How should we share covid vaccines?

Vaccinations in the UK are going well. Source: Unsplash

Covid-19 has had a devastating impact across the world. But now, thanks to the wonders of science, there are several vaccines which are safe and effective. Given that it takes time to administer the vaccines, not everyone can receive it straight away, so some people will have to wait their turn.

What I want to consider is how it should be determined who receives the vaccine first. The virus seems most dangerous to old people and those with underlying conditions such as diabetes, so I'll take it as a given that within a country, those people should be prioritised. However, what I'm wondering is how it should be determined which countries are first to receive vaccines, and how many. I'll consider these possibilities, that the countries to receive/use the vaccines first of all should be...

1. The countries that make the vaccines 
2. The countries with the highest death tolls
3. The countries with the highest death rates
4. The countries with the oldest populations
5. The countries best able to administer the vaccines quickly

The countries that make the vaccines 

If country X has put extensive time, effort and money into researching and developing a vaccine, perhaps it is fitting that the citizens of that country are first in line to receive that vaccine. This seems fair in the same way that if I work hard to obtain some commodity or money, I should be allowed to spend it to benefit my kids. I did the work, so I can reap the benefits. 

A problem with this is that the covid vaccination system then becomes a question of wealth, with the richest countries in the world, such as the USA, China, Japan, and much of western Europe being first in line to receive vaccines, with the poorest countries in the world in places such as Africa, Asia and Latin America, being left behind. 

In the UK, we hold our NHS dearly - even more so since covid - and believe that healthcare should be based not on wealth, but on need. This means that we should find it uncomfortable to endorse a system where the countries which sink the most money into developing vaccines are the ones to receive the vaccine first, just in virtue of having been rich enough to develop a vaccine.

The countries with the highest death tolls

If we think that healthcare should be distributed based on need, then death tolls seem a pretty good measure of need. In the USA nearly half a million people have died from covid-19; it might seem like they are most in need of the vaccine, and therefore the USA should be the ones to receive it first.

But allocating vaccines according to brute number of deaths is obviously going to favour countries with large populations. it is no surprise that of the ten countries with the largest populations, five of them are among the top ten countries with the highest death tolls (Mexico, Brazil, USA, Russia, and India). This would mean that countries with small populations would be way down the list of who gets the vaccine, even though they may be in dire need of it, and experiencing far more deaths per head of population than some of the heavily populated countries, such as India.

The countries with the highest death rates

Calculating deaths per head of population seems quite a reasonable way of determining which country is in the most dire need of the vaccine. After all, they are losing the greatest proportion of their population to covid, it seems only fair that they should be helped the most by receiving the vaccine. 

However, this might unfairly favour tiny countries and territories. For example, these statistics (as of 4 Feb 2021) show that Gibraltar and San Marino have the highest number of covid deaths per head of population; they have suffered 79 and 68 deaths respectively, but because of their tiny populations, they are top of the table in deaths per head of population.

Moreover, simply having a high total number of deaths per head of population doesn't mean that a country is in dire straits now. It's possible that a country has had a high death rate per head of population, but then got things under control and now they don't have any cases. I'm not sure whether any countries actually fit into this hypothetical category, but they could do. Normally, in philosophy, the fact that something hypothetically could exist is good enough to prove a point, but this is real-world applied ethics, so reality matters. There are certainly countries who have got things more under control than others though, and a country whose daily death rate is really on its way down is perhaps less in need than a country whose daily death toll is on its way up, even if its overall death rate is currently low, because covid hit them later.

The countries with the oldest populations

There are several covid vaccines
available. Source: Unsplash

Covid is most dangerous to older people, so perhaps the countries with the oldest populations should be prioritised. Sure, there will be some countries with an ageing population who haven't been really troubled by covid, but why should that matter? Simply because they haven't had a high death toll or death rate yet doesn't mean they won't have one. And since a vaccine is about preventing deaths rather than treating those who are already ill and dying, then it really shouldn't matter at all that we'd be sending vaccines to some countries who aren't suffering too badly as yet.

However, countries which currently have low rates of infection don't really seem to be in dire need of vaccines in the same way that those with high rates of infection are. Perhaps such countries are good at stemming the spread of infection by other means, such as lockdown and mask-wearing, or perhaps the virus has mutated into a less potent strain in their area, and they won't really need the vaccine after all. So perhaps giving vaccines to countries basted on their population age isn't the best idea after all.

The countries best able to administer the vaccines quickly

Vaccines are a valuable resource - both economically and health-wise. It would be a tragedy if vaccines were given to a country which squandered them. There are some countries which lack the infrastructure, refrigeration facilities, staff, or other necessities to administer the vaccines quickly and effectively. It would be a great shame if vaccines were given to such countries and they were wasted, when other countries could have used them to save lives. 

Conclusion 

I've considered several possibilities above, and none are unproblematic. I believe that out of all the options, some sort of combination of death rate per head of population, and brute number of deaths, coupled with some understanding of who is suffering the worst right now. This would put Belgium, Czechia, Italy, the UK and USA as some of the first countries to receive the vaccine in great numbers. This isn't really a perfect solution, but I think it's a reasonable solution. Once the most vulnerable people in these countries have been vaccinated, it would be fair to move on to other countries (but if/when I'm offered it, I'll be snatching their hand off!)

In practice, there seems to be a mixture of sharing methods taking place. I'm glad that the UK is doing very well with its vaccine rollout -- we have a very high death rate at the moment, and I'll feel much more at ease when that's under control. I just hope that the vaccine rollout can be swift and effective everywhere, and that the pandemic will soon be over.

And finally...

Look at this infographic I drew. It took me ages, and without any special software, so please look at it! Alas, I can only put it on here as a flattened image, so the links don't work. And I can't get it to be high resolution, or the right dimensions for the screen. But here it is anyway!