Allocate COVID-19 vaccines behind the 'veil of ignorance'

In political philosopher John Rawls's famous "Theory of Justice," he begins his argument with a thought experiment: the veil of ignorance. It asks a hard question: if we all sit behind the veil, having no idea of our social status, what kind of social principle or structure would we select to ensure justice in society?

Such an experiment has its limitation, but the question itself is ever more relevant today given what the world is today: that it is suffering a once-in-a-generation pandemic and the long-waited vaccines are ready to be rolled out.

Usually, it takes more than a decade from researching a vaccine until it finally goes to the market. But the urgent need for a solution to the pandemic has created a miracle. Russia has already begun mass vaccinations of its Sputnik V vaccine; Britain is to follow soon with its Pfizer vaccine. On Monday, Indonesia has received its first batch of COVID-19 vaccine from China's Sinovc Biotech.

Given COVID-19 cases have passed 67 million with 1.5 million deaths, the demand for vaccines is huge. In fact, some wealthy countries have already locked a large chunk of vaccine supplies by signing contracts with pharmaceutical factories or research labs. According to reports from the Associated Press, the populations of those countries accounts for 13 percent of world populations, but they have already bought half of the vaccines on the market. This means the competition for vaccines would be fierce.

Then it goes back to the question of fairness. If we are not sure which country we would be born in, would we still agree to the market principle applied to COVID-19 vaccines, where the richer get protection while the poor can only wait?

For now, inequality seems to be the case. Given that vaccine, R&D is extremely investment and technology-intensive. Many countries would not even have the resources to join the race; meanwhile, rich countries are already signing countries with various research labs to diversity their bets, even many of them were still in the first stage of a clinical trial. When those vaccines are successful enough to get to the market, rich countries will end up having more vaccines than they need.

In an interview with NPR, Andrew Taylor, Assistant Director at the Duke Global Health Innovation Center, estimated that the US would probably have more than twice enough to vaccinate their population while Canada will have five times over for their population. Some people in poor countries will likely not be immunized until 2023.

This is far more than a moral issue but an urgent realistic problem. If poor countries get left out as vaccines being rolled out, the holy grail answer to the current pandemic will simply not be good enough. In a modeling study done by Northeastern University, they have compared two vaccination allocation strategies: the cooperative one, where vaccines are distributed according to countries' population, and the uncooperative one, where most of the vaccines are hoarded by high-income countries. Researchers find that the cooperative one would avert more than 30 percent of COVID-19 deaths than the cooperative one. That's a lot of lives saved.

Efforts are being made, but it's simply not enough. The most global one is COVAX launched by the WHO to ensure the equality of vaccine allocation. It aims to provide 2 billion vaccines to the world, half of which will be used in low-income countries. According to Capital Economics, sub-Sahara countries will all be dependent on COVAX to get their vaccines.

To achieve this, high-income countries will have to pre-order vaccines through COVAX for the organization to buy them from the pharmaceutical factory. But so far, there is still a $5 billion gap to reach the target. The richest country, America, even refused to join the program. EU is also skeptical about the supply capacity of COVAX and will order their vaccine independently.

In October, China announced that it will also join the program, giving confidence to the vaccine alliance. Ayelet Berman, Senior Research Fellow at the National University of Singapore, said that the move was not only a symbolic demonstration of global solidarity but also means more investment and logistics convenience given China's strength.

But it always takes more than one to tangle. In this case, it takes the whole world. It's not a hard decision to include poor countries in an affordable and equal vaccine allocation program; it also should not be a hard choice to make more efforts in achieving the target.