COVID-19 Vaccine Distribution: An Example of Distributive Justice
After a tumultuous year filled with fear and uncertainty regarding COVID-19 and its impact on our lives, it finally seems like there is light at the end of the tunnel with the FDA and CDC authorizing the Pfizer vaccine. However, one thing is clear — the demand for the vaccine will fast outstrip the supply especially in the short-term. Given this short-term supply problem, how does the US government determine the right pattern and priorities for distributing the vaccine? While this may seem like an economic issue, it is fraught with ethical dilemmas given how the virus has unevenly impacted people living in the United States, especially the elderly and racial/ethnic minorities. I wanted to analyze the vaccine distribution plan the US has adopted through the lens of distributive justice.
Plan Summary: The U.S. Department of Health and Human Services (HHS) has adopted a four-phased equitable allocation framework to distribute the vaccine based on a report by the National Academies of Sciences, Engineering, and Medicine. Phase 1 is split into two sections, a and b, covering 15% of the population who are at high risk. Phase 1a is focused on people on the medical frontlines and first responders who are at risk of encountering bodily fluids or aerosols; this group is critical to the United States healthcare system and thus was deemed fit to be the first recipients of the vaccine. Phase 1b is focuses primarily on people at high risk of death or hospitalization if exposed to the disease, including the elderly and people with respiratory disorders. Phase 2 focuses on professionals who cannot avoid high exposure to COVID-19, such as school workers and public transportation workers; it also applies to people at moderate risk of health ramifications if they contract COVID-19. Phase 3 focuses on people who are at moderate risk of exposure and are important to society’s functioning. Finally, Phase 4 will introduce the vaccine to any American who chooses to receive it. For each phase, special effort will be made to deliver the vaccine to residents in high-vulnerability areas by using the CDC’s Social Vulnerability Index. This would incorporate the most linked variables to the disproportionate impact of COVID-19 on people of color. COVID-19 has disproportionately impacted Black, Hispanic or Latinx, American Indian and Alaska Native, and Native Hawaiian and Pacific Islanders with higher transmission rates, morbidity, and mortality. This reflects the impact of systemic racism and the socioeconomic factors that increase the likelihood of acquiring the infection, such as having frontline jobs, crowded living conditions, lack of access to personal protective equipment, and inability to work from home.
My Take: The distribution plan aims to incorporate multiple forms of distributive justice to ensure an equitable distribution that maximizes the population’s safety and health. While Strict Egalitarianism or complete equality may seem to be the most preferred principle, it is simply not practical to have the vaccine distributed to everybody at the same time. On the other hand, pure Libertarian principles may also not apply here as the government has not only funded the rapid development of the vaccine, but at least for the foreseeable period, is planning to distribute the vaccine free of cost. Instead, I contend, the plan, is rooted in welfare-based principles, as it follows the utilitarian belief that the policy should maximize “goodness,” which, in this case, would be a “protecting people against death and disease caused by infections” without consideration to the cost. In addition, in order to determine the right sequencing of the vaccine distribution, elements of Rawls’ theory of justice and desert-principles seem to have been applied. Phase 1a for example, where the focus is on our medical first responders, the principles applied appear to be a combination of welfare and desert. The first responders are constantly being exposed to the virus, and thus are in a position to not only get infected themselves — but also carry it home to their families and communities. I also contend that given their heroic battle and contributions during the COVID-19 pandemic, we may believe that in some ways they “deserve” to get first access to the vaccine — and hence the desert-based principle may come to play. Phase 1b could be thought from a Rawls difference principle perspective too — the vaccine is being distributed to people for whom it would make the most difference. Especially, one could consider people in nursing homes as having a “power” disadvantage in the sense that they cannot easily advocate for themselves. Phase 2 and Phase 3 bring back the combination of welfare- and desert-principle again as they focus on professionals who are important to the functioning of society, and getting them vaccinated will increase overall welfare of the society (schools, transportation etc.). Finally, Phase 4 is when everyone in the US has access. I would contend that in Phase 4, while the vaccine is free, if at that point there is still limited supply, the “Equality of Opportunity/Luck Egalitarianism” principle should be applied, and perhaps a system of lottery should be used to ensure that no particular segment or class of individuals can gain advantageous access.
Additionally, the plan follows a form of Rawlsian Justice by incorporating stipulations designed to benefit people of color and lower socioeconomic status. Each phase will incorporate a section of people who fall within high-vulnerability areas as determined by the CDC’s Social Vulnerability Index. Throughout the pandemic, reports of medical bias and lack of access to critical health infrastructure such has testing and contact tracing has inequitably hurt people of color, and policy makers adopting a deliberate measure to prioritize disadvantaged communities will lead to a more ethical framework of distribution.
The vaccine distribution plan could have been a highly contentious issue. It could have also been implemented in a way that people of higher socioeconomic status or high-productivity workers were prioritized first. However I believe the policy makers have taken a well-reasoned approach that balances the different principles of distributive justice to arrive at an equitable plan that still maximizes welfare across all sections of the society.
