Compare two otherwise similar towns. In Town A there have always been 1000 deaths every month from disease X. In contrast, Town B has been free of disease X for as long as anyone can remember until very recently when disease X suddenly started to kill 1000 people per month. A vaccine for disease X is
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Compare two otherwise similar towns. In Town A there have always been 1000 deaths every month from disease X. In contrast, Town B has been free of disease X for as long as anyone can remember until very recently when disease X suddenly started to kill 1000 people per month. A vaccine for disease X is developed. Which town should receive expedited vaccinations?
From a utilitarian perspective, both towns present equally compelling cases for immediate vaccination (1). Vaccination will avert 1,000 deaths per month in either location. The ethical imperative is thus to act swiftly in both instances. Lives are lives. However, given human psychology and societal norms, Town B is more likely to be perceived as facing an “emergency,” whereas Town A’s situation may be erroneously dismissed as less dire because deaths are the status quo.
A case in point. The WHO just approved a malaria vaccine for use in children, the R21/Matrix-M vaccine. Great! There are still some 247 million malaria cases globally every year causing 619,000 deaths including 476 thousand deaths of children under the age of 5. That’s not 1000 deaths a month but more than 1000 deaths of children every day. The WHO, however, is planning on rolling out the vaccine next year.
Adrian Hill, one of the key scientists behind the vaccine is dismayed by the lack of urgency:
“Why would you allow children to die instead of distributing the vaccine? There’s no sensible answer to that — of course you wouldn’t,” Hill told the Financial Times. The SII said it “already” had capacity to produce 100mn doses annually.
…“There’s plenty of vaccine, let’s get it out there this year. We’ve done our best to answer huge amounts of questions, none of which a mother with a child at risk of malaria would be interested in.”
Hill is correct: the case for urgency is strong. More than a thousand children are dying daily and the Serum Institute already has 20 million doses on ice and is capable of producing 100 million doses a year. Why not treat this as an emergency?! Implicitly, however, people think that the case for urgency in Africa is weak because “what will another few months matter?” The benefits of vaccination in Africa are treated as small because they are measured relative to the total deaths that have already occurred. In contrast, vaccination for say COVID in the developed world (Town B) ended the emergency and restored normality thus saving a large percent of the deaths that might have occurred. But the percentages are irrelevant. This is a base rate fallacy, albeit the opposite of the one usually considered. Lives are lives, irrespective of the historical context.
Hill, director of the university’s Jenner Institute, compared the timeframe with the swift rollout of the first Covid vaccines, which were distributed “within weeks” of approval.
“We’d like to see the same importance given to the malaria vaccine for children in Africa. We don’t want them sitting in a fridge in India,” he said. “We don’t think this would be fair to rural African countries if they were not provided with the same rapidity of review and supply.”
The term “emergency” inherently embodies the conundrum I highlight. Emergency is defined as an unexpected set of events or the resulting state that calls for immediate action. When formulating a response to an emergency, however, the focus should not be on whether the events were unexpected but on the resulting state. The resulting state is what is important. The resulting state is the end that legitimizes the means. The unexpected draws our attention–our emotional systems, like our visual systems, alert on change and movement–but what matters is not what draws our attention but the situational reality.
Lives are lives and we should act with all justifiable speed to save lives. The WHO should accelerate malaria vaccination for children in Africa.
(1) You might argue that in Town B the 1000 deaths are more unusual and thus more disruptive but you might also argue that Town A has undergone the deaths for so much longer that the case for speed as matter of justice is even greater. These are quibbles.
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