While rich countries like the USA and UK are starting to vaccinate their populations against COVID-19, poor countries may lack access to a vaccine for years. A global effort to provide vaccines through the COVAX facility Accelerator) aims to distribute 2 billion vaccinations by the end of next year, but the USA has refused to join and even those rich countries that have joined are entering into bilateral deals with pharmaceutical companies to buy up the supply. Canada, for instance, (...) has already secured enough to vaccinate its entire population nine times over, and the USA, European Union, UK, Australia and Japan can vaccinate their populations between 2 and 8 x.1 Vaccine nationalism is neither ethically justified, nor even in rich countries’ long-term self-interest. No one deserves the luck of their birth and few have much control over their country of residence. So, when there are four ventilators per 12 million people in some low-income and middle-income countries, and people are being buried in cardboard boxes in mass graves, it is simply unconscionable to argue that wealthy countries can keep their vaccines to themselves or even help their populations first.2 Vaccine nationalism fails to respect basic human rights and the people who have them. Moreover, many argue that rich countries have contributed to global poverty through a shared and violent history of colonialism and oppression and profit from instituting, upholding and sustaining coercive rules that often exacerbate, rather than alleviate, global poverty.3 Be that as it may, putting basic health systems in place to ensure everyone can get vaccinated, not only against COVID-19 but a host of other terrible diseases, would better protect even the rich from …. (shrink)

Developing World Bioethics, Volume 21, Issue 3, Page 99-99, September 2021.

Developing World Bioethics, Volume 21, Issue 3, Page 99-99, September 2021.

This paper considers the forms of vaccine nationalism specific to responses to SARS-CoV-2. First, it considers the initial vaccine responses to SARS-CoV-2 and how the competition unfolded in a broader, global sense. The second part considers the way the European Union adopted its own type of nationalism, despite claiming to distinguish itself as more humanitarian and equitable in approaching COVID-19 vaccine production, supply, and distribution. The creation of the export control mechanism, and the threat of (...) its use, was itself an expression of Euro-nationalism in action. The need to do so was largely a product of the EU’s own making, given its own contractual relationships with the pharmaceutical companies. Finally, this paper contends that the advocacy for vaccine passports, championed by the EU, served to cause parochial ruptures in the bloc for commercial reasons. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality (...) while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

In this article we articulate a case from moral responsibility to assist Palestinians living in the Occupied Palestinian Territory (OPT). We contextualize this responsibility by focusing on access to healthcare and the provision of vaccines against COVID-19. We specifically present two arguments from responsibility, one that is global or cosmopolitan, and one that is country-specific. For the latter, we focus on Israel.

In this article we articulate a case from moral responsibility to assist Palestinians living in the Occupied Palestinian Territory (OPT). We contextualize this responsibility by focusing on access to healthcare and the provision of vaccines against COVID-19. We specifically present two arguments from responsibility, one that is global or cosmopolitan, and one that is country-specific. For the latter, we focus on Israel.

In this article we articulate a case from moral responsibility to assist Palestinians living in the Occupied Palestinian Territory (OPT). We contextualize this responsibility by focusing on access to healthcare and the provision of vaccines against COVID-19. We specifically present two arguments from responsibility, one that is global or cosmopolitan, and one that is country-specific. For the latter, we focus on Israel.

This letter attempts to put some preliminary thoughts on the COVID-19 pandemic in relation to Foucault's writings on Biopower, critique of Capitalism, and global wealth injustice. The Letter concludes that schemes, such as COVAX, which are meant to overcome global wealth inequalities, serve better as visible symptoms of these inequalities.

Are countries especially entitled, if not obliged, to prioritize the interests or well-being of their own citizens during a global crisis, such as a global pandemic? We call this partiality for compatriots in times of crisis “crisis nationalism”. Vaccine nationalism is one vivid example of crisis nationalism during the COVID-19 pandemic; so is the case of the US government’s purchasing a 3-month supply of the global stock of the antiviral Remdesivir for domestic use. Is crisis (...) class='Hi'>nationalism justifiable at all, and, if it is, what are its limits? We examine some plausible arguments for national partiality, and conclude that these arguments support crisis nationalism only within strict limits. The different arguments for partiality, as we will note, arrive at these limits for different reasons. But more generally, so we argue, any defensible crisis nationalism must not entail the violation of human rights or the worsening of people’s deprivation. Moreover, we propose that good faith crisis nationalism ought to be sensitive to the potential moral costs of national partiality during a global crisis and must take extra care to control or offset these costs. Thus, crisis nationalism in the form of vaccine nationalism or the hoarding of global supplies of therapeutics during a global pandemic exceeds the bounds of acceptable partiality. (shrink)

