Covid Vaccine Ethics

Let’s just put this out there… any government that hasn’t promised a free vaccine is a disgrace. And there are some that haven’t, e.g. NZ (although I acknowledge the possibility the article is out of date and I haven’t noticed). But that doesn’t resolve the question of how to distribute an effective vaccine. All it says is that once it’s started rolling out, no-one should be paying at the point of purchase.

(EDIT: 26/11/20… NZ will have a free vaccination programme.)

Now, I’m going to be really frank with you… probably everything you know about New Zealand is PR bullshit. We’ve got notoriously bad water quality (don’t swim there), a government that lets the biggest greenhouse gas polluters slide (who are also the major reason for the water quality situation), our “kind” PM who was elected on the basis of a housing crisis has allowed the market to reach new records (during a recession!) as her government has closed off policy avenues and healthcare sucks here. Unless you go to a hospital, you’ll probably get charged an arm and a leg by your local GP. It’s not as bad as the US (so I hear) but that doesn’t make it good. And the administrative side is also… weirdly complex for NZ.

And here’s another thing that is PR Bullshit… the claim that NZ faces hard ethical and practical choices on a Covid-19 vaccine. Oh, sure, most countries probably do, but not us. And here’s why: the purpose of vaccination should be elimination. Of course, vaccines usually can’t eradicate diseases (and the one, iirc, time that happened it took decades to do it) and given the transfer between humans and animals we’ve seen with Covid, it looks like one of the ones that’s not going away. But we can use vaccines to eliminate epidemics and pandemics… if people get them (remember the Measles disasters of 2019? or has the chaos of this year driven them from your mind??). The thing is that elimination has been our policy the entire time.

At the moment NZ’s an archipelago at the bottom of the world, thousands of miles from anywhere and surrounded by dangerous seas. Look, that probably sounds like“easy mode” when it comes to dealing with a pandemic but it’s not. We need shit and it costs a lot to come here. It’s the same problem all Pacific nations face, we’re just lucky that we’re so much bigger that it’s not as bad. The point I’m making is that NZ’s an economy that depends on the outside world, so while we’ve got “easy mode” when it comes to border control, the problem is so much bigger than that. I mean, our schools literally use export education (international students) to correct funding shortfalls… not to get nice things but to get the basic things. Like teachers. And there are currently no new international students… not even from China which (a) has Covid basically under control, (b) buckets of potential international students and (c) a long history of sending them here.

(Wait… “at the moment”? I assure you, NZ has no current plans to relocate somewhere else. Nor does it appear anyone’s going to build some islands offshore.)

You may be wondering, “Okay, but what does that have to do with vaccine distribution?” Well, there’s the obvious trouble of getting the Pfizer -70C anywhere… and, in particular, to the aforesaid other Pacific nations (many of which are poor countries). But my main point is this: because we’ve managed to secure the virus (twice!) and because we know how it keeps getting in (literally squeaking through the border) and because we need the border to stay open (or do I mean… to open?) and because it’s all about elimination, the ethical issue disappears. We don’t need to worry about whether 90 year old grandparents or newborn grandchildren deserve a vaccine more or would gain more or whatever. They’re covered if only we can get the border sorted out.

Thus… a hierarchy, with those at the top to receive a vaccine before those below them:

1. Border and MIQ (managed isolation and quarantine) workers
2. Healthcare workers & key public health officials (so they can go overseas if necessary to help other countries)
3. Emergency response workers (NZ has a drowning problem… and also, to an extent, a lost in the wilderness problem) and defence personnel
4. Close contacts of border, MIQ and healthcare workers
5. Supermarket staff
6. Hospitalised patients, prisoners and sufferers of long-term illnesses (people with very limited options when it comes to exposure and mitigation)
7. All other essential workers (this is clearly defined in NZ, if you’re wondering)
8. Care workers and teachers (schools were closed under Level Four, ipso facto not essential workers)

And at that point I think we’ve basically reached the end of the “get everyone” list… and it’d be a lot of people. But here’s the thing… what to do next isn’t such a big problem either. Of course, it depends on some other factors such as the situation in the smaller Pacific nations to whom we bear more than a small measure of responsibility, but the general idea is clear. A lottery.

Okay, but what are those factors to think about?

• If we’ve got a lot of vaccines left after we’ve got through 1–9, I would have half of them go overseas… if they look like they’ll have vaccine supply issues (which, I am given to understand, is already the case). The remainder should prioritise, in the lottery, vulnerable groups like asthmatics and Aucklanders.
• If there aren’t many vaccines left, just ship them all off overseas.
• actually, those are the situations I could think of… I’m tired.

On the face of it, that hierarchy would work in most countries except the rationale doesn’t necessarily make sense. If the disease is in the population so saying that border workers are a group whose immunity would be particularly beneficial doesn’t really make sense. Indeed, you might say that supermarket and healthcare workers are the people to go for most… high exposure. What makes New Zealand different here, the only thing that matters, is simply that it’s easier to say with confidence that we can roll out a vaccine based on spreading risk. We can look at a group and say, “Right, you’re the people we’ve got to be concerned for and about”.

n.b. we might need to add neighbours of MIQ facilities in at the supermarket stage.