by Richard B. Gibson
Ensuring that healthcare resources are made available to those in the greatest need of them – be that individuals, groups, populations, or countries – is not only a matter of public health but also one of ethics. A failure to implement appropriate resources allocation, reflective of a situation’s specific demands, illustrates not only an ignorance of public health factors but also betrays ethical shortcomings. In short, those stakeholders facing the toughest healthcare challenges should be afforded the greatest number of resources.
Does this mean, if one applies this form of reasoning to the global Covid-19 vaccination strategy, it follows then that those countries facing the most virulent viral variations should be given priority access to the vaccine? For example, should the UK jump to the front of the line?
The Covid-19 variant, known as B117, is reportedly 71% more transmissible than the virus’ current globally predominant strain. Identified in October 2020, this new strain of the SARS-CoV-2 virus has rapidly spread through the UK, prompting even tighter national and international restrictions. On the 15th of December, Dr Jenny Harries and Dr Susan Hopkins presented data, on behalf of the UK government, which indicated that this virus variant is out-competing other forms. Indeed, since this press briefing, the more infectious form of the virus appears to have dominated the country and forced the UK into its third national lockdown.
While B117 does not appear to be more lethal, its emergence is a considerable concern as greater transmission increases the likelihood of the virus infecting those for whom any form of Covid-19 infection is materially fatal. With a greater propensity for transmission also comes an increased likelihood that healthcare providers will become overwhelmed with an ever-increasing demand for their services, as is feared the case for the UK’s National Health Service. Additionally, with a greater capacity to replicate comes an increased likelihood that the virus will once again mutate into a more virulent strain.
Thus, measures aimed at preventing this variant’s spread are likely instrumental in combating the Covid-19 pandemic. Efforts to contain B117 within the UK will help conserve vital resources, allow more time to deploy the various Covid-19 vaccines globally, and ultimately save lives. However, given the spread of B117 throughout the UK, as well as its appearance in other parts of the world, despite stringent lockdown measures, there is a legitimate concern over whether these restrictions, on their own, are sufficient. It may be that other interventions are required to curb the spread of B117. Despite the recent Twitter hashtag, the UK cannot be isolated forever and treated as a ‘#PlagueIsland’. Without actively combating the B117 variant, it will almost inevitably spread from the UK and intensify an already precarious epidemiological disaster.
Currently, the global vaccine strategy (if one can call it that) rests upon economics; those countries that can afford to pay for the vaccine are those being prioritised. Recent projections indicate that a small number of affluent countries have secured over half of the Covid-19 vaccine stock, much to the expected detriment of other nations (and potentially themselves).
Consideration needs to be given to the idea of a readjustment of this market-led approach; a readjustment that would favour vaccine deployment in areas in which the virulent B117 variant has become prevalent. This strategic readjustment would instrumentalise immunity against Covid-19 and slow the spread of the virus’s more virulent form. This readjustment would mean that the UK is given priority for vaccine assignment, given that it currently has the majority of the B117 variant infections.
While a targeted approach to vaccine deployment, one which favours one of the wealthiest countries on the planet, appears to be fraught with ethical quandaries, there is a good argument to take such an approach; that being that we’re not talking about the same identical virus anymore.
If the virus was comparable across the globe – i.e. it spread at the same rate – then a prioritisation of one state over another would be highly problematic, but this is not the case. Because B117’s infection rate is substantially higher, the variant that has spread through the UK is a different beast from that which much of the rest of the world is battling. Thus, given that the UK is tackling a more dangerous form of the virus – a danger born from the variant’s increased transmission rate – it seems only fair to prioritise the UK when it comes to vaccine deployment. Suppose one believes that inequalities in healthcare are pertinent to resource allocation (that principles of egalitarianism should influence how healthcare assets are deployed). In that case, it follows that those facing a more dangerous form of Covid-19 should be afforded extra resources and vaccine prioritisation.
Additionally, from a consequentialist standpoint, preventing the spread of B117 will have positive outcomes for everyone, both within the UK and beyond its borders. Currently, the variant is, for the most part, contained within an island nation. This is the perfect time to tackle it and reduce the chance that B117 spreads globally, endangering countless more lives. A failure to prevent this harmful outcome should undoubtedly be seen as an ethical, as well as epidemiological and public health, failure.While the ideal scenario is one in which Covid-19 has been eliminated globally, and this is the eventual goal, it may be the case that in the shorter term, we collectively need to decide which form of the virus we want to combat first. Rather than deploying the vaccine globally according to market forces, and inviting B117 to spread beyond the UK further than it already has, there is an argument that vaccine deployment needs to target those areas where B117, as well as the South African 501.V2 variant which I have not touched upon in this blog, is prevalent. Delays in population inoculation in areas where these virulent variations are prevalent – delays caused by an inability to secure enough vaccinations to eradicate these viral mutations – propagate the risk that these more infectious variants will spread globally. Entertaining this risk for any longer than is minimally necessary flirts with catastrophe and exposes so many of us to almost incalculable harm.