Current Issue

On one highly intuitive picture of what we ought to do, the harmful upshots of inequitable distribution of vaccines are impossible to justify when well-resourced states have excess stockpiles of vaccines. The fact that vaccine interventions prevent life-threatening situations seems to make it intuitively obvious that excess vaccines ought to be shared, so far as the costs are reasonably low. In fact, the potential costs of equitable vaccine distributions are likely to be very low. As noted in the discussion, an IMF estimate shows that a mere $50 billion in funds are needed to distribute vaccines such that around 40% of the global population is equitably vaccinated by the end of 2021, and nearly 60% equitably vaccinated by the middle of 2022. [8] These costs are negligible relative to the scale of the economies of well-resourced states.

On this consequentialist view, the absence of such measures to distribute vaccines globally cries out for justification on part of well-resourced states, especially when COVAX projects that only 1.5 billion doses, or barely enough to vaccinate just 20% of the developing world, will be delivered to low-and middle-income countries by the end of 2021. [7] On this view – call it the beneficence view of responsibility – the moral responsibility that well-resourced states have to equitably distribute vaccines directly results from a comparison between total global welfare losses (of which well-resourced states will experience very little in sharing excess vaccine stockpiles) and gains (the large gains to those who live in poorly resourced states).

This beneficence view can be fleshed out in several ways but let us consider a representative example: a straightforwardly maximizing view. On this utilitarian position, we ought to do what maximizes total welfare; that is, we must prioritize the greatest increase in welfare in our use of limited resources. In the case of a global pandemic response, it seems intuitively obvious that those in poorly resourced states are collectively the easiest to help, given that they suffer the greatest welfare deficits and that these deficits can be reduced or eliminated easily through a return to normal socioeconomic conditions. As such, those who are best placed to assist, namely well-resourced states, have an obligation to help those in poorly resourced states. In other words, we may say that well-resourced states are obligated on this view because the marginal utility of a vaccine dose ‘spent’ on vaccinating those in poorly resourced states is extremely high, relative to the alternative of stockpiling.

However, there are strong countervailing considerations that are proffered by opponents of such straightforwardly consequentialist views. Many prominent ethicists and political theorists argue that ethics must make room for reasonable partiality towards those who stand in special relation to us – say, our co-citizens – in the distribution of important and often life-saving resources. ⁸ [34, 35, 36] This is why, the objection might go, it is justified for well-resourced states to favor their own citizens in distributing welfare-related resources more generally, even in the face of desperate circumstances of the global poor. If this view is correct, it may seem to support the conclusion that well-resourced states are justified in stockpiling vaccines to prioritize their own citizens.

The intuition that grounds this objection is that any plausible normative position cannot systematically demand that we ought to abandon a level of partiality that we ascribe to projects, communities, and persons we stand in special relation to, in favor of better consequences overall. This is because, intuitively, partiality is central to the very structure of our valuing. We are creatures that value things not merely for the value that those things have but for the particular relation in which they stand to us; while we can recognize an indefinite array of things in the world to be of value, we can ourselves only value a limited number of things. For instance, many people recognize that other people’s parents are of equal value and moral status as their own parents and yet are unable to value others’ parents in the same way that they do their own. The intuition is that this limit to the array of things we can value is a not a ‘bug’ but a feature in our valuing. Valuing one’s parents is possible on this view, because of the special relationship that one enjoys with one’s own parents – namely, that one is their child – which one does not enjoy with others.

Further, it seems plausible that this particularistic valuing of things is probably how we learn to see general importance of things such as happiness. Since this partiality-based valuation is what allows us to see and accept value in the first place, it may be argued, a consequentialist grounding of responsibility is simply incoherent as it contravenes the most central aspect of human valuing. For this reason, even when we recognize that there may be serious ethical problems raised by the prevalence of human suffering, we have a moral ‘prerogative,’ in Scheffler’s terms, to not be mere instruments to the betterment of overall consequences: we must have moral room, as it were, to put our special relations ahead of the overall good. [37]

In similar fashion, well-resourced states’ obligations towards those who are in need but who do not stand in special relation to them, namely of being citizens, may be limited pace consequentialist intuitions. Call this objection the reasonable partiality objection since it appeals to strong intuitions about our right to be reasonably partial towards our compatriots. On the picture of obligations painted by the reasonable partiality view, moral obligations to equitably distribute vaccines cannot be grounded merely in the relative value or disvalue to various individuals being vaccinated in the way the consequentialist argument concludes. If we are to meet this strong objection, therefore, we must explain the relationships that ground the ways in which well-resourced states may incur obligations to equitably distribute vaccines.

