Securing a globally fair diffusion of COVID-19 vaccines

28 May 2020

Writing for the Open University’s Social Scientific Research in the Time of COVID-19 series of informed articles, Innogen’s Director, Theo Papaioannou, argues that combating the pandemic will require global application of a non-ideal justice in innovation.

COVID-19 has so far infected more than 3.19 million people worldwide and caused the premature death of more than 228 thousand of them. At the same time, the disease continues to put at risk the livelihoods of 1.5 billion workers in both the Global North and the Global South. There is now proliferation of articles and blogs, trying to understand what has caused the pandemic in the first place and to predict its social, economic and political consequences. Commentators disagree on many issues, except one: combating COVID-19 globally will be a matter of both innovation and justice. On the one hand, the development of novel treatments and effective vaccines for such a highly infectious disease requires cutting edge life sciences technologies. On the other hand, legitimate diffusion of a new drug and/or vaccine requires robust principles of fairness. This second requirement i.e. justice might prove to be much more complex than the first requirement i.e. innovation. The reason being the difficulty of reaching an agreement on ideal principles (e.g. cosmopolitan, liberal egalitarian and utilitarian principles of fairness) which can apply to innovation at global level. As Michael Savage in his recent piece at the Guardian newspaper warns, there is already an increasing “vaccine nationalism” that will be exacerbated by the competition of powers such as the US, China, Russia and India. These global powers have already refused to back a WHO initiative on equitable sharing of any treatments and vaccines around the world. Their absence from the WHO initiative is not of course surprising to those researchers who work on the theory and practice of global justice. Such a theory is predominantly liberal and unashamedly ideal, making the unfounded assumption that every country might be able to agree on abstract principles of fairness and cooperate towards a liberal justice outcome of innovation diffusion. The reality is rather different. This is not due to the absence of a global and sovereign state that could implement justice in innovation. This is due to national competition for new life sciences technologies which can deal with the disease and the absence of non-ideal or pragmatic principles which can achieve justice on the ground through global institutions. In what follows I will explain why such principles are so important to be developed and affirmed by WHO members to combat COVID-19.

First, I have shown elsewhere; innovation is a human action; intentional and guided not only by epistemic norms of ethics (e.g. coherence, simplicity, truth, etc.) and economic values and interests (e.g. use/exchange values, utility, materialism, cost/profit, etc.) but also by moral and political values and interests (e.g. freedom, equality, happiness, etc.).

Second, as a value-bound human action, innovation, especially in health, is significant for justice. Indeed, as Buchanan et al also point out, innovation creates opportunities for promoting justice but also poses risks of injustice i.e. it can worsen existing injustice, or it can create new injustice. Imagine for a moment that a vaccine for COVID-19 was found but its diffusion would have to be based on global market principles which by definition prioritise the interests of high-income countries and peoples or on global power dynamics which again favour powerful countries such as the US and China. This scenario would worsen existing global injustice given that some low-income countries and peoples e.g. Latin American countries are already disadvantaged by high mortality rates and would have to wait in a long treatment and vaccine queue. Innovation as such is not of course a mere instrument of justice. Rather it presupposes justice in order to be legitimised. In the case of COVID-19, this means that unless the development of new treatments or vaccines follows some plausible principles of justice (away from global market principles and power dynamics) it can end up ignoring the interests of the very people it meant to cure (e.g. disadvantaged people especially in low-income countries, including elderly and BAME people) and and therefore lose legitimacy. This implies that some of these people would not even bother to turn up to be vaccinated risking new waves of infections in their communities and countries.  

Third, the idea of justice in innovation is not just about diffusing fairly the fruits of new technologies but also about equalising relations in the process of generation and application of new knowledge. When it comes to innovation for COVID-19, we have reasons to ensure not only the equal share of new treatments and vaccines for each member of global society but even more importantly the equal relations between each member of global society, including innovators, regulators and publics. Reducing or eliminating relations of domination and oppression in the process of generation and application of new knowledge for an emerging disease such as COVID-19 should be the main objective of a global justice in innovation. Every knowledge about the virus matters and this means for example that the knowledge of innovators, regulators and publics from some powerful countries in the Global North should not be arbitrarily privileged or prioritised against the knowledge of innovators, regulators and publics from other less powerful countries in the Global South. Equality of relations in innovation enables global collaboration for problem-solving and this is exactly what is needed as precondition for a global agreement on just diffusion of innovative technologies for combating COVID-19.    

Fourth and more importantly, the idea of global justice in innovation should be non-ideal if it is to guide fair development and diffusion of new treatments and vaccines for COVID-19. What does this mean? It means that it cannot be based on abstract constructions or philosophical devices which are fact insensitive. Instead, it can be based on empirically true assumptions which succeed to pass a feasibility test i.e. a test conducted to provide empirical evidence of whether a global plan for justice in innovation is feasible in real world. The aim here should be to mitigate global health injustices instead of moving us from the current unjust state of the world to a perfectly just one. Non-ideal theorists consider a perfectly just world to be empirically impossible. In the case of COVID-19 this implies that just diffusion of new treatments or vaccines would not automatically achieve an absolute just outcome at global level but would probably reduce substantially the mortality rate and the economic damage in disadvantaged countries and badly affected communities.

Although this non-ideal approach to global justice in innovation at first glance appears to be somewhat less ambitious than ideal justice, it takes on board issues of partial compliance with principles of fairness and unfavourable circumstances. For example, it is almost certain some countries e.g. the US, Russia and China would prefer their peoples to be vaccinated first failing to comply with non-market principles which can prioritise other countries e.g. Peru. This is why these countries might use ‘advance purchase agreements’ to secure supplies. What would be important here is to have in place a rigorous empirical investigation and diagnosis of the underlying causes of global health injustices. This could remove the ‘veil of ignorance’ and enable WHO members to reach an agreement on an imagined plan for global justice in innovation diffusion that would provide clear and evidence-based solution to the problem of who needs to be vaccinated first in which country. Such a global plan for justice might be implemented with the assistance of WHO and guided by respect for human rights, equity of social relations, recognition of vulnerable minorities and democratic participation principles.

As Elizabeth Anderson puts it in her book 'The Imperative of Integration': Non-ideal justice begins with a diagnosis of the problems and complains of our society and investigates how to overcome these problems.

In the spirit of Anderson’s argument, one might suggest that new research is needed for global solutions to the problem of fair diffusion of COVID-19 vaccines and treatments to be established and then be implemented or tried on the ground in order to mitigate global injustices. There is a need for empirical data about the problem and then countries under the aegis of WHO would put imagined solutions to test. If they pass it (i.e. producing relatively just outcome) countries might be able to mitigate global health injustice. Constant testing of imagined solutions to problems of global justice in innovation constitutes the main methodology of a non-ideal approach. Instead of using ideals as a priori standards of social and political assessment at global level, this approach uses ideals as social and political tests in the global reality and complexity of affected countries.