diekema, Douglas S., “Vaccine Ethics: An Ethical Framework for Global Distribution of COVID-19 Vaccines,” Journal of Medical Ethics 47, no. 5 (2021), pp. 308–17Google Scholar.

20 “Excess Deaths Associated with COVID-19,” National Center for Health Statistics, Centers for Disease Control and Prevention, www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm.

21 “2017–2018 Estimated Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths and Estimated Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths Averted by Vaccination in the United States,” Influenza (Flu), US Centers for Disease Control and Prevention, www.cdc.gov/flu/about/burden-averted/2017-2018.htm; and Jiaquan Xu, Sherry L. Murphy, Kenneth D. Kochanek, and Elizabeth Arias, Mortality in the United States, 2018, NCHS Data Brief 335 (Hyattsville, Md.: National Center for Health Statistics, January 2020), www.cdc.gov/nchs/products/databriefs/db355.htm#:~:text=NOTES%3A%20A%20total%20of%202%2C839%2C205,according%20to%20number%20of%20deaths.

22 Emanuel et al., “An Ethical Framework for Global Vaccine Allocation.”

23 Ibid.

24 Jecker et al., “Vaccine Ethics.”

25 Jennifer Summers, Hao-Yuan Cheng, Hsien-Ho Lin, Lucy Telfar Barnard, Amanda Kvalsvig, Nick Wilson, and Michael G. Baker, “Potential Lessons from the Taiwan and New Zealand Health Responses to the COVID-19 Pandemic,” Lancet Regional Health—Western Pacific 4, no. 100044 (November 1, 2020); and Isabel Kershner, “With Most Adults Vaccinated and Case Numbers Low, Israel Removes Many Restrictions,” New York Times, updated June 18, 2021, www.nytimes.com/2021/06/01/world/middleeast/israel-covid-restrictions.html.

26 Rawls, John, The Law of Peoples: With “The Idea of Public Reason Revisited” (Cambridge, Mass.: Harvard University Press, 1999)Google Scholar.

27 Miller, David, On Nationality (New York: Clarendon, 1995)Google Scholar.

28 Goodin, Robert E., “What Is So Special about Our Fellow Countrymen?,” Ethics 98, no. 4 (July 1988), pp. 663–86CrossRefGoogle Scholar.

29 Harriet Washington, “The Ethics of Coronavirus Vaccine Trials in Developing Countries,” interview by Sacha Pfeiffer, All Things Considered, July 4, 2020, NPR, www.npr.org/2020/07/04/887325575/the-ethics-of-coronavirus-vaccine-trials-in-developing-countries.

30 Matt Apuzzo and David D. Kirkpatrick, “Covid-19 Changed How the World Does Science, Together,” New York Times, updated April 14, 2020, www.nytimes.com/2020/04/01/world/europe/coronavirus-science-research-cooperation.html.

31 Samanth Subramanian, “Without Vials and Needles, a Virus Vaccine Is Just a Formula,” Bloomberg, August 12, 2020, www.bloomberg.com/features/2020-covid-vaccine-manufacturing-essenti.als/.

32 Russ Bynum, Michelle R. Smith, and Rachel La Corte, “Playing Favorites? Hospital Boards and Donors Get COVID-19 Shots,” Los Angeles Times, January 30, 2021, www.latimes.com/world-nation/story/2021-01-30/playing-favorites-hospital-boards-donors-get-covid-shots.

33 Chaudhry, Rabail, Dranitsaris, George, Mubashir, Talha, Bartoszko, Justyna, and Riazi, Sheila, “A Country Level Analysis Measuring the Impact of Government Actions, Country Preparedness and Socioeconomic Factors on COVID-19 Mortality and Related Health Outcomes,” EClinicalMedicine 25 (2020)CrossRefGoogle ScholarPubMed.

34 “COVID-19 Coronavirus Pandemic,” Worldometer, accessed June 24, 2021, www.worldometers.info/coronavirus/country/australia.

35 Colin Packham, “Australia Hails Faster Economic Recovery as COVID-19 Outbreak Suppressed,” Reuters, December 16, 2020, www.reuters.com/article/australia-economy-budget/australia-hails-faster-economic-recovery-as-covid-19-outbreak-suppressed-idUSL4N2IX0OG.

36 “COVID-19 to Add as Many as 150 Million Extreme Poor by 2021,” Press Release No. 2021/024/DEC-GPV, World Bank, October 7, 2020, www.worldbank.org/en/news/press-release/2020/10/07/covid-19-to-add-as-many-as-150-million-extreme-poor-by-2021.

37 Ferigato, Sabrina, Fernandez, Michelle, Amorim, Melania, Ambrogi, Ilana, Fernandes, Luísa M. M., and Pacheco, Rafaela, “The Brazilian Government's Mistakes in Responding to the COVID-19 Pandemic,” Lancet 396, no 10263 (November 21, 2020), p. 1636CrossRefGoogle ScholarPubMed.

38 Emanuel, Ezekiel J., Which Country Has the World's Best Health Care?, 2nd ed. (New York: PublicAffairs, 2021)Google Scholar.

39 “The Key to Viet Nam's Successful COVID-19 Response: A UN Resident Coordinator Blog,” UN News, August 29, 2020, news.un.org/en/story/2020/08/1070852; and “Coronavirus in Senegal: Keeping Covid-19 at Bay,” BBC News, October 5, 2020, www.bbc.com/news/world-africa-54388340.

40 Ezekiel J. Emanuel and Govind Persad, “This Is the Wrong Way to Distribute Badly Needed Vaccines,” Opinion, New York Times, May 24, 2021, www.nytimes.com/2021/05/24/opinion/vaccine-covid-distribution.html; and Lie and Miller, “Allocating a COVID-19 Vaccine.”

41 Alexander Lukashenko, quoted in Andrew Roth, “Belarus Crowdfunds to Fight Coronavirus as Leader Denies It Exists,” Guardian, April 17, 2020, www.theguardian.com/world/2020/apr/17/belarus-crowdfunds-to-fight-coronavirus-as-leader-denies-it-exists.

42 Emanuel, Which Country Has the World's Best Health Care?

43 “MSF: Gavi Must Ensure COVID-19 Vaccines Produced through Its New Global Fund for Vaccine Development Are Affordable for People Everywhere,” Medecins sans Frontieres/Doctors without Borders, June 23, 2020, www.doctorswithoutborders.org/what-we-do/news-stories/news/msf-gavi-must-ensure-covid-19-vaccines-produced-through-its-new-global.