Vaccine nationalism – at this point in the COVID‐19 pandemic: Unjustifiable

Not only among bioethicists has there been a debate about the ethical justifiability of what has been termed ‘vaccine nationalism’. There are varieties of vaccine nationalism, but fundamentally vaccine nationalism is about the controversial view that countries of the global north are ethically justified in prioritising their citizens over citizens of countries of the global south when it comes to the supply and rollout of COVID-19 vaccines. In bioethics, among proponents of different ethical approaches, it would not have been surprising to see distribution priorities defended that focus on clinical need and some outcome metric such as lives preserved or life years preserved. The justification for such an impartialist approach is based on the view that human lives and the life years we are able to live are universally valuable and so maximising the number of human lives or human life years (my preferred metric) preserved ought to be the aim of any just policy concerning the distribution of COVID-19 vaccines. Based on what we now know about the virus, this would have required to preserve the lives of people at greatest risk, the elderly, healthcare professionals involved in patient care, and so on. Importantly then, people in these categories should have been prioritised globally. What has instead happened? Countries of the global north have used their wealth to purchase vaccines many times their population over. Canada, for instance, purchased about 10 vaccine doses per resident. To be fair to the country, much like other countries now charged with being vaccine nationalists, the people in charge of purchasing vaccines made something akin to an advance purchase commitment. They could not have known at the time whether any of the vaccines they were purchasing would eventually work. Today Canada sits on many more vaccine doses than it can possibly administer. Reportedly it has begun destroying expired doses, because there aren't enough takers any longer for the surplus quantities of vaccines that are available. The same is true for the USA and other countries of the global north. Equally problematic, one of Canada's provinces, Quebec, is reportedly offering third vaccine doses to its residents, but not based on any urgent clinical need. Rather, given that Canada's vaccination rollout depended on mixing vaccines depending on availability, man of the country's citizens are now not considered fully vaccinated by other countries, even though they have been fully vaccinated, for all intent and purposes. The mixing of vaccines, even though medically sound, has become a travel hindrance for fully vaccinated people because some jurisdictions do not recognise a vaccination record displaying two different types of vaccines. In other words, vaccine doses that could be utilised to serve urgent needs in the global south are used in the global north so that travel requirements can be met. Meanwhile, in the global south even those most at risk of death and debilitating illness are unable to access vaccines. Haiti only received its first shipment of vaccine doses in July 2021, 500,000 doses flown in from the USA, for a population of 11 million. By comparison, also in July 2021 about 70% of the Canadian population had received at least one dose, and 50% of the country's residents were fully vaccinated. Arguably there were some initial justifications for vaccine nationalism in the global north. Countries of the global north were initially hardest hit by the virus, Italy and the USA are good examples of this. A fair distribution mechanism would have recognised that and prioritised a rollout in those countries, targeting those most vulnerable for death and debilitating illness. There is another – pragmatic – argument to be had in this context: It is unlikely that the citizens of these democratic countries would have taken kindly to any government that would have shared their purchased vaccines with poorer countries, regardless of what ethicists might make of that. In democracies where governments want to be re-elected, such sharing would have guaranteed any government's defeat at the ballot box. The continuing stockpiling of vaccines in the global north has since become impossible to justify, however. The most vulnerable people in those countries have been vaccinated, as well as many of these countries' citizens who were not at great risk of death or debilitating disease to begin with. In other words, the lives of people in the global south, and the life years they would be able to live have been greatly discounted compared to the lives and life years of those in the global north. The reported death toll in countries like, for instance, India and Indonesia has been staggering. There is another harmful consequence of vaccine nationalism. Because the virus is able to spread in the global south quite efficiently, the likelihood of vaccine resistant mutations is increasing. There is a fair chance that the nationalistic vaccination efforts in the global north, selfish as they arguably were, will end up being less efficient than they were thought to be. The pandemic might eventually teach us that we are all in this together, if not quite how national public health promotion materials in the global north envisaged it.

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