Towards a new model of global health justice: the case of COVID-19 vaccines

Abstract

This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and down the chain of vaccine development who contribute to global vaccine inequities. Section 1 (Background) presents an overview of moments in which diverse global actors, each with their own priorities and aims, shaped subsequent vaccine distribution. Section 2 (Collective action failures) characterises collective action failures at each phase of vaccine development that contributed to global vaccine disparities. It identifies as critical the task of establishing upstream strategies to coordinate collective action at multiple stages across a range of actors. Section 3 (A Multilateral model of global health governance) takes up this task, identifying a convergence of interests among a range of stakeholders and proposing ways to realise them. Appealing to a responsibility to protect (R2P), a doctrine developed in response to human rights atrocities during the 1990s, we show how to operationalise R2P through a principle of subsidiarity and present ethical arguments in support of this approach.

Stewardship according to context: Justifications for coercive antimicrobial stewardship policies in agriculture and their limitations

“…49 For this to be avoided, ethical subsidiarity is necessary: policies should be designed and implemented by the communities they will affect, without the imposition of generalisations or justifications for policies that apply in high-income settings without consideration of the limiting factors and how these may vary in a context-specific way. 50 The following quote summarises my point in this section perfectly:…”

Ethical allocation of scarce vaccine doses: The Priority-Equality protocol

“…Second, for each priority class, one distributes the vaccines to the territories proportionally to the size of the class in each territory. This protocol can be applied to any multi-territory organization, ranging from current multi-jurisdiction countries and alliances to the ideal of a global vaccine distribution ( 19 , 20 , 28 – 30 ). In contrast, currently-used protocols have been essentially based on an approach where, first, vaccines are allocated to territories proportionally to population ( 7 , 31 , 32 ), and then allocated to classes following priority within each territory ( 33 , 34 ).…”

“…There exist many frameworks addressing distributional fairness in healthcare (4, [16][17][18][19][20][21][22], but they typically remain unspecified, that is, they discuss desiderata but stop short of identifying actual distribution mechanisms. For the case of vaccine allocation, at this point, society needs an allocation procedure or vaccine rationing protocol fulfilling the two key requirements discussed above.…”

Realizing Ubuntu in Global Health: An African Approach to Global Health Justice

“…Ten Have recommends considering a communitarian approach to global bioethics ( ten Have, 2011 ). Jecker et al set forth a non-statist framing of global justice that appeals to a principle of subsidiarity to normatively order the many individuals and groups that must coordinate their efforts ( Jecker et al , 2022 ).…”