Ethicists prioritize poorer nations for COVID-19 vaccine


picture of COVID-19 vaccine vials atop a world map
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By one estimate, low- and middle-income nations won’t be fully vaccinated against COVID-19 until 2023 or 2024.

Humanity’s future, in which COVID-19-like viruses are more frequent reminders of our shared vulnerability to disease, should be met with an African ethic of solidarity instead of the self-interested nationalism displayed over the past year, two ethicists write in a paper published today.

The analysis appears in the Hastings Center Report, a bioethics-focused journal. Solidarity, as described by the authors, “prescribes acting for the good of others and the community – not just out of simple altruism, but because one’s own good is intrinsically bound to that of others.”

picture of bioethicist Nancy Jecker

“An ethic of solidarity has been glaringly absent” from vaccine-distribution efforts to date, says bioethicist Nancy Jecker.

The authors apply the tenet to their guidance for future global distribution of COVID-19 vaccines, identifying three priority populations (in order):

  • low- and middle-income nations
  • people at high risk of infection
  • people at high risk of severe disease and death

“First, we prioritize poorer nations that have less ability to access vaccines. Next, people at high risk of infection are prioritized by criteria such as population density, public sanitation, access to soap and water, crowded living and working conditions, and inability to work from home,” Jecker said. Last, priority goes to “people at high risk of severe disease and death, such as those with certain comorbidities, older adults, or those lacking access to critical healthcare resources. These populations are all major pathways for viral spread.”

The paper does not set out a fully developed framework for distributing vaccines globally. Rather, it underscores that “an ethic of solidarity has been glaringly absent and should factor into global distribution,” Jecker said.

The approach is not only ethically justified, she said, but strategically sound in its targeting of populations who must rely on global partnerships to obtain vaccines. “This is not charity but solidarity, because there is not an ‘us’ and a ‘them,’ only a ‘we’ when it comes to safety from the SARS-CoV-2 virus,” she said.

If wealthy nations had mustered support for vaccine-distribution partnerships such as COVAX and QUAD at COVID-19’s outset, rather than adopting me-first stances, “I think we would be moving more quickly and not expecting to wait until 2023 or 2024 to vaccinate low- and middle-income nations,” Jecker added, referencing Duke University’s tracker.

picture of bioethicist Caesar Atuire

“COVID-19 has exposed deep weaknesses in our social fabric,” said bioethicist Caesar Atuire. Photo by Amicus Onlus Ghana

To buttress their rationale for solidarity, the authors also invoke the concept of “syndemic,” a term coined in the mid-1990s. Syndemic, rather than pandemic, is a more appropriate term to describe the crisis facing the world because it considers socioeconomic disparities that allow diseases to flourish.

“Pandemic, as we think of the word, tends to focus us on medical solutions. But COVID-19 has exposed deep weaknesses in our social fabric,” said Caesar Atuire, the paper’s co-author. “Attacking the virus medically – get your jab, build your immune system, and return to life as usual – does not change the conditions to address future outbreaks, which may have equally disastrous consequences.”

For example, while high-income nations have temporarily despaired about shortages of ventilators, masks and vaccines, many low-income nations persistently lack adequate nutrition, soap and water, among other basic health needs.

“You can’t untangle these components from measures of medical health,” said Atuire, a health ethicist and senior lecturer in philosophy at the University of Ghana. “The infection rate does not account for all of the damage of COVID-19. People are losing their livelihoods. Some of these effects will be with us 30 years from now,” he said.

Despite the global nature of this crisis, nations have focused on citizens’ well-being within their own borders – a narrow and ultimately futile posture, the authors said, because viruses do not stop at borders.

“We’re in an interconnected reality in the 21st century, not just in terms of emerging infectious diseases but issues like climate change, gene editing, supply chains, technologies and cybersecurity,” Jecker said. “Respect for individual autonomy does not serve well in a globally interconnected world. African solidarity can meet the moment.”

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