“To what extent is it the responsibility of world leaders to distribute COVID-19 vaccinations to their own people and those of other nations?”
Introduction
Even before the emergency-use authorisation of the first COVID-19 vaccine on the 11 December 2020, (1) wealthier countries had already purchased 3.8 billion doses of coronavirus vaccines. This incredible amount could allow them to immunise their entire populations, however, consequently left the developing world vulnerable and without access to protection. (2) As high-income countries (HICs) move to vaccinate most people, there is a growing divide between developed and developing countries regarding their ability to fight the pandemic. The inequity of vaccine distribution and its detrimental impacts on quality of life led us to question, “To what extent is it the responsibility of world leaders to distribute COVID-19 vaccinations to their people and those of other nations?” This question is hugely significant as the global COVID-19 pandemic transcends political and physical boundaries; the world is increasingly globalised, and isolation is essentially an impossible means of survival. This research paper aims to demonstrate why world leaders should vaccinate the global population. In the COVID-19 pandemic, world leaders are responsible for aiding worldwide vaccination efforts to achieve international herd immunity. This paper intends to show the benefits of doing so by setting out the moral obligations and the economic recovery available to the nations that choose to aid their own and other populations. ‘Vaccine nationalism’, or prioritising the vaccination of your own country’s people, neglects the bigger picture. While an individualistic approach may protect a nation from COVID-19 in the short term, a global and interdependent effort is needed to end the pandemic.
Economic Factors
The COVID-19 pandemic has had an unmistakable impact on the global economy and individual economies; growing unemployment, recessions and the struggling tourism industry have led the IMF to estimate a shrinkage of 4.4% in the global economy in 2020. (3) Despite the virus impacting most parts of the world economy, slower responses from governments to curb the spread of infections exacerbated the public health crisis. Their inability to react quickly consequently worsened the state of the economy, as seen in India and Brazil. (4, 5) It is now the job of these governments to help their economies recover from the devastation of the pandemic. This paper aims to show how achieving immunity through vaccinations is crucial to helping the world bounce back. World leaders should be held responsible for vaccinating their people, and where resources are available, they should aid economically disadvantaged countries with their vaccine rollout to achieve global herd immunity faster.
The United Kingdom
The U.K. is a prime example of the benefits of a government taking responsibility to vaccinate the population against COVID-19. In March 2021, the U.K.’s GDP grew by 2.1%, ‘the fastest monthly growth since August 2020’ (6), following nearly 40% of the population receiving at least one COVID-19 vaccine dose in the first three months of the year. (7) By July 2021, over half of the U.K.’s population was fully vaccinated against the virus. An increasing proportion of vaccinated people allowed the government to slowly ease coronavirus restrictions, such as lifting lockdowns, reopening schools and non-essential businesses, and removing legal limits on social contact and wearing masks. (8) Logically, with people free to move around and partake in leisure activities after months of restrictions, there was a boom in the services sector. Output grew by 37.1% between April and May 2021. Despite being below pre-pandemic levels, the steady month-on-month rise is a promising start to a recovering economy boosted by vaccinations. (9) Retail, tourism and travel sectors can start to bounce back. In addition to helping the economy recover by rebounding specific sectors, vaccinations have also allowed the government to spend less on coronavirus-related hospitalisations. In the U.K., the National Health Service (NHS) provides universal healthcare, funded through general taxation. (10) Public Health England estimates that up to the 27 June 2021, vaccinations against COVID-19 have prevented 46,300 hospitalisations of people aged 65 and older. (11) Public health resources and funds can be diverted less towards treating coronavirus patients, thus reducing the drain on the economy.
The reason the U.K. acted so quickly to secure vaccines and, by extension, to help the economy recover, was due to a legal duty to protect human lives. The United Nations and the European Convention on Human Rights set out a universal standard for human rights. However, the U.K.’s Human Rights Act of 1998 directly weaves these standards into the legislation. This Act of Parliament protects the absolute right to life in Article 2, and the government and the NHS as a public body are obliged to act upon said right. Encouraging the vaccine rollout was one such way of protecting the right to life. Preventing people from contracting COVID-19, especially those at high risk of doing so, is an evident example of acting in accordance with Article 2 of the ECHR. (12) By holding themselves accountable to international and national human rights legislation, the U.K. government saved lives and reaped the economic benefits of doing so.
