ABSTRACT
In the context of pandemics, there exist inequalities in how risks of infection, hospitalization, and death are distributed across different groups, with these stemming principally from socioeconomic factors, or as referred to the social gradient of health. When rationing life-saving critical care, patients should be treated similarly, regardless of socioeconomic status. Up to the point of treatment, the pandemic response should include measures aimed at correcting the disproportionate burden of risk, such as by giving individuals in worse-off groups relative priority in the rationing of vaccines. The chapter attempts to clarify a definition of ethically objectionable vaccine nationalism and suggests that ethical concern arises when countries receive a disproportionally large number of vaccine doses due to their political/economic power while other countries are more in need. This issue is difficult to resolve as there exists no global allocation mechanism sufficiently powerful enough to eradicate favoritism and vaccine nationalism. Following the COVAX model, the chapter suggests that it benefits all countries to allocate vaccines in a way that, first, protects health care professionals and people at an increased risk of severe conditions in all countries and, second, allocates vaccines according to where the situation is more urgent at each period.
