Rawlsian Justice & Vaccine Distribution

Hope has returned. Operation Warp Speed seems to have worked. The vaccines are here. People are getting jabbed with a dose of ‘returning to normal’, and with herd immunity possible by late spring or early summer, things are looking up. While skepticism around the vaccine exists, a large percentage of Americans are ‘vaccine hesitant’, and cases are skyrocketing across the country, there is finally a reason to feel optimistic.

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For some of the world. More specifically, for rich parts of the world. At this point, most of us have used some algorithm to calculate our place in the vaccination line. There is a general consensus on who should receive it first, and even a viral campaign to change the NYTimes Person of the Year from Joe Biden and Kamala Harris to front line health care workers. Nursing homes and health care professionals is a logical next tier. Then the debate begins as to the pecking order. Fast food and factory workers? Grocery store employees? Child care providers? Teachers? Eventually we have the ‘Zoom Class’, folks who can do their jobs virtually. (There is no virtual cheeseburger). While not easy (e.g., childcare), these people have the ability to maintain physical distancing procedures not possible for other workers. For instance, an accountant can keep working from home, making sure the Kroger employees receive get the vaccine first.
 
This is decidedly not a post about the pecking order in the United States. This is a post about the ethics of the global distribution of the vaccine. As a shock to nobody, the wealthiest nations are securing a disproportionate number of vaccines for their citizens compared to the poorer ones. In fact, while some countries have preordered more than their total population (USA, EU, Japan, Hong Kong, Israel) 2x their population (Australia, Chile, UK), or even 4x their population (Canada), lower income countries are grasping at the remaining syringes on the shelves, hoping the get enough for those frontline workers, elderly, and health care providers mentioned above. Which raises the question: should a Zoom Class worker in Canada receive a vaccine before a factory worker in Bangladesh?
 
To help answer questions of equality and wealth disparity, I find John Rawls’ Theory of Justice helpful. The theory has received criticism and is much more complex than this, but essentially, Rawls argues that your lot in life is pure chance. We have no say into what circumstance we are born: wealth or poverty, high or low social status, we cannot control our gender or race, our physical strength or appearance, our intelligence or sexual orientation. Rawls calls this the original position, and from this vantage point, we view the world through a veil of ignorance. If you were ignorant to your position in the world, how would you wish wealth and prosperity to be distributed? How would you want policy decisions to be made? How would you develop global principles of justice?
 
According to the theory, if every human subscribed to this logic, the most rational arrangement would be to distribute wealth in a way that maximizes the prospects for those least well-off in society. It’s as if life is a five-card Poker draw with a huge pot in the middle. You could be dealt a Royal Flush, a 2-3-4-8-9 off-suit, or anything in between. If nobody is allowed to see their cards, would you place a bet? Or would you ask to split the pot?
 
Of course, the problem with this analogy is that we have all seen our cards. We know what we’ve been dealt, so no justice decisions can be made objectively. In my sustainability class, I pose it this way. Imagine you were born tomorrow and fell into one of three categories: there was a 10% chance you would be advantaged (wealthy parents, high social status, smart, good-looking), a 50% chance you would be Average (middle-class parents, moderate social status, average looks and intelligence), and a 40% chance you would be Disadvantaged (impoverished parents, low social status, unattractive, low intelligence). Given those odds, how would you want the world to work?

1. The way it currently works
2. Everything is distributed equally
3. Everything is distributed equitably (the least well-off get the most)

 
Most students choose option B or C (even though humans tend to overvalue low odds). This is an acknowledgement that the current system is flawed, perhaps unjust. Had you peeked at your cards and saw you were holding a Full House, maybe you are just fine with inequality because you are likely to win the pot. But behind a veil of ignorance, the safe—and smart—bet is to make sure everyone gets enough, including yourself.
 
It is a tricky conversation, particularly when you add things like gender, race, or sexual orientation. Because it does not mean that any one person is better than anyone else. In fact, that is the point. Each person has the same intrinsic value; however, certainly some folks are better ‘off’ than others. White people enjoy benefits that Black people do not just as men experience privilege simply by their gender. Even things as arbitrary as height influence how individuals fair in life. This is not to say hard work doesn’t count, but there are unseen headwinds and tailwinds at play.
 
Applied to the COVID-19 vaccine, in the simplest terms, if you were born into a poor country you will probably wait longer for a vaccine than had you been born in a rich country. Is this fair? Did Person A choose to be born in El Salvador while Person B chose Japan? At the national and state-levels, decisions are being made based on equity, as those who need the vaccine most will receive it first. But when we aggregate to the global scale, the distribution does not seem equitable or even equal.  
 
This is not an attack on capitalism or nationalism. Countries look out for their citizens, states for their states, communities for their communities, and families for their families (see every disaster movie where the protagonist doesn’t mind everyone dying as long as their kids are saved). In my heart of hearts, I am happy the US has secured so many vaccines. By chance, my spot in line is ahead of someone born in Kazakhstan. There is no veil of ignorance. We all have a clear view of our position in life, and it is natural to use this information in our decision-making.
 
I am not proposing a solution; I cannot even articulate the ‘problem’. There is so much about this crisis that we don’t know, and I trust that experts and policy-makers are doing their best with the information they have. This is merely a point of view. I believe the following statements are both true: People want what’s best for them; People want what’s best for others. The difficulty arises when these two statements are at odds with one another. The former will usually win the day because it is human nature to make decisions subjectively. More than that, it is rational and logical (Darwin was onto something). But taking an objective viewpoint to distributive justice leads to morally prudent decisions, and perhaps pushes us closer to balancing an unbalanced world.