Nevertheless, although the British government did its duty to vaccinate and protect its people, it may be argued that it was at the expense of less economically developed nations. The U.K. was among the countries ordering the highest doses of vaccines at the end of 2020 – enough to vaccinate the population multiple times over. (13) Securing such a large number of vaccines, even before experts approved them for use, could be seen as a selfish and nationalistic move by the U.K. government. However, pre-ordering ensures you get first access to the vaccines, and helps to fund and hence speed up the process of vaccine development. (14) Nevertheless, now that the U.K. has administered 122 doses of COVID-19 vaccines per 100 people, (15) it and other G7 nations should be looking at helping poorer countries whose reliance on the COVAX global vaccine sharing initiative has resulted in little success. In February 2021, U.K. Prime Minister Boris Johnson pledged to donate most of the nation’s surplus of vaccines to poorer countries. Ministers will not decide when this distribution will occur until later in the year, in case booster shots for fully vaccinated people are needed. (16) It seems unfair and illogical that people in high-income countries are worried about boosting their two vaccine doses as new virus variants emerge. In contrast, only 1% of people in low-income countries have received at least one dose. (17) There are not enough vaccines to immunise all high-risk groups in developing countries, such as healthcare workers and the elderly. So, theoretically, global vaccine supplies should be directed towards these groups, not children at lower risk of being infected and affected by the coronavirus. (18)
Sharing global vaccine supplies and helping the worst-affected countries benefits the local economy, even though government money is being spent on foreign vaccination programmes. Globalisation has interlinked individual economies to the degree where autarkies and closed economies cannot survive. Government leaders might vaccinate their entire populations against the coronavirus to reopen the local economy. However, if they do this while depriving other nations of the vaccine, it will work against them. Borders would need to be shut, and trade stopped to prevent the virus from entering the country at all. (19) The U.K.’s exports of goods and services as a percentage of GDP is 31.60%. (20) Individualism would serve no benefit to any countries wealthy enough to vaccinate their entire populations without foreign aid. A spokesperson from Gavi, the Vaccine Alliance, said, “The economic burden of this [individualistic] approach—aside from the human cost—would be catastrophic.” (21) Thus, wealthy nations, particularly those belonging to the G7, should focus more on aiding the developing world with its preliminary vaccine rollout to ensure that high-risk groups are protected globally, even if they can immunise their entire populations first.
Brazil
In comparison, Brazil is suffering from a meagre vaccination program, hard hit by the President himself spreading falsehoods, reluctance to take vaccines and vaccine shortages. The consequences are dire – the virus killed 540,000 people in the country, the second-highest total deaths by covid globally. (22)
Moreover, the pandemic has been a disaster from an economic standpoint. The International Monetary Fund estimates that Brazil’s 2020 GDP will shrink by 9.1%. (23) A month before vaccine rollouts started in Brazil, COVID-19 cases were surging in the country. During this time, President Jair Bolsonaro publicly criticised the Pfizer-BioNTech coronavirus vaccine. He suggested that even ‘if you turn into a crocodile’, the company would take no responsibility for side effects. He also included becoming ‘superhuman’ and women starting ‘to grow a beard’ as possible reactions to the vaccine. Such misinformation, coupled with his insistence that he would not take the vaccine himself, was an extreme failure as a leader to set an example for his struggling country to follow. (24) On the same day as his rant against vaccines, Brazil’s Supreme Court issued a ruling opposing the President. The legislation stated that Brazilians could be ‘required, but not forced’ to be vaccinated or risk bans from certain activities and public spaces. (25) Regardless of the power of legislation, Bolsonaro’s popularity created a reluctance to partake in the COVID-19 vaccination program. Bolsonaro won the 2018 election by a 55% vote – he has fervent supporters in Brazil (although his approval rates have fallen to 24% following his handling of the pandemic) (26). Even if he did not have supporters, he still holds great power and influence as the country’s figurehead. (27) His power can be evidenced by the increase in Brazilians refusing to take the vaccine from 9% in August 2020 to 22% in December of the same year, when Bolsonaro smeared the vaccine. (28) The U.K. has shown that vaccinations can successfully help control the pandemic to the point where it is safe to reopen and rebound the economy. If Brazilians, spurred on by Bolsonaro, remain distrustful of the vaccines, the country may never reach the stage of recovery where the economy can return to pre-pandemic conditions.
