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We had a situation where there was this vast inequity in the distribution of

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vaccines globally of the six billion or so that had been given in summer 2021.

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Four billion of those doses had been given in just 10 countries.

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And in a global pandemic, that's simply not acceptable. There is wide agreement that the unequal distribution of vaccines globally is a problem.

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But what has led to this problem and what can we do about it? In this interview, I talk to Dr. Jonathan Pugh about vaccine nationalism.

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Dr. Pugh is Parfit Radcliffe Richards senior research fellow at the Oxford 

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Uehiro Centre for Practical Ethics at the University of Oxford. Hello, I'm Katrien Devolder.

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This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.

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If you'd like to see more of my videos, don't forget to subscribe to the practical ethics channel.

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You can also just listen to the interviews on Apple Podcasts.

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Also so the UK and other high income countries have been criticised for hoarding vaccines.

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They've been accused of vaccine nationalism. But what is that?

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What is vaccine nationalism? So vaccine nationalism in the broadest strokes is the idea that governments can be justified

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in prioritising their own citizens when it comes to the rollout and distribution of vaccines.

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And now she's secretary, and that's been a widely discussed position in the pandemic.

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It's been quite controversial and I think to get a handle on the moral of the business area,

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it's useful to take a step back and think about the ways in which that sort of position might have a kind of philosophical justification.

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So one reason that people might think that vaccine nationalism is a wrong headed

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idea is that you might think that morality should really be an impartial farce.

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You might think that morality is all about following universal rules and that we all

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have obligations that apply equally to each and every member of the moral community.

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Now that's a very popular view of morality, but it's not the only one. So some people might think that morality also includes special kinds of moral

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reasons that apply specifically to people with whom we share a close relationship.

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So the classic example of this is the relationship between a parent and their child.

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We might think that a parent was missing out on a really important moral dimension if they treated that child completely impartially.

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They didn't prioritise their child's interest, perhaps over the interest of a stranger's child.

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So one way of thinking about how vaccine nationalism might have some sort of

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moral justification is to think about the question of whether nationality or

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perhaps the relationship between a government and its citizens could be the sort of relationship that could ground this special kind of moral reason,

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this reason of partiality. Right. And so why would it be justified for countries to prioritise their own citizens?

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So this is the really important question and really the crux of the matter,

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because obviously not all kinds of relationship can ground these special kind of moral

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reasons so that we think that a mother can perhaps justifiably prioritise that their child.

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We certainly don't think it would be right to prioritise the interests of our own sex, for instance, that would amount to discrimination.

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So there are a number of different approaches to try and tease out this question of what kinds of relationship can ground these special reasons.

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So one approach of conditionality is to appeal to French considerations.

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So you might think that if national partiality is justified,

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we as a global society might be able to achieve other kinds of important intrinsic goods, such as justice and equality.

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Other people take a slightly different approach. One appeals to the nature of what it is to be a citizen in a nation state.

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So when you're a citizen in a nation state, you have to sacrifice some of your liberties and you are liable to the state exercising coercive power.

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But that's just part of being a citizen in a nation state and both. And so you might think in order for that, to be a fair bargain if you like,

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it's only fair that citizens can expect that governments to prioritise their own interests over the interests of other countries.

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So that's a an institutional approach to justify national partiality.

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The final one really takes its lead from the example of the mother child example I spoke about earlier.

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So it tries to claim that nationality is just the same sort of valuable relationship and that

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we can see with other close and important relationships such as between parents and children,

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but also between friends and other relatives.

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Now, of course, that seems quite an odd idea because, you know, we don't know all of the other citizens in our own countries,

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and it seems quite odd to say that we share anything like the same sort of close relationship we have with friends and family.

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But there are other considerations that might come into that.

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So we might think the fact that we as a nation have produced certain goods over time as a shared sort of enterprise.

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So one example of this which.

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I think Thomas Hiker's used is the NHS in in the UK, so as well as having this shared community by virtue of being part of the same nation,

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we all came together to produce this this good, which ensured people could access health care.

