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Love thy neighbour? Allocating vaccines in a world of competing obligations
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  1. Kyle Ferguson,
  2. Arthur Caplan
  1. Division of Medical Ethics, New York University Grossman School of Medicine, New York, New York, USA
  1. Correspondence to Dr Kyle Ferguson, Division of Medical Ethics, New York University School of Medicine, New York, NY 10016-6402, USA; kyle.ferguson{at}nyulangone.org

Abstract

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.

  • ethics
  • philosophical ethics
  • distributive justice
  • international affairs

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Footnotes

  • Contributors KF contributed to the conception and design of the work, reviewing and interpreting the literature, drafting the article and revising the article. AC contributed to the conception and design of the work, critical revision of the article and gave final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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