Vaccine apartheid is creating conditions that make for premature death, poverty, and disease in racialized ways. Invoking vaccine apartheid as opposed to euphemisms like vaccine nationalism, is necessary to highlight the racialized distributional consequences of vaccine inequities witnessed with COVID-19. This commentary clarifies the concept of vaccine apartheid against the historical and legal usage of apartheid. It reflects on the connections and important disjunctions between the two. It places the intellectual property regime under heightened (...) scrutiny for reform and transformation. This commentary finds that drawing on the intersections between a human rights and health justice approach can provide creative and novel approaches for anti-subordination. It concludes that acknowledging and naming the structural injustice of vaccine apartheid is only the first step towards providing redress. (shrink)

Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle (...) to it. For there are role-based and community-embedded responsibilities to take care of one’s own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one’s own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as (...) well as economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 12-17, September‐October 2021.

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine (...) under conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations. (shrink)

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine (...) under conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations. (shrink)

In 2020, the world faced a new pandemic. The corona infection hit an unprepared world, and there were no medicines and no vaccines against it. Research to develop vaccines started immediately and in a remarkably short time several vaccines became available. However, despite initiatives for global equitable access to COVID-19 vaccines, vaccines have so far become accessible only to a minor part of the world population. In this article, I discuss the global distribution of COVID-19 vaccines from an ethical point (...) of view. I reflect on what ethical principles should guide the global distribution of vaccines and what global justice and international solidarity imply for vaccine distribution and I analyse the reasons for states to prioritize their own citizens. My focus is on ethical reasons for and against ‘vaccine nationalism’ and ‘vaccine cosmopolitanism.’ My point of departure is the appeal for international solidarity from several world leaders, arguing that ‘Where you live should not determine whether you live’. I discuss the COVAX initiative to enable a global vaccination and the proposal from India and South Africa to the World Trade Organization to temporarily waive patent rights for vaccines. In the final section, I argue for global vaccine sufficientarianism, which is a modified version of vaccine cosmopolitanism. (shrink)

In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

Accelerated COVID-19 vaccine development represents an important accomplishment and a milestone in the history of vaccine evolution. However, the vaccine’s scarcity made its equitable global allocation and distribution ambiguous. Despite the initial pledges from wealthy countries for fairness and inclusivity towards the poorer ones, the policies followed diverged significantly. Wealthy countries have vastly superior access to vaccines in a reality likened to an ethical disaster. This paper calls for the need for fair global vaccine allocation and (...) distribution and examines the barriers that were met along the way, originating from different points, such as the nationalistic approach on the matter that most wealthy countries have adopted or the inability of poor countries to purchase or manufacture vaccines. Further, a suggestion regarding the ethical principles and values that ought to guide global vaccine allocation and distribution is provided with a higher priority given to helping the worst-off, saving the most lives, protecting people in high risk, such as frontline healthcare professionals, and minimising social gaps, along with an ethical theoretical background for each prioritisation. It is not too late for wealthy countries to realise that vaccine inequity prolongs pandemics, so that they change their policies in favour of the global common good that will not only provide immediate universal benefits but will also serve as a guide for future pandemic crises. (shrink)

This article analyses how the French Academy of Sciences assessed Jaime Ferrán’s cholera vaccine submitted for the Prix Bréant in the 1880s. Ferrán, a Spanish independent physician, discovered the treatment in 1884 and tried it on thousands of patients during the cholera outbreak in Valencia the following year. His evaluation sparked a controversy in Spain and abroad on the vaccine’s efficacy. The Bréant jury did not see any evidence for it in Ferrán’s submission, a decision usually interpreted in (...) terms of French scientific nationalism (or simple chauvinism): an outsider from the scientific periphery could not be awarded the Bréant. Drawing on the archival records of the award, we suggest that Ferrán failed instead to provide data that the Academy could consider unbiased, according to the contemporary standards for data presentation. We will illustrate these standards at work in the assessment of another submission from Spain, by Philipp Hauser, who received the Bréant for the thoroughness of his statistical endeavour. (shrink)

This article proposes the adoption of a multi-modal system for allocating vaccine doses during large transnational outbreaks of infectious diseases. The chosen allocative criteria (public health need; country-income level; qualification through funding; and, subsidiarily, a modified lottery system) are adapted from a current embodiment of allocative multi-modality outside the context of public health: the New York City Marathon.

