Andrew Fenton and Letitia Meynell maintain that there is no ethical obligation to re-distribute COVID-19 vaccines to Ontario until the province justly and effectively manages their pandemic response.
Currently, Ontario is seeing an alarming surge of COVID-19 cases in their worst wave of the pandemic to date. Health care professionals are sounding the alarm, warning that hospitals are reaching capacity and so threatening their ability to provide sufficient care to those in need. This desperate state of affairs has prompted the Canadian Medical Association (CMA) to suggest that other provinces, whose situation is less dire, should permit the redirection of vaccines that are currently designated for their residents to COVID-19 hotspots in provinces like Ontario.
In Nova Scotia, both the premier and the chief medical officer are understandably reluctant to do this. Many Nova Scotians are still unvaccinated, including some who are at risk of getting seriously ill. What’s more, in provinces like Nova Scotia, residents have sacrificed as they comply with varying public health measures, with many experiencing income uncertainty, financial difficulties, and social isolation. Diverting vaccinations from Nova Scotians means they will continue to face these risks and carry these burdens yet longer, further delaying their return to some sort of normal.
The CMA, the Nova Scotia premier, and chief medical officer are each attending to aspects of the crisis that are ethically significant. Residents in other parts of Canada shouldn’t ignore Ontario’s current public health crisis or fail to respond if they can. If Nova Scotians were in the same predicament, we would hope that other Canadians would come to our aid. Moral traditions from around the globe emphasize not only that we should treat others as we would want to be treated ourselves but also express commitments to eliminating suffering by responding with compassion and care. Such commitments are on display in our hospitals and clinics and praised by many in our communities, suggesting their importance to most Canadians.
From a social contract perspective, we should recognize that a society committed to justice must benefit the most vulnerable and needy among us. This is a long-standing commitment of the best of so-called Western political philosophy. However, just as this commitment to social justice might inspire Nova Scotians to continue to sacrifice to help other Canadians, it also constrains the conditions under which it would be reasonable for them to do so. Put simply, if any of us are to risk our wellbeing to benefit others, it is reasonable to expect that it will be worth it. In this context, we need to have confidence that our contribution will genuinely help to alleviate the pandemic and protect those most vulnerable and in the most desperate need. To do otherwise fails to properly weigh the relevant harms and benefits. Without a well-founded confidence that the redistribution of vaccines would benefit those most in need, we would also disrespect Nova Scotians and their sacrifice. We would treat them as mere means to achieve something less than what could reasonably and ethically motivate their sacrifice, perhaps political expediency or the appearance of political leadership in a crisis.
Underrepresented and underprivileged groups are bearing the brunt of this pandemic. Toronto Public Health has reported that roughly three quarters of Toronto’s cases have been in “racialized” groups and that people with lower incomes have been three times more likely to test positive than those who were not low income. Some of the most vulnerable, the inner city homeless, are facing a housing crisis as cases surge in shelters. However, as critics have noted, the measures implemented by the Ontario government have not been adequate, nor has the government adequately addressed the inequities making certain socio-economic groups vulnerable to harm. Moreover, there is ample evidence that vaccines in Ontario are neither being effectively distributed to those places where the virus is worst nor to those populations who are currently at the most risk.
Right now, vaccines are a sufficiently scarce commodity, and the public health crisis is sufficiently dangerous to all Canadians, that redirecting vaccines from provinces like Nova Scotia shouldn’t be supported without placing conditions on the redistribution. If provinces like Nova Scotia are to take on the risks associated with the current pandemic and continued harms associated with public health measures, the benefits must clearly outweigh these harms and in ways that do not violate justice. There must be reasonable confidence that redistributed vaccines will go to those most in need and be used for maximum efficacy in fighting the pandemic. If the Ontario provincial authorities continue to inadequately respond to the current public health crisis, it is difficult to see how a just and ethical harm-benefit analysis would favour redirecting vaccines. That is why, despite the overwhelming need in Ontario, provinces like Nova Scotia can rightly say “not yet.”
Andrew Fenton is an Associate Professor of Philosophy at Dalhousie University
Letitia Meynell is an Associate Professor of Philosophy at Dalhousie University