In April 2020 as the COVID-19 pandemic killed thousands daily, caused long-lasting effects in 25 percent of those infected, and shut down economies, an international effort tried to create a program that would distribute vaccines equitably. This plan, known as COVAX, would vaccinate people at high risk in both rich and poor countries at the same time, and only later would it give doses to healthier individuals. While the organization can still distribute vaccines to impoverished countries now, it failed in its original goal. Some idealists may blame the selfishness of wealthy governments and their citizens for COVAX’s failure, but the organizers should have considered mankind’s selfish nature when designing the program.
For COVAX to work, many rich countries agreed to purchase at least 10 percent of their vaccines from the program and donate funds to subsidize vaccines for poorer countries. With these resources, COVAX could make massive vaccine purchases at lower prices from suppliers, who are producing them as fast as possible, and then fairly distribute them worldwide. Healthier and younger people would wait until healthcare workers, the elderly, and other vulnerable groups across the globe received their doses. But the efforts unraveled when the Trump administration bypassed COVAX and bought vaccines for Americans at higher prices. Others, like the United Kingdom and European Union, did the same. The humanitarian program could not outbid these wealthy governments, so vaccines have gone first to the citizens of wealthy countries and others with diplomatic ties to states manufacturing them, particularly Russia and China. With limited funds, COVAX did distribute some vaccines before its supplier, the Serum Institute of India (SII), stopped exporting them to innoculate Indians during a deadly outbreak there.
Many, including World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, have said vaccinating younger and healthier people in rich countries, instead of prioritizing those at risk in poorer countries, would be a “catastrophic moral failure.” So wealthy states had an obligation to donate vaccines to poor countries instead of vaccinating less vulnerable citizens. After all, this situation is not like an airplane passenger needing to put on an oxygen mask first and then helping others; the US does not need most citizens vaccinated to buy and send doses to poorer countries. By implication, lockdowns and economic disruption in the United States and other prosperous countries would have lasted longer. With vaccinated (and unvaccinated) Americans returning to stores unmasked, hugging older relatives, learning in classrooms, enjoying baseball games in packed stadiums, going on postponed vacations, and resuming their pre-pandemic normalcy, the US did not choose this altruistic course. Meanwhile, the pandemic continues elsewhere, and new variants could cause havoc in the coming months.
Setting aside the perspective that governments have a moral obligation to serve their citizens first and foremost, states should beware of policies that might create social unrest or mass discontent. For many Americans, the last 16 months have already been some of the most disruptive and tumultuous within living memory, and delaying vaccines risked exasperating discontent. If politicians told voters they must social distance, cancel plans to see loved ones, risk death or serious illness, and live with COVID-19 until December 2021 or longer, they risked losing their jobs after the next election, even if they intended to help poorer countries. Citizens will tolerate some charity, but only if it costs them little or is in their interest. COVAX would cost them dearly, and because vaccines are highly effective, the program was not in their interest. Some might say the risk of potential new variants means equitable distribution is in their interest, but if manufactures can only make so many vaccines each month, variants will develop somewhere sometime despite fair distribution. So the variants increase the incentive for wealthy countries to buy up vaccines to protect themselves first before the inevitable variant arrives. These political realities should have been obvious. Both Republicans and Democrats would of course reject a policy that, for the sake of global charity, makes them unpopular and potentially gives the other party the White House. Consider, would Democrats now promote a different form of international generosity that might help, say, Donald Trump or Ron DeSantis occupy the Oval Office in 2025?
Frustration over slow vaccine rollouts was already palpable in wealthy countries, even without the further delays COVAX’s original plan would have required. Earlier this year, I watched a terse interview when EU-based reporters, with uncharacteristic angst in their voice, grilled an EU official for why his organization, which originally supported COVAX, failed to procure enough vaccines when the British and Americans could. Exemplifying this irritation, one Bloomberg editorial argued:
The painfully slow rollout of Covid-19 vaccines across the European Union is undermining any claims that government knows best, whether at a national or supranational level. Unless Europe gets its mass inoculation programs right, quickly, it will be hard to believe that its political model can deliver better results to its citizens than what’s available in the rest of the world.
Idealists should have understood that COVAX could not force every wealthy governments to participate, and after one inevitable defection the others must follow. Frustrated citizens would force their governments’ hands, or they would seek new leaders or possibly other forms of government. The last government out the door would likely face the most social unrest.
But after its mass-vaccination efforts, the United States should still donate life-saving vaccines abroad as quickly as possible, if for no other reason than to reduce the risk that a new variant could develop and threaten the current vaccines’ effectiveness. Deciding when to start can be tricky, and in hindsight many will critique the timing. Arguably, the US needed to start roughly around May 13 when the Center for Disease Control announced that fully vaccinated people could go maskless in most situations. At this point, political opposition to this humanitarian program, typical of most foreign aid, would be sufficiently low. Moreover, millions of Americans have refused to get the shots, which they need to prevent future waves, particularly if the delta variant becomes more prevalent or when winter weather forces people back indoors. Because of their refusal, the US should help those abroad who need the vaccine.
To its credit, the Biden administration announced on May 17 the US would donate 80 million vaccines, though this was nowhere near enough. The White House later said on June 10 the US would donate 500 million doses, mostly through COVAX, and other wealthy governments pledged a further 500 million doses. Some humanitarian groups and others still criticize these efforts. But these vaccines will still arrive years faster than any other in history, and they exist largely thanks to the prosperous governments’ funding and efforts that started in 2020. This is hardly a “catastrophic moral failure.”
Though laudable, COVAX should have anticipated how wealthy governments would buy and distribute vaccines to their citizens first. Proponents of the program may be tempted to blame wealthy people’s selfishness for the failure of COVAX, but its organizers had an obligation to understand the selfish nature of mankind and then design a pragmatic response. For instance, the goal should have been fast, not equitable, distribution. This way the program could have initially allowed governments to vaccinate their citizens first and then donate doses to poorer countries. Essentially, the US and others are following this pattern. But if idealists insist that a government implements altruistic policies that might cause social unrest, they should understand they are creating unrealistic expectations or future frustration. If a government does follow their advice, the policy could cause unintended consequences. The result of more realist, pragmatic policies may not be ideal, but human nature does not allow for much more.