The world awaits a SARS-CoV-2 virus vaccine to keep the populace healthy, fully reopen their economies, and return their social and healthcare systems to “normal.” Vaccine safety and efficacy requires meticulous testing and oversight; this paper describes how despite grandiose public statements, the current vaccine development, testing, and production methods may prove to be ethically dubious, medically dangerous, and socially volatile. The basic moral concern is the potential danger to the health of human test subjects and, eventually, (...) many vaccine recipients. This is further complicated by economic and political pressures to reduce government oversight on rushed vaccine testing and production, nationalistic distribution goals, and failure to plan for the widespread immunization needed to produce global herd immunity. As this paper asserts, the public must be better informed to assess promises about the novel vaccines being produced and to tolerate delays and uncertainty. (shrink)

Ernest Gellner's final book, first published in 1998, is a synoptic interpretation of the thought of Wittgenstein and Malinowski.

In ‘Against vaccine nationalism’, Nicole Hassoun misrepresents our argument, distorts our position and ignores crucial distinctions we present in our article, ‘Love thy neighbor? Allocating vaccines in a world of competing obligations’. She has created a strawman that does not resemble our position. In this reply, we address two features of ‘Against vaccine nationalism’. First, we address a phantom premise. Hassoun misattributes to us a thesis, according to which citizen-directed duties are stronger than noncitizen-directed duties. This (...) thesis is a figment of her imagination, not a fragment of our argument. Second, we address a shape-shifting ism. Ambiguity attaches to ‘vaccine nationalism,’ ambiguity that Hassoun exploits despite our distinguishing various meanings of the phrase. As a result, the type of vaccine nationalism she argues against is not the type we defend. (shrink)

With the coronavirus pandemic and the Omicron variant once again forcing countries into lockdown, this essay seeks to outline a Foucauldian critique of various legal measures taken by the Danish government to cope with COVID-19 during the first year and a half of the pandemic. The essay takes a critical look at the extra-legal measures employed by the Danish government, as the Danish politicians attempted to halt the spread of the, now almost forgotten, Cluster 5 COVID-19 variant. This situation will (...) serve as a critical point from where to start using Foucault’s writings on life and biopolitics in order to expose various legally problematic governmental decisions that became visible during the handling of COVID-19 in general and the Cluster 5 mutation in particular. Reframing the pandemic within Foucault’s concept of biopolitics, this essay concludes that the state of exception has led to an increase in biopolitical logic, where some lives have come to matter more than others. As a critical counterpoint to this logic, the conclusion suggests that the notion of biocommunism could provide a suitable reconfiguration of communism. A reconfiguration that could mitigate some of the issues related to biopolitics is uncovered earlier in the essay. (shrink)

In 1892, the British agricultural authorities introduced a policy of slaughtering animals infected with foot and mouth disease (FMD). This measure endured throughout the 20th century and formed a base line upon which officials superimposed the controversial "contiguous cull" policy during the devastating 2001 epidemic. Proponents of the slaughter frequently emphasized its capacity to eliminate FMD from Britain, and claimed that it was both cheaper and more effective than the alternative policies of isolation and vaccination. However, their discussions reveal that (...) a less obvious but nonetheless important reason for maintaining the slaughter policy was the conviction that in its manner of operation and its outcomes, it benefited the state and status of the British nation. To its supporters, slaughter was far more than a method of disease control; it acted also as a moralizing and civilizing force, an indicator of veterinary ability and a "virility symbol" of British international leadership. This "cultural" rationale for FMD control by slaughter declined during the late 20th century and was wholly undermined by the 2001 epidemic, when extensive culling failed to convey the intended image of an organized, enlightened Britain. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by some (...) high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

This paper argues in support of the WHO’s proposal to forego COVID-19 booster shots until 10% of people in every country are fully vaccinated. The Ethical Argument section shows that we save the most lives and ensure the least amount of suffering by allocating doses first to unvaccinated people. It also argues that there is a duty to support decent lives and to promote health equity, which establish that refraining from boosters is a requirement of justice, not charity. The Replies (...) to Objections section answers objections that appeal to pragmatism, nationalism, ownership, scientific advancement, self-interest, semantics and futility. The Conclusion section emphasizes that for now, wealthy nations should not boost vaccinated people’s immunity and should instead send doses to poorer nations where they are most urgently needed. No data was used in this study. (shrink)

This article examines how growing fears, insecurities and uncertainties during the COVID-19 pandemic have prompted an emotional distance from others. The aim is to explore how global solidarity and nationalism are challenged and constructed as collective emotional processes concerning ‘others’. Drawing on social theories of emotions during crises and emotions towards others, this study looks at policy decisions around vaccines and health services and their associated emotions in the context of Korea, which has a relatively small migrant population and (...) a short history of supporting people in lower-income countries. The study finds that the COVID-19 pandemic has strengthened nationalism, both ethnic nationalism and cosmopolitan nationalism. This points to the need to highlight global norms such as human rights and justice and cultivate foundational emotions such as empathy and compassion. This article suggests paying attention to the role of emotions in generating othering practices and developing global solidarity. (shrink)

