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Are we OK that low-risk populations in rich countries (like ours) are being vaccinated before high-risk populations elsewhere?

Many people want to know who in their country will be the first to get the COVID-19 vaccine and where they are on the priority list. I am more interested in who should be the last to get the vaccine, and not only in rich countries that have early access to vaccines, but around the world.

COURTESY PHOTO - Françoise Baylis is University Research Professor at Dalhousie University and the Wayne Morse Chair in Law and Politics 2020-2021 at the University of Oregon.Last in line should be people for whom there are no clinical trial data confirming the vaccine is safe and will prevent symptomatic, moderate or severe COVID-19 infection. For most of the available vaccines that means, for example, that youth under the age of 16 or 18 (depending upon the vaccine) should not be vaccinated.

Among those for whom there is data about safety and efficacy, last in line to get vaccinated should be people under the age of 50, who are in good health, from non-racialized communities, able to shelter in place, and if gainfully employed able to work remotely.

If one looks at national vaccine plans the priority groups for the initial rollout are, for the most part, strikingly similar. The focus is on those at high-risk of infection including the elderly, especially those in long-term care facilities, and front-line health care providers. This prioritization is not surprising given the overarching common goal to reduce the number of cases, infections, hospitalizations, admissions to intensive care units and deaths while moving toward population immunity.

What is surprising is that this prioritization is bounded by geographical borders as governments look to vaccinate their own populations, turning a blind eye to what is happening elsewhere. While this strategy may make sense politically, it makes no sense in terms of the goal of ending this pandemic. A pandemic is a global challenge. It requires a coordinated global response.

To date, neither the prospect of moral approbation nor naked self-interest has been sufficient to coax political leaders to abandon vaccine nationalism and do the right thing; the right thing being to distribute vaccine on the basis of risk. As a result, it is widely anticipated that low-risk people in high-income countries will be vaccinated long before high-risk people in low- and middle-income countries.

On Feb. 15, 2021, Dr. Ngozi Okongo-Iweala, the head of the World Trade Organization, spoke out against vaccine nationalism which she described as "a phenomenon where rich countries are vaccinating their populations and poor countries have to wait behind."

On Feb. 10, 2021, Ms. Henrietta Fore, the executive director of UNICEF, and Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, issued a joint statement emphasizing our interdependence and stating in no uncertain terms that "in the COVID-19 vaccine race, we either win together or lose together." Their statement included the following harrowing facts:

Of the 128 million vaccine doses administered so far, more than three quarters of those vaccinations are in just 10 countries that account for 60% of global GDP.

As of today, almost 130 countries, with 2.5 billion people, have yet to administer a single dose.

This unequivocal joint statement followed on the heels of an earlier statement by the director-general of WHO. In blunt terms he warned that the world was "on the brink of a catastrophic moral failure."

These plain language pleas by world leaders for justice and equity have fallen on deaf ears. How can this be?

One plausible explanation is that even if political leaders think globally, they believe they must act locally because they have special obligations to citizens and residents that supersede obligations to foreigners.

A less generous explanation is that political leaders want to be re-elected and they believe the path to re-election will be especially challenging, if not foreclosed, if voters hold them responsible for their delayed access to vaccine.

Without knowing if either of these explanations is applicable, the challenge before each and every one of us is to stop and think about the kind of world we want to live in. In my book, "Altered Inheritance: CRISPR and the Ethics of Human Genome Editing," I argue that "I want to live a world that promotes equity and justice and celebrates difference, a world where everyone matters. I want to live in a world where we embrace neighborliness, reciprocity, social solidarity, and community; and a world that values collegial as opposed to competitive relations."

In this imagined future world, we all flourish. No one is left behind. You can help to build this world by standing up for the poor and downtrodden. By letting your government know that you support the view that vaccines should be distributed on the basis of need, not on the basis of wealth, power and geography.

City Club of Portland

Françoise Baylis is university research professor at Dalhousie University and the Wayne Morse Chair in Law and Politics 2020-21 at the University of Oregon. On Thursday, Feb. 18, she will make a presentation at City Club of Portland on the ethical implications of a promising new technology that could allow doctors to "rewrite" the code of specific genes that cause genetic diseases. Learn more about her "State of Being" address, and City Clubs entire "State of the Possible" series, here.

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