We had a situation where there was this vast inequity in the distribution of
vaccines globally 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.
And in a global pandemic, that's simply not acceptable. There is wide agreement that the unequal distribution of vaccines globally is a problem.
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.
Dr. Pugh is Parfit Radcliffe Richards senior research fellow at the Oxford
Uehiro Centre for Practical Ethics at the University of Oxford. Hello, I'm Katrien Devolder.
This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.
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Also so the UK and other high income countries have been criticised for hoarding vaccines.
They've been accused of vaccine nationalism. But what is that?
What is vaccine nationalism? So vaccine nationalism in the broadest strokes is the idea that governments can be justified
in prioritising their own citizens when it comes to the rollout and distribution of vaccines.
And now she's secretary, and that's been a widely discussed position in the pandemic.
It's been quite controversial and I think to get a handle on the moral of the business area,
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.
So one reason that people might think that vaccine nationalism is a wrong headed
idea is that you might think that morality should really be an impartial farce.
You might think that morality is all about following universal rules and that we all
have obligations that apply equally to each and every member of the moral community.
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
reasons that apply specifically to people with whom we share a close relationship.
So the classic example of this is the relationship between a parent and their child.
We might think that a parent was missing out on a really important moral dimension if they treated that child completely impartially.
They didn't prioritise their child's interest, perhaps over the interest of a stranger's child.
So one way of thinking about how vaccine nationalism might have some sort of
moral justification is to think about the question of whether nationality or
perhaps the relationship between a government and its citizens could be the sort of relationship that could ground this special kind of moral reason,
this reason of partiality. Right. And so why would it be justified for countries to prioritise their own citizens?
So this is the really important question and really the crux of the matter,
because obviously not all kinds of relationship can ground these special kind of moral
reasons so that we think that a mother can perhaps justifiably prioritise that their child.
We certainly don't think it would be right to prioritise the interests of our own sex, for instance, that would amount to discrimination.
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.
So one approach of conditionality is to appeal to French considerations.
So you might think that if national partiality is justified,
we as a global society might be able to achieve other kinds of important intrinsic goods, such as justice and equality.
Other people take a slightly different approach. One appeals to the nature of what it is to be a citizen in a nation state.
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.
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,
it's only fair that citizens can expect that governments to prioritise their own interests over the interests of other countries.
So that's a an institutional approach to justify national partiality.
The final one really takes its lead from the example of the mother child example I spoke about earlier.
So it tries to claim that nationality is just the same sort of valuable relationship and that
we can see with other close and important relationships such as between parents and children,
but also between friends and other relatives.
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,
and it seems quite odd to say that we share anything like the same sort of close relationship we have with friends and family.
But there are other considerations that might come into that.
So we might think the fact that we as a nation have produced certain goods over time as a shared sort of enterprise.
So one example of this which.
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,
we all came together to produce this this good, which ensured people could access health care.
So you might try and outline three nationalities and building this really bad evil relationship,
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.
So it seems like there is something to say for giving priority to one's own citizens.
So what exactly then is is the problem with vaccine nationalism?
Is there really a problem? Yes. So the first thing to say is that these reasons of partiality only raise moral
issues when they come into conflict with what impartial ethics might tell us today.
Now, in the pandemic, it appears that that has been the case to some degree, at least, particularly in the summer of 2021,
when countries developed countries were beginning to initiate so-called booster programmes for vaccination before
many less developed countries had begun to roll out in first doses of vaccinations to the most vulnerable citizens.
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.
Around four billion of them have been delivered to just 10 countries. So really staggering inequity in distribution.
Now, there are certainly some debate about the extent to which vaccine supply was solely responsible for that.
But it's certainly true that the director of the World Health Organisation felt it appropriate to call for a
moratorium for booster programmes in August 2021 in order to prioritise first doses less developed nations.
There seemed to be an area in which reasons of national partiality for prioritising vaccines for countries
own citizens came into conflict with what impartial ethics Michael distributing vaccines more widely.
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.
So one way in which reason of partiality might not conflict with impartial ethics in a
resource allocation decision is when there's enough of the resource to go around anyway.
So certainly a number of people responded to the Who's call for moratorium by suggesting it was calling for a false choice.
I perhaps there were enough vaccines to go around.
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.
So another issue that was discussed at the time of initiating booster programmes was it might have actually been in developed
countries best interest to donate more vaccines to less developed nations in order to reduce the number of global cases.
And the reason that might have been in the interests of more developed nations
is that that might hopefully reduce the chance of a dangerous virus mutation
occurring at the sort of mutation that might in fact undermine the effectiveness
of the vaccines so that we might have had a strategy where what was in fact,
in developed nations, erm, best interests was helping other people.