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So you might try and outline three nationalities and building this really bad evil relationship,

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not necessarily due to the closeness of the ties between each and every member, but due to the manner of the goods that it can produce.

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So it seems like there is something to say for giving priority to one's own citizens.

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So what exactly then is is the problem with vaccine nationalism?

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Is there really a problem? Yes. So the first thing to say is that these reasons of partiality only raise moral

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issues when they come into conflict with what impartial ethics might tell us today.

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Now, in the pandemic, it appears that that has been the case to some degree, at least, particularly in the summer of 2021,

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when countries developed countries were beginning to initiate so-called booster programmes for vaccination before

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many less developed countries had begun to roll out in first doses of vaccinations to the most vulnerable citizens.

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So one statistic that was being talked about around that time was so August 2021 or so around six billion vaccine doses have been delivered.

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Around four billion of them have been delivered to just 10 countries. So really staggering inequity in distribution.

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Now, there are certainly some debate about the extent to which vaccine supply was solely responsible for that.

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But it's certainly true that the director of the World Health Organisation felt it appropriate to call for a

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moratorium for booster programmes in August 2021 in order to prioritise first doses less developed nations.

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There seemed to be an area in which reasons of national partiality for prioritising vaccines for countries

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own citizens came into conflict with what impartial ethics Michael distributing vaccines more widely.

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However, there are some ways in which it might be the case that these two moral reasons might not have been in such stark conflict.

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So one way in which reason of partiality might not conflict with impartial ethics in a

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resource allocation decision is when there's enough of the resource to go around anyway.

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So certainly a number of people responded to the Who's call for moratorium by suggesting it was calling for a false choice.

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I perhaps there were enough vaccines to go around.

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Another way in which these conflicts might not be so stock is when reasons of partiality call for us to do the same thing as through ethics.

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So another issue that was discussed at the time of initiating booster programmes was it might have actually been in developed

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countries best interest to donate more vaccines to less developed nations in order to reduce the number of global cases.

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And the reason that might have been in the interests of more developed nations

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is that that might hopefully reduce the chance of a dangerous virus mutation

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occurring at the sort of mutation that might in fact undermine the effectiveness

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of the vaccines so that we might have had a strategy where what was in fact,

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in developed nations, erm, best interests was helping other people.

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So greens of partiality and impartial effects would have coincided again,

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a lot of empirical issues about whether that would have been the case or whether it would have been more beneficial to initiate booster programmes.

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Since that time, of course, we've seen the development of the Omicron variant, which, you know, change the change.

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The scales a little bit in that regard.

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But ultimately, it seems to some extent at least the lack of vaccine supply has played some role in the vast inequities in vaccine distribution.

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And insofar as that's the case,

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we really have to deal with this question of vaccine nationalism and the extent to which it can be justified, if at all.

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And so is there an alternative to vaccine nationalism?

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What are what are the other options? Yeah.

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So the polar opposite view is this idea of vaccine cosmopolitanism, and this view appeals to these impassioned ideas about ethics,

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largely so it claims that community membership just doesn't have the kind of ethical relevance that vaccine nationalists claim.

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Instead, vaccine distribution should really be determined by a more powerful moral obligations.

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So that's the general idea. It's useful, I think, to distinguish a couple of different types,

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and this is drawing on some work by Lowry and shook like these people, I very much recommend.

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But one way of approaching this general idea of cosmopolitanism in this context is to appeal to,

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again, these general, impartial moral ideals such as human rights, for example.

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So you might claim that all humans have rights to basic levels of health care, and they all share an equal entitlement to secure their.

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Resources, they need to exercise those rights. So again, that might speak in favour of distributing the vaccines to where there is the greatest need,

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where they're going to bring about the most benefit.

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Similar vein He could appeal to something like Peter Singer's principle of equal consideration of interests.

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So the idea that we should give equal weight to the like interests of all those who are affected by our actions.

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So again, there may be some circumstances, at least,

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where a vaccine dose would have a far greater benefit as someone's first dose than it would as a third booster dose for someone else.