Even if President Bolsonaro encouraged his people to take the COVID-19 vaccine, shortages of vaccines have severely hampered the rollout of life-saving inoculations. In February 2021, Brazilian health minister Eduardo Pazuello, the third of four health ministers serving during the pandemic, (29) promised a delivery of 11.3 million doses of vaccines. The ministry announced this without commenting on the 2 million doses of AstraZeneca vaccines included in the plan, which Indian producers had not yet confirmed. (30) Major cities throughout Brazil have had to halt vaccinations due to lack of supply. At the end of June 2021, São Paulo, João Pessoa, Aracaju, Florianópolis and Campo Grande stopped administering the first doses of the vaccine. They limited themselves to only giving out second shots. (31) Two-dose vaccines need to be completed within a window of time. If there are insufficient deliveries to supply the second dose after the people receive their first, they cannot be fully vaccinated. (32) Many blame federal incompetence for the catastrophic crisis COVID-19 has created in Brazil. Brazil has 26 state governments and over 5,500 municipal governments, (33) which have failed to coordinate a centralised public health response to the pandemic. The politicisation of medical facts and public health measures has further exacerbated the disorganisation. (34) 7.78% of Brazil’s economy is reliant on travel and tourism. (35) As infections continue to grow and the country remains a discouraging travel destination, (36) the economy takes a tremendous toll each day.
In addition to government officials being unable to secure vaccine deals and failing to inoculate the Brazilian population efficiently, (37) COVID-19 crises elsewhere in the world have diverted vaccine supplies away from the country. India is the world’s largest vaccine producer and home to the Serum Institute of India (SII). As the country entered its second wave of the coronavirus in March of 2021, India had to delay exports of vaccines to lower-income countries participating in COVAX. India had to divert supplies from reaching the international community to prioritise its citizens, (38) leaving Brazil and others without vaccines. (39) Having such a considerable reliance on India created massive instability in global vaccine provision as efforts were focused on overcoming the country’s deadly second wave.
Although India was going through a particularly extreme scenario, other countries, including Brazil, also had serious concerns about increasing rates of infections. Former European Commission President José Manuel Barroso said it is “extremely important to be supportive of India … [but] we have to think about other parts of the world from Africa to Latin America,” calling Brazil an example of an “awful situation.” (40) More aid and support from the international community are needed to ensure that all less economically developed nations can access vaccine supplies, not just one or two acute cases. As previously stated in this paper, the U.K. committed to donating its surplus of vaccines to COVAX. However, in April, during the height of the second wave in India, a spokesperson for Boris Johnson said the nation had no surplus doses it could donate – it was prioritising vaccinating its population. (41) India’s second wave was a severe wave of COVID-19 infections inhibiting the global distribution of vaccines to poorer countries that need them the most. Nevertheless, it was not enough incentive for HICs to share supplies, despite having already inoculated their high-risk groups. World leaders should take responsibility for aiding less economically developed countries with their vaccination programmes to benefit the global community. The Gamma and Delta mutated variants of the coronavirus have originated from Brazil and India, respectively. Both have been identified in the U.K. (42) The international spread of COVID-19 mutations shows that it is beneficial to G7 leaders such as Prime Minister Boris Johnson to vaccinate the world’s population. Stopping infections and variants emerging in foreign territories will help the foreign economies recover and ensure their own economic rebound is unhampered.