We argue that there are at least three grounds on which well-resourced states can be held morally responsible for the equitable distribution of vaccines by appeal to the relationships that ground such an obligation. First, on a plausible view of obligations towards others within a scheme of global cooperation, we argue that well-resourced states uphold global institutions that give rise to problems of equitable distribution vaccines and so have a duty of justice to promote feasible schemes that promote and enhance human rights through equitable distribution. Second, a widely accepted international legal framework of Common but Differentiated Responsibility (henceforth CBDR) seems to apply to the problem of pandemic vaccine distributions. CBDR is a set of responsibility principles that encode ideas of national responsibilities for climate change, but we argue, that the pandemics share much of the same structural features as climate change – and so are plausibly covered by CBDR. Finally, on a narrow national-interest view of responsibility, well-resourced states have a responsibility towards their own citizens to equitably distribute vaccines to decrease risks associated with pandemics. With these arguments, we hope to show that the normative stakes of defection in both stages of the vaccine procurement game viz. inequitable global distribution of vaccines are extremely high, on some of the most plausible normative theories about national and international responsibilities.

One prominent way to relationally ground obligations on the part of well-resourced states to contribute to equitable global vaccination is through a cosmopolitan position of responsibility. On Thomas Pogge’s institutionalist theory of duties, to take one example, certain moral duties of human rights arise as a result of our participation and perpetuation of institutional practices. For instance, by participating in institutions of national politics citizens not only incur a “duty not to cooperate in the imposition of unjust practices,” but also “obligations to promote feasible schemes that would enhance the fulfillment of human rights.” [38] The basic intuition is this: those who participate in institutions that perpetuate unjust practices, by participating, uphold and sustain violations others’ rights and so also have that associative duty to promote the protection of rights. For instance, it seems that we ought to feel a sense of dismay if we were franchised citizens of a political community that permits and enforces slavery. Why would this be so if we do not ourselves enslave others? Pogge’s answer is that it is because we, as franchised participants of the institutions, sustain slavery via institutions, by upholding the rules which explain the very existence of slavery. We collectively violate rights in the slavery case.

Pogge’s normative position on institutionally generated duties can be applied to the international context. It is plausible that we have a set of common practices that bind nation-states together into one global institutional scheme in economic cooperation (such as the WTO) and public health (such as the WHO or Gavi, the Vaccine Alliance). As well-resourced states generate, reform, and participate in these institutions and draw significant advantages from them as privileged participants who are effectively enfranchised with the power to influence changes in the institutional structure, they are responsible for the deleterious consequences of inequitable distribution of vaccines. These well-resourced states’ perpetuation and sustaining of certain rights-violating consequences, such as the destruction of minimally decent standards of living is a grave wrong because well-resourced states fail to promote feasible schemes that would enhance the fulfillment of human rights in much the same way as in the slavery case. This is so because, if our analysis is correct, then ending the pandemic earlier to prevent serious harms is an institutionally feasible outcome.

This view is immune to the partiality objection. For those find the empirical premise that global institutions are implicated in the consequences of vaccine inequities plausible, the institutional relationship, unlike in the consequentialist case, is what grounds well-resourced states’ obligations on the cosmopolitan view. Thus, obligations on well-resourced states derived from their participation in international schemes of cooperation is a promising way of justifying strong moral obligations for equitable pandemic vaccine distribution.

CBDR in international law is a responsibility principle which encodes substantive insights on what efforts are needed to achieve equitable burden-sharing for the preservation of the environment. Under that norm, while it is recognized that all share a responsibility for the preservation of common resources, more well-endowed agents have greater duties to address environmental problems in reflection of their higher contribution to these problems, as well as the likely higher burden of bad consequences for poorer countries. [39]

‘Common’ in CBDR refers to the plausible idea that certain resources are “affected and are affected by every nation on earth,” because they are scarce and degradable, and in need of preservation. [39] The intuition is that irreducibly common but scarce resources tie states together in a special relationship which inescapably generates a normatively important scheme of cooperation, even when states fail to recognize that normative importance.

‘Differentiated’ in CBDR has two dimensions: differentiation based on capacity and differentiation based on culpability. Let us take each in turn. Differentiating responsibility according to capacity is, as noted above in our discussion of duties of beneficence, a normatively intuitive one. While it would be ideal for each state to independently address common issues without external help, many states lack the capacities to detect, prevent and control the consequences of degradation of the common resource. Given this fact, it seems intuitively clear that those who have the capacity to, ought to contribute more, ceteris paribus, since the remaining slack must be taken up in order to sustain the common resource. Here, the invocation of capacity in the case of CBDR does not suffer from the problem of ignoring reasonable partiality, for the allocation of responsibility according to capacity in the normative principle of CBDR is grounded in the special common interest that various communities in a particular common resource. Thus, the capacity-based foundation of CBDR need not imply an unlimited duty to help all those who are in need. As opposed to the consequentialist view, CBDR constrains the application of capacity-relative responsibility to a specific problem irreducibly common to many agents. But even with this constraint, there seems to be a minimum cost on capable political communities below which (say, 0.7% of national GDP), if they do not contribute, they are open to moral criticism.

