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Global Vaccine Obligations: Do Wealthy Countries Have a Duty to Ensure Low-Income Countries Have Fair Access to Vaccines?

17 Dec 2021
By Professor Adrian Walsh
President Rodrigo Roa Duterte receives a vial of the COVID-19 vaccine developed by British-Swedish drugmaker AstraZeneca from World Health Organization Country Representative, 2021. Source: King Rodriguez/Presidential Photo

In the developing world, in many instances, there are simply not enough vaccine shots available to vaccinate everyone. Wealthy nations have a moral obligation to developing countries to ensure they have access to vaccines.

At the present time, while many developing countries have insufficient access to COVID-19 vaccines, wealthier, more developed countries are instigating booster programs to strengthen the immunity of their citizens. Many of those wealthier countries have actively engaged over the past 12 months in aggressive competitive behaviour which has prevented poorer countries from accessing vaccines.

One might think we should simply be political realists – international relations is, in this view, simply a matter of a “war of all against all” – the stronger nations simply have more purchasing power, and there is nothing more to say about the matter.

However, those of us in the developed world have some moral obligations towards those less fortunate than ourselves, and should give priority to those who are less fortunate.

But the question remains: how should we understand the nature of those obligations? And on what basis might we ground such duties?

Of course, this is not to suggest that there has been no debate about the global distribution of vaccines. However, much of that discussion about vaccines has been entirely prudential. It has been argued that if we wish to prevent new, more virulent and possibly more deadly strains of COVID-19 emerging, then we must ensure that everyone across the globe has access to the vaccines. This line of argumentation is not based on other-regarding moral concerns: instead, it is a form of enlightened self-interest.

It might be argued that if the prudential argument suffices to motivate action, then why bother with moral concerns. Don’t such concerns, then, become redundant?

The answer is simply “no.” Firstly, it is not difficult to imagine circumstances in which our self-interest does not align with the needs of the developing world. In such cases, we would not feel any compulsion to assist the developing world in obtaining more vaccines. Secondly, simply relying on prudential considerations fails to capture the force of what is wrong with the developing world taking the lion’s share of medical supplies.

What is the nature of our obligations with respect to the distribution of vaccines? How might we ground those obligations? One way of grounding them derives from the work of the North American philosopher John Rawls, who argued that we have a political obligation to give priority to the worst-off. In his 1971 seminal work A Theory of Justice, Rawls argues that justice is what we would agree to in an imaginary situation – that he terms the “Original Position” – in which we do not know what position we will hold in the society for which we are formulating principles to govern our society. We do not know in the original position if we will be, for instance, rich or poor, physically healthy or not, and so on – he calls this the “veil of ignorance.” Rawls’ theory involves an acknowledgement of the way that positional bias affects our claims about what is fair; that is, how our position in society influences our views on justice.

In such an original position we would, Rawls suggests, support principles that make the worst-off as well as they can be, just in case we find ourselves in the worst circumstance when the “veil of ignorance” is lifted.

Rawls’ ideas have been developed by subsequent theorists and this Rawlsian tradition is often now referred to as “prioritarianism,” because priority is given to the worst-off.

What might prioritarianism tell us about our global pandemic obligations? Although Rawls, in his later writings, limited the applicability of his ideas beyond particular Western nation-states, other prioritarians have not been so cautious. They have used his idea of according priority to the worst-off to outline what obligations we have to the developing world.

A prioritarian theory of justice would say that we have a moral duty to ensure that those in the developing world — who clearly count as the worst off in this situation — are given priority when it comes to access to vaccines. Furthermore, if a choice has to be made between booster shots in the developed world and initial vaccination in the developing world, then clearly the vaccines should go to the less fortunate.

Some in the Rawlsian tradition have found the idea of always giving priority to worst-off to be too demanding in terms of its implications for the allocation of resources. Thus, in response they advocate the milder view of sufficientarianism, according to which we need to ensure each of us has enough, rather than trying to make the situation of the least well off as good as possible.

Sufficientarianism urges to ensure that everyone has sufficient access to social resources and, hence, it would advocate making certain that all people have vaccinations, in preference to vaccines being used for booster shots.

If we accept the Rawlsian position, we do indeed have moral obligations to developing countries to ensure they have access to vaccines and, accordingly, we should not act in ways that undermine their opportunities to do so. Therefore, aggressively out-competing poorer countries for vaccines in order to provide booster shots, when those in the developing world have not yet been vaccinated at all is morally wrong. The same can be said for vaccine-hoarding. Furthermore, the reason we should act upon these moral obligations is that they involve principles that we would indeed endorse when stripped of our own positional bias. If we strip away our own biases based on our own self-interest, it is clear that this is the morally right thing to do.

Adrian Walsh is a Professor of Philosophy and Political Theory at the University of New England, Armidale, Australia

This article is published under a Creative Commons Licence and may be republished with attribution.