Moral Factors
It is further essential to explore moral reasons for world leaders to donate and distribute vaccines across their own countries and foreign ones. Morality can be defined as “actions that are good, fair and honest”, (43) and while terms such as “good” are debatable and can vary, terms such as “honest” and “fair” are not as flexible in meaning. Philosophers have debated the definition of ‘morality’ for centuries, never reaching a definitive conclusion. This struggle exists because subjective words such as “good”, “correct”, and “right” (words often used to describe morality) do not have specific or absolute definitions themselves and vary between cultures. Hence, the idea of morality depends on the context and community in which it is being used. Despite this, according to HLA Hart, a legal philosopher, it is further necessary to note that while critical theorists see the law as mainly political, law theorists enrich the idea that the law is informed by morality rather than personal gain. (44) Consequently, while this means that laws will inevitably diverge and modify between nations, one could argue that breaking international or national law is an immoral act. Therefore, in this context, given that it is against legislation to refuse vaccinations or interfere with other states’ policies, the idea that governments hold a responsibility to protect their citizens from COVID-19 is a very significant concept.
Arguably, world leaders should be responsible for the vaccination of as many people as possible, inside and outside their borders, as leaving civilians without access to vaccinations may be seen as a violation of international law. According to the United Nations Universal Declaration Of Human Rights, every person has a right to an adequate standard of living, hence medical care. (45) Although some free-market economies provide mainly private hospitals (which could be considered a human rights violation in itself), an inability to provide vaccinations to those unable to afford medical care puts a more significant number of lives at risk. Those without the vaccine can both contract the virus and spread it to the more vulnerable. Therefore, many believe that the government has a moral obligation to ensure that everyone possible is vaccinated, as otherwise, a more significant number of lives are put at risk.
Furthermore, as seen in recent months, allowing a virus to spread increases the chances of a deadlier mutation. At the end of 2020, the Delta variant of COVID-19 mutated in India, spreading to other countries quicker than the original COVID-19 virus. (46) Not only is this variant more contagious, but it is also suggested to be even deadlier, hence accelerating the pandemic. (47) Mutations to the coronavirus such as the Delta variant only occur if the virus goes untreated. They can be lethal, given that they provide the virus with the opportunity to withstand and survive the conditions it lives in. Consequently, it could be suggested that governments have the responsibility to provide vaccines – inside and outside their own country – as a failure to do so inevitably leads to mutations, hence more significant public safety risks. This endangers civilians and, by extension, many may not consider it “fair” as some people are not being given the same opportunities to health and life as others who are vaccinated in another region of the world. Therefore, one could argue that refusing to vaccinate a population or a community is not “moral”.
Moreover, one could argue that governments have a moral responsibility to donate vaccinations as, if the virus continues to spread, then so will the levels of poverty and inequality. As previously discussed, the pandemic has negatively impacted economic growth in many nations, increasing the unemployment rate and money being injected into the economy. When looking at the U.K., for example, the BBC states that economic growth is at the lowest point since the 2008 credit crunch, (48) the unemployment rates are rising to the highest number in 5 years, and 67% of the workforce have seen a salary cut. (49) Ultimately, all of these factors inevitably lead to an increase in poverty and suffering. Once again, given that morality is defined as “good, fair and honest” actions, it can be argued that for a leader to neglect civilians – in terms of vaccines – who depend on them for stability and safety, is immoral. Even in democratic states, hospitals and healthcare services have mainly relied on government funding to donate vaccines. One could suggest that the government has a moral responsibility regardless of the law. This duty exists because, without government funds to purchase the vaccines, populations would not be vaccinated as quickly or efficiently, and populations would suffer; civilians themselves cannot buy the vaccine online like ordering Amazon packages. Therefore, civilians depend upon their government to provide healthcare, hence giving the government a moral duty to provide for the health and survival of their nation.
In addition, given that failure to vaccinate a population can lead directly to severe health risks, and unfortunately, in many cases, death, it is vital to discuss at what point it becomes genocide. According to international law statutes, genocide is described as “the deliberate killing, harming, forcing violence, preventing births and/or taking children away from a national, ethnical, racial or religious group”. (50) When looking at North Korean leader Kim Jong Un’s response to the pandemic, this question becomes relevant. In early July, Kim Jong Un refused approximately two million vaccines as donations from China, despite not having already vaccinated any of his population. South Korean officials further speculate that North Korea is not honest about its coronavirus count, or lack thereof. (51) It could be argued that failing to provide vaccinations to his civilians, hence leaving them at risk of a deadly virus, could be genocide. Initially, it must be noted that the entire population of North Korea can be categorised as a ‘national group’ when discussing the international law regarding genocides. However, the debate lies in the question as to whether leaving a population defenceless against the fatal COVID-19 virus is “deliberate killing/harming” (UN). While North Korean officials are not physically killing/harming their citizens, they deliberately leave citizens defenceless despite likely death.
