Ethics should guide COVID-19 vaccine distribution

That the United States, the United Kingdom and the European Union have formally approved the Pfizer-BioNTech and Moderna vaccines of COVID-19, which are 95 percent and 94.1 percent effective respectively, and the UK has given the green light to the Oxford/AstraZeneca vaccines for emergency use has paved the way for mass vaccination in many Western countries.

Indeed, this is good news, but it has raised ethical questions on the fair allocation and distribution of the vaccines across the world and within countries.

Given the limited supply of the vaccines in the initial phase and its critical role in containing the novel coronavirus pandemic, which is still raging in many parts of the world and has infected 83.91 million people and claimed 1.83 million lives globally, how to distribute vaccines fairly and equitably has become an important ethical issue.

Therefore the distribution of vaccines should be guided by ethical principles.

Vaccines should be distributed equitably

Due to the limited supply of the vaccines and huge demand, countries are scrambling to procure them.

If the international community does not set ethical rules for vaccination, wealthy and developed countries could end up hoarding astronomical doses of the vaccines while most of the low－and middle-income countries will struggle to inoculate their citizens.

To contain the pandemic and mitigate its destructive effects on the international community and the global economy, some ethical principles must be followed. To begin with, the vaccines must be considered global public goods needed to save lives and protect the well-being of people across the world, and bring global society and the world economy back to normal.

The allocation of the vaccines should also be based on the ethics of utilitarian and equitable approach.

Of course, countries that enjoy advantages in vaccinating the population, thanks to their strong medical system, should get the vaccines too. But more importantly, the vaccines should be equitably allocated to low-income countries, so that global disparities can be reduced.

Also, multinational pharmaceutical companies making the vaccines should more vigorously fulfill their corporate social responsibilities in allocating vaccines globally. That such companies should seek profits is understandable.

But if they only pursue profit and supply vaccines based purely on economic considerations, they would be acting unethically and unfairly, because very high prices would put the vaccines beyond the reach of many developing countries.

As a result, most of the people in those countries would be left to fend for themselves with little or no resources. And people in no country, no matter how developed it is, can be safe until people in all countries are safe.

Therefore, it is the moral obligation of "Big Pharma" to make the vaccines available at affordable prices to all countries, particularly the low-and middle-income countries.

Also, major countries should never use multinational pharmaceutical enterprises, through global vaccine distribution, as an instrument to spread their geopolitical influence.

Besides, the international community should collaborate through COVAX, the vaccine pillar of the Access to COVID-19 Tools Accelerator, to boost global collaboration and accelerate the development, production and equitable access to COVID-19 tests, treatments and vaccines. COVAX is co-led by the World Health Organization and Gavi, the Vaccine Alliance.

More important, no country should resort to vaccine nationalism by restricting vaccine exports, because such acts are detrimental to the global fight against the virus, not to mention morally reprehensible. And fair and equitable vaccine allocation will help even low-and middle-income countries to obtain enough doses of the vaccines to inoculate their citizens.

Fair vaccination within countries

Distributing the vaccines ethically within countries is as important as ensuring their fair and equitable distribution globally. For policymakers and health officials who are grappling with ethical issues in the allocation of the limited volume of vaccines available in the initial phase, they should be guided by ethical principles. The vaccines must be distributed in a way that maximizes public health and the socioeconomic well-being of all and minimizes mortality. In other words, they should be distributed in a way that mitigates health inequities and reduces health disparities.

Finally, the principle of promoting justice and transparency－as recommended by the Advisory Committee on Immunization Practices affiliated to the US Centers for Disease Control and Prevention－is also crucial for fair vaccination. So the vaccines should be distributed transparently and with respect for people, promoting mutual responsibility and solidarity.

Without doubt, in the initial phase, priority groups should be vaccinated first. Since health workers are at a high risk of being infected, and then transmitting the novel coronavirus to other people, they should be the first to be vaccinated. This is important not only to better protect the lives and health of medical workers but also to ensure there is no dearth of such professionals to care for COVID-19 and other patients.

Also, people with certain medical conditions or co-morbidities, regardless of their age, and senior citizens are at increased risk of falling victim to COVID-19. Vaccination is important to protect this group.

The priority groups include other professionals such as teachers, police and customs officers, airport staff and food service workers, who maintain the functioning of society and, due to the nature of their work, are at a higher risk of contracting the virus. Early vaccine access is therefore critical not only to protect them but also to maintain the essential services they provide.

Use vaccines to restore normalcy

With the limited supply of vaccines in the initial phase, ethical principles must guide the distribution of the vaccines both globally and within countries.

The development of effective vaccines has brought hope to the international community after a horrendous year of fear, pain and despair. Yet the distribution of the vaccines will be a test of morality and human wisdom, which can be gained from global collaboration coordinated by the World Health Organization. Only through ethical and fair allocation of the vaccines can the pandemic be effectively contained and the international community and global economy return to normal.

The author is a professor at and director of the Center for Global Governance and Law, Xiamen University of Technology.

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