The Morality of Anti-COVID Vaccines Redistribution: Hobbesian and Utilitarian Editions
By the 5th of October 2021, almost half of the world population has received at least one dose of one anti-COVID vaccine. However, as the graphic below shows, populations are far from being equal concerning access to vaccines (source).
As it appears, less than 3% of people in low-income countries have received at least one dose. This is so, despite the COVAX initiative aiming at promoting as fair as possible access to vaccines worldwide. My interest here is not explaining this state of affairs, which is obviously the result of a conjunction of factors ranging from logistic difficulties to policies in wealthy countries giving priority to local populations. There is a sense – obvious for most persons – that this state of affairs is unjust. As such, this is a reason for wealthy countries to increase their efforts to redistribute vaccines more widely, especially given the fact that now in some of them near the totality of the willing-to-be-vaccinated persons have received two doses. This may not be sufficient however to trigger the required action. Now, the case for a more significant and faster redistribution can be made by establishing that the current situation is unfair according to different, and even sometimes conflicting standards. Here, I will just briefly consider two of them and point out that they lead to the same conclusion.
Consider first the utilitarian case for vaccines redistribution. A first argument is that the marginal utility of an additional vaccine will be far greater in low-income countries than in wealthy countries. This is true either with a hedonic or a preference-based version of utilitarianism. There are several reasons for this. For instance, even though no country has reached herd immunity, non-vaccinated people leaving in a country with a high rate of vaccination have less chance of catching the virus than those leaving in a region where few persons are vaccinated. Even though vaccines do not seem to block the transmission, they reduce its frequency. Another reason is that, especially that now hospitals in wealthy countries are no longer overloaded, sick people in wealthy countries will get better treatments than those in poor countries. This comes on top of the fact that by default health institutions in wealthy countries provide a better service thanks to far greater access to resources and competencies. The last reason is that a significant proportion of the remaining non-vaccinated people in wealthy countries just do not want to be vaccinated. There is therefore a high chance that many of the doses will just not be used.
Of course, the utilitarian calculus should include the case for using the doses for the third jab – which the European Medicines Agency has just approved and recommended. Again, however, there are reasons to think that the marginal utility of a first or second jab is greater than the marginal utility of a third jab – at least for some time. The point is not only that the decrease of the probability of catching a strong form of the virus is probably bigger with the first and second jab than with the third. A more decisive argument is that the less a population is vaccinated, the higher is the rate of circulation of the virus and so the higher is the chance that the virus mutates into a potentially more transmissible and deadly variant. Even if this probability is relatively low, the potential adverse consequences are so high that they are sufficient to decisively shift the calculus in favor of redistribution of vaccines. This utilitarian logic was already suggested to support the idea that it is better to have more people having received one dose than fewer people having received two doses. It is clearly even stronger now with the third dose issue.
The problem with the utilitarian case is that it appeals to a normative judgment made from the “point of the view of the Universe” to use Henry Sidgwick’s words. Policymakers are not utilitarians in this sense for obvious reasons. Parochialism and self-interested reasons block the implementation of the utilitarian calculus at the policy level. Now, the good news is that the same conclusion can be reached quite differently, based on a Hobbesian argument. The Hobbesian logic is quite different, as it takes each agents’ personal interests as its point of departure to determine what is the right thing to do. So, consider self-interested parties engaged in a bargain to allocate a resource (anti-COVID vaccines) in something approaching the Hobbesian state of nature. That means that there is no institution, no enforceable rule that can constrain a party to act in a particular way. The allocation will depend on each party’s interests and bargaining power. In an imaginary bargain between a wealthy and a poor country, no doubt that the former would receive the lion’s share of the resource. However, that depends on the principle of rational choice that parties may be expected to use in the state of nature. In his account of Hobbesian moral and political philosophy, Gregory Kavka has convincingly argued that what is the relevant principle depends on the characteristic of the choice situation within this state. Suppose that the situation possesses a “disaster-potential”, meaning that it can lead with a nonnegligible probability to a disastrous outcome from the point of view of the parties themselves. Suppose moreover that parties face radical uncertainty, meaning that they do not have access to reliable estimates of the probabilities of various possible outcomes. However, each agent is still able to rank the outcomes in terms of their probability. Suppose, finally, that depending on how the other party behaves, each action by an agent can potentially lead to a disastrous outcome.
In this choice situation, Kavka argues that the most relevant rational choice principle is disaster-avoidance reasoning. It consists in choosing in such a way as to minimize the probability of facing a disastrous outcome. I think that this applies perfectly well to the problem of vaccine redistribution. Worldwide vaccination cannot guarantee that the emergence of a highly deadly and transmissible variant will not happen in a near future. We cannot estimate the probability that such a disastrous outcome happens. But we know that the more people are vaccinated in the world, the less probable this disaster is. True, there are differences with Kavka’s account. Parties in the Hobbesian state of nature are assumed to be roughly equal. Here, wealthy and poor countries may not be equal against the potential disaster. Nonetheless, I think that the probability that it happens and affects badly wealthy countries is still nonnegligible as to warrant the use of disaster-avoidance reasoning. Because the justification of this principle directly builds on everyone’s personal interest, it has a better chance to trigger the required political response.
As wealthy countries are considering or even starting to administrate a third jab to their populations, there are therefore strong arguments to give priority to increase the number of vaccinated persons worldwide. There are political, economic, and technical constraints that make the task difficult. We can do better, though.