Covid data show that wealth is not health. What then are the major variables that affect public health in the Covid–19 pandemic? Based on onsite research in 26 countries across the world this paper singles out three variables – knowledge, state capability and social cooperation. If one of these is dysfunctional or absent Covid–19 performance suffers. The variables work best in combination. Under consideration are three phases of Covid–19 – virus control, vaccines, and the race with variants. Which types of (...) society best combine these variables? Comparing varieties of market economies – liberal, coordinated and state-led market economies, Covid–19 data indicate that coordinated and developmental state-led market economies tend to generate the best combination of variables and public health outcomes, and liberal market economies and rightwing populist countries produce the worst combination. Comparative Covid–19 research points to the limitations of macro theories and methodological nationalism, the importance of the unit of analysis and the database, and how variables interact. At a time when multiple crises interact it leads to reflection on glaring limitations of global governance. (shrink)

Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and mortality than those (...) targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Context In response to outbreaks of vaccine‐preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercive vaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as “vaccine mandates.” However, mandatory vaccination is not a unitary concept. Rather, coercive childhood immunization policies are complex, context‐specific instruments. Their (...) legally and morally significant features often differ, and they are imposed by political communities in varying circumstances and upon diverse populations. Methods In this paper, we introduce a taxonomy for classifying real‐world and theoretical mandatory childhood vaccination policies, according to their scope (which vaccines to require), sanctions and severity (which kind of penalty to impose on vaccine refusers, and how much of that penalty to impose), and selectivity (how to enforce or exempt people from vaccine mandates). Findings A full understanding of the operation of a vaccine mandate policy (real or potential) requires attention to the separate components of that policy. However, we can synthesize information about a policy's scope, sanctions, severity, and selectivity to identify a further attribute—salience —which identifies the magnitude of the burdens the state imposes on those who are not vaccinated. Conclusion Our taxonomy provides a framework for forensic examination of current and potential mandatory vaccination policies, by focusing attention on those features of vaccine mandates that are most relevant for comparative judgments. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion (...) and education when addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

While COVID-19 vaccines provide light at the end of the tunnel in a difficult time, they also bring forth the complex ethical issue of global vaccine distribution. The current unequal global distribution of vaccines is unjust towards the vulnerable living in low-income countries. A vaccine tax should be introduced to remedy this. Under such a scheme, a small fraction of the money spent by a country on vaccines for its own population would go into a fund, such as (...) COVAX, dedicated to buying vaccines and distributing them to the world’s poorest. A vaccine tax would provide a much-needed injection of funds to remedy the unequal distribution of vaccines. The tax allows for a distribution that, to a lesser degree, reflects the ability to pay and is superior to a donation-based model because it minimises the opportunity for free-riding. (shrink)

We ask whether it is reasonable to delay or refuse to take COVID-19 vaccines that have been shown in clinical trials to be safe and effective against infectious diseases. We consider two kinds of vaccine hesitancy. The first is geared to scientifically informed open questions about vaccines. We argue that in cases where the data is not representative of relevant groups, such as pregnant women and ethnic minorities, hesitancy can be reasonable on epistemic grounds. However, we argue that hesitancy (...) is not reasonable if a vaccine has passed well-conducted clinical trials. The second kind of hesitancy is to do with beliefs about the institutions offering a successfully trialled vaccine and the justifiability of cooperating with those institutions. For example, in the UK, distrust of the UK Government or the National Health Service is identified as a factor in the vaccine hesitancy of minority ethnic populations. We ask whether this sort of hesitation is reasonable given normative requirements of fair co-operation, both with those institutions and the wider population. We suggest that the answer is not straightforward. Sometimes the hesitation is unreasonable but understandable. -/- . (shrink)

Vaccine hesitancy has been a major cause for concern throughout the COVID-19 pandemic. The World Health Organization have previously addressed vaccine hesitancy via the ‘3C model’ (Convenience, Complacency, and Confidence). Recent scholarship has added two more ‘Cs’ (Context and Communication) to formulate a ‘5C model’ that is more equipped to adapt to the uncertainties of the pandemic. This paper focuses on the four ‘Cs’ that explicitly concerns trust (Complacency, Confidence, Context, and Communication) and phenomenologically distinguishes confidence from trust. (...) Experts view vaccines in terms of confidence, where the prospect of an undesirable outcome is extremely rare. Hence, not vaccinating and compromising herd immunity is seen to be unreasonable. Hesitant individuals contest the expert perspective and view vaccines in terms of trust, where the prospect of disappointment is likely. From this perspective, to vaccinate is to take a risk, and it is within reason to have the freedom to choose otherwise. This paper focuses on the hesitant perspective to identify the two social indicators of trust in vaccines most prominently shown during the COVID-19 pandemic in the Global North: (i) the expert reaction to hesitant concerns and (ii) the loss of freedom in relation to vaccine requirements. (shrink)