Differentiation based on culpability needs to be understood broadly. While international law has traditionally focused on a conception of responsibility that is based on direct causal responsibility for actions, CBDR relates to a set of diffuse causal relationships, and which are therefore broader in scope. For instance, in the case of accounting for the causes of deforestation in a particular region, it is often difficult or impossible to tell apart agents who are directly causally implicated in the destruction of the common resource of forestry. Imagine a scenario in which such deforestation happened due to a combination of (a) an increase in average surface temperature owing to global warming in which billions of actors are inculcated, (b) increased chemical usage in a neighboring factory, and (c) an incidental increase in the number of droughts due to natural causes. In this case, it is impossible to pin the blame on any particular actor. Such is the issue in most evaluations of culpability in CBDR issues. As such, it is often fruitful within CBDR to allocate responsibility by the greatest probable contributions.

Taken together, CBDR is a doctrine that ascribes differential responsibility for the causation as well as capacity to solve various problems that are common to all countries and people. For instance, developed countries have relied on fossil fuels and contributed to the use, extraction and development of the environment for a longer period of time and to a greater extent. Further, they are most capable of developing and implementing technologies that can mitigate the effects of climate change. This intuitively imposes greater responsibilities on developed countries for the amelioration of the effects of climate change.

It seems plausible that this framework of responsibility not only applies to the common resource of a non-degraded environment but also to the common resource of an environment free of lethal and infectious diseases. Two central commonalities are striking. First, both degradation of the environment and the spread of infectious diseases are irreducibly common yet degradable resources. In the case of the spread of epidemic diseases, there is well-recorded evidence that the very same forces that harm the environment are wreaking havoc by creating conditions amenable to outbreaks. For instance, even in developed countries, warming climates are associated with higher incidence of epidemics. [40] This is largely because intrusion and destruction of wildlife habitats change wild animals’ extinction and migration patterns, which conduce to species jumps in pathogens.

Second, both the problem of global environmental protection and global pandemic readiness are public goods that exhibit characteristics of both a “weakest link” public good and a “aggregate efforts” public good. Pandemic readiness, like environmental protection is an aggregate efforts public good in the sense that it requires efforts from everywhere to see results. Without adequate responses to epidemics everywhere, a disease-free environment and its benefits fail to materialize. Further, it is also a “weakest link” global public good in the sense that a pandemic does not end without the ‘weakest link’ having the capability to end the pandemic within its borders.

Given that pandemic preparedness is a public good, how might differentiation based on capacity and culpability establish a normative responsibility on well-resourced states to equitably distribute vaccines? First, most such developments concerning the increased risk of pandemics have historically been caused by inhabitants or governments in the richest nations, either through direct investments in trends that have increased the risks of pandemic such as investment in infrastructural or food systems projects that significantly reduce wildlife diversity or increase likelihood of ecosystem destruction. In other indirect instances, wealthier economies have contributed much more to large-scale emission of greenhouse gases, deregulation despite high probability of large-scale environmental destruction.

Although it is unclear that the current coronavirus epidemic is a direct result of a species jump related to climate change on a global scale, there is much reason to believe that we ought to ascribe responsibility in a probabilistic manner given the diffuse nature of causes of pandemics. This means that at least a large part of the human, health, and economic costs borne of viral pandemics can be attributed to those who produce and contribute to an environment more conducive to infectious diseases, namely well-resourced states.

Further to these historical contributions to disease patterns, we can explain the historical contributions that well-resourced states have made to the likelihood of the bad consequences of pandemics through international institutions. Structural adjustments – or loan conditionalities - that were imposed on many poorly resourced states by international institutions such as the IMF and World Bank with the aim of improving macroeconomic indicators were led at the behest of various well-resourced states. These structural adjustments, including austerity measures, meant that public health and development budgets in many parts of the world have been stripped down over the past few decades.

Moreover, aggressive lobbying on the part of well-resourced governments to protect various pharmaceutical intellectual property rights through the WTO has meant both that health expenditure per capita on patented drugs left fewer resources available for epidemic readiness. It has also meant that pathways to local development and manufacturing capacities for vaccines and other therapeutics for pandemic diseases have been cut short. In short, the poorly resourced states have had difficulties maintaining health systems to adequate capacity in large part due to deliberate policy choices of well-resourced countries.