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And again, I think his principle is going to tell us we should give it to the person who will benefit most regardless of where they live.

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So this is a very humanitarian approach to cosmopolitanism, but you can have a more political approach.

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So on on this kind of approach, you might think, well, if there are some developed nations or perhaps other powerful global actors,

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which are in some way causally responsible for the poor health conditions in less developed nations,

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then it might be argued that these more developed nations have a duty of justice to to rectify that situation.

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So the political approach is somewhat narrower the obligation to help less developed nations falls and those who have this sort of responsibility.

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The general idea about cosmopolitanism really speaks against vaccine nationalism

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that really speaks in favour of ensuring a far more equitable distribution

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of things which doesn't take community membership in a nation that's having the kind of strong moral relevance that vaccine nationalists claim.

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Yeah. So we have these two opposing views.

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And so what should we do? Like, how can we sort of resolve the conflict between vaccine nationalism and vaccine cosmopolitanism?

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Of course, one way to resolve the conflict is to establish that, you know, one of these philosophical views is completely flawed.

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And I think, you know, obviously the idea of human rights is very much secure.

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So people have adopted this approach, have really tried to undermine the nationalist approach.

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I'm against the partiality or more narrowly, vaccine nationalism. There are a couple of ways in which you might do that.

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So you might question whether cow nationality is a sufficiently valuable relationship to form the foundation for a powerful reason of partiality.

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On the instrumental approach that I mentioned right at the outset,

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you might question whether national passion is going to be instrumental to bringing about impartial global goods such as justice and equality.

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So that certainly is a strategy you might adopt. One problem with it is that vaccine nationalism, national partiality.

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I met a really wide range of different justifications, and a lot of those justifications have quite strong, intuitive and indeed political support.

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So we might be a little sceptical of how feasible it's going to be to solve the practical issue

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by settling this somewhat abstract philosophical debate between nationalists and cosmopolitans.

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So an alternative approach is to try and recognise the force of both views and to find a

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compromise position between the two that allows us to risk bond to both our duties of partiality,

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but also impartial duties.

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So we might try and say that national partiality can be justified, perhaps to an extent, but only within certain quite strict limits, perhaps.

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So one example of that is the influenza standard that Owen Schaefer and colleagues have written about.

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So in that approach, broadly, the idea might be that something like vaccine nationalism can be permitted,

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but only insofar as it's necessary to ensure that COVID 19 ceases to be an emergency in that country,

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going beyond background health risks such as those associated with influenza.

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Once the level of need is equal to the health risk posed by influenza,

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then prioritising your own citizens can no longer be justified by a more abstract level.

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I suppose the the idea of trying to reconcile these these two ideas about what morality is

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telling us to do is to say that we need perhaps to stipulate certain thresholds of high need,

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but can be invoked to justify prioritising our own citizens.

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Or we might appeal to a threshold of basic needs that we must satisfy for people in other countries before we can begin prioritising those in our own.

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So what do you think is the most important lesson learnt from the pandemic?

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What should we do better when being faced with the next pandemic?

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Yeah, I think this is a really difficult question because there are perhaps a lot of lessons,

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but I think the issue in talking about today speaks to perhaps one of the most important ones,

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and it's really just a reflection of that statistic, I said earlier.

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For whatever reason, we had a situation where there was this vast immigrant day in the distribution of vaccines globally.

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So just to repeat it, of the six billion or so that had been given in summer 2021, four billion of those doses had been given in just 10 countries.

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And in a global pandemic, that's simply not acceptable.

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Now there is a debate about the extent to which vaccine nationalism was solely responsible for that.

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That's probably too simplistic a view there, of course, very difficult logistical challenges with delivering vaccines to different parts of the world.

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There's also the, of course, the issue of vaccine hesitancy in different parts of the world.

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But it seems true that we would need to think very carefully in the next public

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health emergency about how we can fix this issue of vaccine nationalism,

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which does seem to me at least have played some causal role in the inequity that we've we've seen.