Lifeboat Ethics: Understanding How a COVID-19 Vaccine Could Exacerbate Global Inequality

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The lifeboat ethics dilemma is easy to understand, hard to resolve, and entirely a problem of resource allocation. Proposed by ecologist Garrett Hardin, lifeboat ethics is a metaphor depicting a lifeboat with the capacity to save only a limited number of vulnerable swimmers without capsizing and thus dooming all occupants. In the context of the global economy, developed countries face the challenge of determining where to best allocate resources to alleviate global poverty and suffering.

While resource allocation is a problem as old as humanity itself, the ongoing COVID-19 pandemic has only intensified global and domestic shortages. With the impending approval of a vaccine by year’s end, experts believe supply shortages could deepen global inequality.

As Yemen, South Sudan, and Syria headlined global humanitarian crises at the turn of 2020, the world’s metaphorical lifeboat was already near capacity and struggling to juggle worsening crises. The emergence of the novel coronavirus in February and March symbolized the tipping point, with Executive Director of the World Food Programme David Beasley issuing a dire warning in April.

“If we don’t prepare and act now – to secure access, avoid funding shortfalls and disruptions to trade – we could be facing multiple famines of biblical proportions within a short few months,” Beasley said.  

However, the ongoing pandemic is not the only contributor to massive shortages. Citing ongoing conflicts, climate change, locust swarms, and corresponding economic shocks as other crises to address around the world, Food and Agriculture Organization Director-General Qu Dongyu suggested that the United Nations was operating at an unprecedented capacity.

“We have mobilized our organizations in ways not seen since the foundation of the UN,” Dongyu said.

While determining the outlook for many of these regional humanitarian crises remains challenging, the global community has already experienced plenty of shortages as part of the pandemic-induced global crisis.

To be clear, these shortages extend far beyond personal protective equipment, ventilators, and even toilet paper. They address both food supply and, more pertinently, secondary treatments and therapeutics used to combat the virus among infected patients. One such example is biopharmaceutical giant Gilead Science’s anti-viral therapy drug remdesivir.

In early July this year, the United States Department of Health and Human Services announced that it had bought out nearly all of Gilead’s supply of remdesivir for the next three months, a move that critics like Sussex University professor Ohid Yaqub said undermines global cooperation and indicates a disregard for social equity in fighting the virus.

"It so clearly signals an unwillingness to co-operate with other countries and the chilling effect this has on international agreements about intellectual property rights," Yaqub said.

As the struggle to tame this novel coronavirus continues, health experts and governments are optimistic about the prospects of an approved vaccine before the year’s end. However — and in the most perverse sense — the approval of a vaccine will immediately present a Pandora’s box of sorts, a new lifeboat. Questions remain unanswered. Tabling the logistical nightmare of mass-producing and distributing vaccines, determining the first vaccine recipients remains the key dilemma.

A strategic advisory group at the World Health Organization agrees in a preliminary framework published last month that this lifeboat should first take on the most vulnerable demographics - the elderly, those with underlying medical conditions, and certain medical professionals among others.

These demographics, however, constitute not only a fraction of the global population but also are not entirely enforceable; notably, the WHO has outlined who should receive the first doses but lacks the authority to enforce its recommendations. Many observers believe it will take much longer for the ordinary citizen to have access to a vaccine.

There is also a discrepancy in globally marginalized groups and who the WHO recommends receives the initial vaccine shipments. Studies have demonstrated that ethnic minorities and those among the lowest economic rungs of global society are much more likely to be affected by COVID-19. Despite recognizing the need for “special attention” paid towards these demographics, the WHO still does not include them as one of the primary recipient groups.

To date, the United States, United Kingdom, and Australia are among the few countries that have signed billion-dollar deals to secure the first hundreds of millions of vaccines produced by frontrunner vaccine candidates. In this scenario, it is rather clear that the more developed countries are deploying their financial flexibility during this pandemic to place themselves at an advantage in the race to distribute vaccines across the world.

If this scenario proves true, a frightening reality could emerge. Global inequality already runs deep. For countries that lack economic diversity, such as those with agrarian societies, the long, drawn-out process of waiting for secondary vaccine batches could make their rebound to pre-pandemic times increasingly harder to achieve. While some developed nations have already secured their spots in the lifeboat through early-bird vaccine contracts, their propensity to consider how limited vaccine doses affect more vulnerable countries will define global inequality for decades to come.

More posts by Benjamin Fu.
Lifeboat Ethics: Understanding How a COVID-19 Vaccine Could Exacerbate Global Inequality
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