As it relates to differentiating responsibility based on capacity, poorly resourced states fail to have much capacity in delivering vaccines because of the structural dynamics outlined in part II. In relation to the COVID-19 pandemic, low- to middle-income countries urgently require vaccines and this relates to the well-being and survival of its citizens. Further, many developed countries that succeeded in procuring sufficient doses of vaccines overshot the demand for vaccines by entering bilateral deals and bidding up the price of each dose of vaccine, thereby pricing out others from the vaccine markets. This situation is grounds for thinking that well-resourced countries are both culpable for the relative lack of access to vaccines as well as capable of addressing the problem. They are culpable in the sense of effectively excluding more poorly resourced countries from vaccine markets and they are capable in the sense that they have excess vaccine stockpiles that they can donate. Further, because they are able to order further doses of vaccines on the markets and further increase manufacturing supply for booster doses, etc. well-resourced states are well-placed to take on the burdens of providing for the global common good without too much additional cost.

Finally, redistributing excess vaccine stockpiles are required by obligations that well-resourced governments owe to their own citizens. States that fail to procure sufficient doses of vaccines for domestic populations are those that did not have the capacity to develop vaccines or were unable to muster the financial resources to compete with well-resourced states on the international vaccines markets. Indeed, well-resourced states were advantaged in the sense that they had much higher informational capacities as well as access to state-of-the-art research and manufacturing facilities that many other states did not have. Added to this mix was the large financial resources that well-resourced countries pulled together, with the net result being an excess stockpile in rich countries such as the United Kingdom, which secured a total of around 11 doses per adult, and Canada, which secured around 13 doses per adult. [10] In the case of America, moreover, the expiry date of many vaccines has led to mass discarding of various types of vaccines. [41]

But this stockpiling has consequences for the inhabitants not only of poorly resourced states but for citizens of well-resourced states as well. Here’s how. Inadequate vaccine procurement in poorly resourced states is likely to cause serious harm in such countries. These poorly-resourced states represent ‘weak links’ in a global pandemic response, undermining both local and global efforts.

It is once again instructive for us to pay attention to the pandemic that we are experiencing currently. In an increasingly globalized world, supply chains are often spread throughout the world, with many corporations relying on the labor of those in poorly resourced states. During pandemics, these corporations are often subject to serious losses due to quarantine measures. Further, these generate bottlenecks within supply chains, leading to increased costs for many essential goods and services which trickle down to higher prices for consumers. This state of affairs represents a significant drag on the economy, and a continuation of detrimental economic effects on citizens. We see, for instance, dramatic increases in the price of commodities and essential technological equipment around the world.

Crucially, however, without adequate provisions of vaccines and medical supplies to poorly resourced states, the risk of pernicious variants arising becomes a greater probability event. Especially in global pandemics such as the one that we experience, the transmissibility of a virus is already extremely high and this means that the probability of mutations that lead to greater lethality or transmissibility becomes greater as infections increase. [42] This creates further problems related to a decrease in the efficacy of vaccines or even total failure of vaccines in preventing the spread of disease. We already see this problem of greater lethality and transmissibility in this pandemic with the rise of the delta variant from India. While the delta variant itself may not be a cause for concern for well-resourced states, it would be irresponsible for such states to ‘wait and see,’ as the state has very strong obligations to protect its citizens’ interests, and the risks of further mutations in the absence of vaccinations are high. Hence, so far as the costs of equitable distribution of vaccines are reasonably low, governments can have an obligation towards their own citizens to distribute in this way.

In sum, there are several highly intuitive grounds on which we can argue that stockpiling vaccines is a violation of moral obligations on the part of well-resourced states. We argued that there are at least four grounds on which to argue that well-resourced states are normatively responsible in equitably distributing vaccines – the latter three of which are consistent with an acceptance of reasonable partiality. First, we argued that compelling consequentialist intuitions ground the moral obligation to equitably distribute vaccines. Given the enormity of the human and economic costs associated with unequal vaccine distributions and the urgency of such costs, there are straightforward and powerful considerations that ground states’ responsibility to redistribute. Second, a cosmopolitan view, like Pogge’s, gives compelling reason to think that well-resourced states have an obligation to make reasonable efforts towards preventing the dire consequences of inequitable distributions of pandemic vaccines within a global scheme of cooperation. Third, the already widely accepted international legal norm of CBDR gives grounds for thinking that there ought to be a collective allocation of responsibility, with greater responsibility given to well-resourced states that have contributed most to conditions conducive to pandemics. Finally, considerations of the adverse impact of inequitable vaccination on the citizens of well-resourced states themselves grounds an obligation on well-resourced states to take all reasonable measures to ensure the end of pandemics.

The ‘overlapping consensus’ of such a wide variety of views on the conclusion that there is a strong moral obligation on well-resourced states to equitably distribute vaccines seems to make it more plausible that we ought to do prevent such inequitable outcomes – and increase the moral risks implied by our failure to do so.