Moreover, the fact that North Korea has declared itself in a state of food shortage since July 2021 should be considered. (52) Assuming that citizens facing a food shortage are also at higher risk for further problems such as malnutrition and multiple immunocompromised conditions, they can be assured they would be at a much higher risk of death given they contracted COVID-19. Altogether, attempting to fit North Korea’s vaccination refusal into the laws of genocide is complex and remains unanswered. However, whether it is genocide or not, the fact that Kim Jong Un is putting his citizens at a high risk of COVID-19 during their food shortage cannot be disregarded. Especially given the autocratic nature and centrally planned economic system that North Korea upholds, it could be suggested that Kim Jong Un must be deemed responsible for vaccine distribution. He is the only figure with the power to do so inside North Korea; his population depends on him for their health.
International Laws Of Sovereignty
However, despite the economic and moral factors supporting the idea that world leaders should be held accountable for distributing vaccinations, the idea of state sovereignty established by the Montevideo Convention and Westphalia contradicts this. According to the Montevideo Convention on the Rights and Duties of States – Article 8 – it was agreed that “no state has the right to intervene in the internal or external affair”. (53) In context, this would mean that if a country were to refuse vaccines and refuse to donate vaccinations (such as the case in North Korea), legally, no other country has the right to step in. While ratified by a mere 16 nations, this act is still a statute for international law and hence is still applicable. The Montevideo Convention also stated that all states remain within their rights to “legislate upon its interests” and “to define the jurisdiction and competence of its courts” (UiO). Therefore, many question the ability of foreign states to intervene in the distribution of vaccines because, as clearly stated by the Montevideo Convention, no other state has the right to interfere with legislation in another state. This notion of state sovereignty reinforces the idea that it is not the role of government officials to distribute and donate vaccines to other nations. If a government does not see vaccinations as necessary, they have no responsibility to distribute vaccines. However, a statement was released in a United Nations press release distributed after the Montevideo Convention on the 8th of October 1999. It declared that while it is crucial to adhere to the new laws of state sovereignty, the law will not be admissible if the law is being used as a “curtain behind which human rights violations were carried out”. (54) Therefore, in the aforementioned case of North Korea’s vaccine refusal, it is legally the responsibility of world leaders to intervene and help protect North Korean citizens.
For a long time, many have speculated about the power that the United Nations holds. There is no official governing body of law enforcement officers and little desire to create one; further, it must be considered how that impacts the decisions of world leaders. The idea that law can be upheld without a governing body has been questioned tirelessly. In addition to this, many are dissatisfied with the intervention that the United Nations has demonstrated in the past. Using North Korea as an example again, the Security Council has attempted interference and consequences against actions of North Korean governments, such as imposing sanctions after their intercontinental ballistic missile (ICBM) tests. (55) However, there has been very little response. North Korea continues to isolate itself from the rest of the world with strict border control. As previously mentioned, North Korea continues to suffer through a food shortage alongside their lack of vaccines. From here, one would expect intensive U.N. intervention as these conditions in North Korea are not uncommon, and the public has been aware of such actions. However, North Korea remains in the hands of Kim Jong Un and the consequences that come with his leadership persevere. The power of the United Nations is essential to discuss when exploring the responsibility of world leaders to distribute vaccines. This is because, although international law (the Universal Declaration of Human Rights and proportional or acceptable foreign interference) pushes world leaders to take responsibility for ensuring adequate healthcare – hence vaccines, there is very little (or inadequate) punishment and consequence for those who break international law. Therefore, despite the idea that world leaders should take responsibility for vaccine distribution, there are no detrimental legal impacts if they do not. As a result, one could argue that if world leaders can get away with not vaccinating their people and foreign citizens, then they will not view it as their responsibility.