So greens of partiality and impartial effects would have coincided again,
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.
Since that time, of course, we've seen the development of the Omicron variant, which, you know, change the change.
The scales a little bit in that regard.
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.
And insofar as that's the case,
we really have to deal with this question of vaccine nationalism and the extent to which it can be justified, if at all.
And so is there an alternative to vaccine nationalism?
What are what are the other options? Yeah.
So the polar opposite view is this idea of vaccine cosmopolitanism, and this view appeals to these impassioned ideas about ethics,
largely so it claims that community membership just doesn't have the kind of ethical relevance that vaccine nationalists claim.
Instead, vaccine distribution should really be determined by a more powerful moral obligations.
So that's the general idea. It's useful, I think, to distinguish a couple of different types,
and this is drawing on some work by Lowry and shook like these people, I very much recommend.
But one way of approaching this general idea of cosmopolitanism in this context is to appeal to,
again, these general, impartial moral ideals such as human rights, for example.
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.
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,
where they're going to bring about the most benefit.
Similar vein He could appeal to something like Peter Singer's principle of equal consideration of interests.
So the idea that we should give equal weight to the like interests of all those who are affected by our actions.
So again, there may be some circumstances, at least,
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.
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.
So this is a very humanitarian approach to cosmopolitanism, but you can have a more political approach.
So on on this kind of approach, you might think, well, if there are some developed nations or perhaps other powerful global actors,
which are in some way causally responsible for the poor health conditions in less developed nations,
then it might be argued that these more developed nations have a duty of justice to to rectify that situation.
So the political approach is somewhat narrower the obligation to help less developed nations falls and those who have this sort of responsibility.
The general idea about cosmopolitanism really speaks against vaccine nationalism
that really speaks in favour of ensuring a far more equitable distribution
of things which doesn't take community membership in a nation that's having the kind of strong moral relevance that vaccine nationalists claim.
Yeah. So we have these two opposing views.
And so what should we do? Like, how can we sort of resolve the conflict between vaccine nationalism and vaccine cosmopolitanism?
Of course, one way to resolve the conflict is to establish that, you know, one of these philosophical views is completely flawed.
And I think, you know, obviously the idea of human rights is very much secure.
So people have adopted this approach, have really tried to undermine the nationalist approach.
I'm against the partiality or more narrowly, vaccine nationalism. There are a couple of ways in which you might do that.
So you might question whether cow nationality is a sufficiently valuable relationship to form the foundation for a powerful reason of partiality.
On the instrumental approach that I mentioned right at the outset,
you might question whether national passion is going to be instrumental to bringing about impartial global goods such as justice and equality.
So that certainly is a strategy you might adopt. One problem with it is that vaccine nationalism, national partiality.
I met a really wide range of different justifications, and a lot of those justifications have quite strong, intuitive and indeed political support.
So we might be a little sceptical of how feasible it's going to be to solve the practical issue
by settling this somewhat abstract philosophical debate between nationalists and cosmopolitans.
So an alternative approach is to try and recognise the force of both views and to find a
compromise position between the two that allows us to risk bond to both our duties of partiality,
but also impartial duties.
So we might try and say that national partiality can be justified, perhaps to an extent, but only within certain quite strict limits, perhaps.
So one example of that is the influenza standard that Owen Schaefer and colleagues have written about.
So in that approach, broadly, the idea might be that something like vaccine nationalism can be permitted,
but only insofar as it's necessary to ensure that COVID 19 ceases to be an emergency in that country,
going beyond background health risks such as those associated with influenza.
Once the level of need is equal to the health risk posed by influenza,
then prioritising your own citizens can no longer be justified by a more abstract level.
I suppose the the idea of trying to reconcile these these two ideas about what morality is
telling us to do is to say that we need perhaps to stipulate certain thresholds of high need,
but can be invoked to justify prioritising our own citizens.
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.
So what do you think is the most important lesson learnt from the pandemic?
What should we do better when being faced with the next pandemic?
Yeah, I think this is a really difficult question because there are perhaps a lot of lessons,
but I think the issue in talking about today speaks to perhaps one of the most important ones,
and it's really just a reflection of that statistic, I said earlier.
For whatever reason, we had a situation where there was this vast immigrant day in the distribution of vaccines globally.
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.
And in a global pandemic, that's simply not acceptable.
Now there is a debate about the extent to which vaccine nationalism was solely responsible for that.
That's probably too simplistic a view there, of course, very difficult logistical challenges with delivering vaccines to different parts of the world.
There's also the, of course, the issue of vaccine hesitancy in different parts of the world.
But it seems true that we would need to think very carefully in the next public
health emergency about how we can fix this issue of vaccine nationalism,
which does seem to me at least have played some causal role in the inequity that we've we've seen.