4.3 Article

Love thy neighbour? Allocating vaccines in a world of competing obligations

Journal

JOURNAL OF MEDICAL ETHICS
Volume 47, Issue 12, Pages -

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/medethics-2020-106887

Keywords

ethics; philosophical ethics; distributive justice; international affairs

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While there is currently no available coronavirus vaccine, the question of how to distribute it globally has already sparked controversy. Limited national partiality in allocating vaccines may be a component of justice rather than an obstacle, as there are legitimate moral reasons for identity-related prioritisation.
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.

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