Conclusion
Although state sovereignty laws would technically reinforce the idea that governments are necessarily only responsible for distributing vaccines to their people and not to those of other states, we cannot disregard the violation of international law. International law states that each nation has a right to complete independence and control within its borders. However, it further emphasises that the human rights and wellbeing of humanity are prioritised over the interest of the state. Due to increased globalisation and interaction between states worldwide, pandemics have become significantly harder to contain and cure – pathogens know no political boundaries. Furthermore, there is enough economic proof and moral reasoning that would emphasise the benefits independent states would reap if they were to aid in the global distribution of vaccines.
Ultimately, this paper contends that governments must take responsibility for distributing vaccinations as the only effective defence against the virus. Distributing vaccines would enable world leaders to manage and protect public health on a local and consequently a global scale. Furthermore, if a state does refrain from vaccinating its population, foreign interference administered and monitored by international organisations such as the U.N. can be justified.
Footnotes:
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41 Reuters, ‘UK has no surplus vaccines to supply to India, says UK PM’s spokesman’ (Reuters, 27 April 2021) <www.reuters.com/world/india/uk-has-no-surplus-vaccines-supply-india-says-uk-pms-spokesman-2021-04-27/> accessed 20 July 2021
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43 Cambridge Dictionary, ‘Meaning of moral in English’ (Cambridge Dictionary, 2021) <https://dictionary.cambridge.org/dictionary/english/moral> accessed 26 July 2021
44 John R Morss, ‘Sources of Doubt, Sources of Duty: HLA Hart on International Law (2005) 10 Deakin Law Review 698
45 World Health Organisation, ‘Human rights and health’ (World Health Organisation, 29 December 2017) <www.who.int/news-room/fact-sheets/detail/human-rights-and-health> accessed 26 July 2021
46 Centers for Disease Control and Prevention, ‘About Variants of the Virus that Causes COVID-19’ (Centers for Disease Control and Prevention, 2021) <www.cdc.gov/coronavirus/2019-ncov/variants/variant.html> accessed 26 July 2021
47 Kathy Kadella, ‘5 Things To Know About the Delta Variant’ (Yale Medicine, 28 June 2021) <www.yalemedicine.org/news/5-things-to-know-delta-variant-covid> accessed 26 July 202
48 BBC News, ‘UK economy suffered record annual slump in 2020’ (BBC News, 12 February 2021) <www.bbc.com/news/business-56037123> accessed 26 July 2021
49 Peter Crush, ‘67% of employees on low pay see salary cut due to pandemic’ (Employee Benefits, 11 February 2021) <https://employeebenefits.co.uk/67-employees-low-pay-salary-cut-pandemic/> accessed 26 July 2021
50 United Nations, ‘Genocide’ (United Nations) <www.un.org/en/genocideprevention/genocide.shtml> accessed 26 July 2021
51 CNA, ‘North Korea rejected AstraZeneca’s COVID-19 vaccine over side Effects: Think tank’ (CNA, 9 July 2021) <www.channelnewsasia.com/news/asia/covid-19-north-korea-rejected-astrazeneca-vaccine-side-effects-15188508 > accessed 26 July 2021
52 Agence France-Presse, ‘North Korea faces 860,000-tonne food shortage, UN forecasts’ South China Morning Post (Seoul, 7 July 2021) <www.scmp.com/news/asia/east-asia/article/3140130/north-korea-faces-860000-tonne-food-shortage-un-forecasts > accessed 26 July 2021
53 CNA (n 51)
54 United Nations, ‘Importance of State Sovereignty, Need to Address Human Rights Violations, Council Reform, Discussed in Assembly’ (United Nations, 2021) <www.un.org/press/en/1999/19991008.ga9633.doc.html> accessed 26 July 2021
55 United Nations, ‘UN Security Council toughens sanctions on DPR Korea over ballistic missile launches’ (United Nations, 5 August 2017) <https://news.un.org/en/story/2017/08/562882-un-security-council-toughens-sanctions-dpr-korea-over-ballistic-miss ile > accessed 26 July 2021
Table of Cases
Brazil Cases: ADIs 6.586 and ADI 6.587 [STF 2020] (BR)
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