Vaccine refusal is not a free rider problem. The claim that vaccine refusers are free riders is inconsistent with the beliefs and motivations of most vaccine refusers. This claim also inaccurately depicts the relationship between an individual’s immunization choice, their ability to enjoy the benefits of community protection, and the costs and benefits that individuals experience from immunization and community protection. Modeling vaccine refusers as free riders also likely distorts the ethical analysis of vaccine refusal (...) and may lead to unsuccessful policy interventions. (shrink)

The Covid‐19 pandemic needs to be considered from two perspectives simultaneously. First, there are questions about which policies are most effective and fair in the here and now, as the pandemic unfolds. These polices concern, for example, who should receive priority in being tested, how to implement contact tracing, or how to decide who should get ventilators or vaccines when not all can. Second, it is imperative to anticipate the medium‐ and longer‐term consequences that these policies have. The case of (...) vaccine rationing is particularly instructive. Ethical, epidemiological, and economic reasons demand that rationing approaches give priority to groups who have been structurally and historically disadvantaged, even if this means that overall life years gained may be lower. (shrink)

Many have argued that human enhancement, in particular bioenhancement via genetic engineering, brain-interventions or preimplantation embryo selection, is problematic even if it can be safely implemented. Various arguments have been put forward focusing on issues such as the undermining of autonomy, uneven distribution and unfairness, and the alteration of one’s identity, amongst others. Nevertheless, few, if any, of these thinkers oppose vaccines. -/- In what follows, I argue for the permissibility of a limited set of cognitive enhancements – in particular, (...) the enhancement of evaluative judgment and self-control – by analogy with the permissibility of vaccines. As a result, it follows that if one accepts the permissibility of vaccines one will also, other things being equal, be committed to the permissibility of these enhancements. I then consider and respond to a number of possible objections in order to defend and clarify my position. (shrink)

COVID-19 vaccine refusal seems like a paradigm case of irrationality. Vaccines are supposed to be the best way to get us out of the COVID-19 pandemic. And yet many people believe that they should not be vaccinated even though they are dissatisfied with the current situation. In this paper, we analyze COVID-19 vaccine refusal with the tools of contemporary philosophical theories of responsibility and rationality. The main outcome of this analysis is that many vaccine-refusers are responsible for (...) the belief that they should not be vaccinated and epistemically rational in holding it. This is an important result because it provides insights into the legitimacy of certain public health policies. In particular, this result shows that a public health policy that would abandon the project of convincing certain vaccine-refusers with reasons – e.g., by simply making vaccination compulsory – is prima facie illegitimate. (shrink)

The 2015 Disneyland outbreak of measles in the US unequivocally brought to light what had been brewing below the surface for a while: a slow but steady decline in vaccination rates resulting in a rising number of outbreaks. This can be traced back to an increasing public questioning of vaccines by an emerging anti-vaccination movement. This article argues that, in the face of diminishing vaccination rates, childhood vaccinations should not be seen as part of the domain of parental choice but, (...) instead, as a non-negotiable legal obligation. The first part of the article formulates and defends two arguments in favour of unqualified mandatory childhood vaccination laws. First, government should not permit parents to put their children at avoidable risk of death and suffering; second, government should guard the common good of herd immunity to protect vulnerable persons. The second part rejects legal and pragmatic objections against such mandatory vaccination laws. (shrink)

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract (...) away from the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values. (shrink)

This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with (...) the greatest need, reducing health disparity, saving the most lives and promoting narrow social utility. It also responds to objections which claim that earlier years have more value than later years. Section III puts forth a practical ethical framework to aid decision-makers and compares it with alternatives. (shrink)

In a recent article, "Can One Both Contribute to and Benefit from Herd Immunity?", Lucie White argues that vaccine refusal is more like free riding than we have claimed that it is. Here, we critically reply to White’s arguments.

Respect for autonomy is problematic in relation to public health programmes such as vaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors to vaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned policies. Objectors (...) have different arguments for not participating in vaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of 'narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refuse vaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. (shrink)

This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe — risking other people’s children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, (...) are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult. (shrink)