The short story “The Mask of the Red Death” by Edgar Allan Poe takes place in a country ravaged by a mysterious plague. Prince Prospero, the monarch of the nation, decides to take refuge in his castle, passing the time in drunken revelry with his courtiers while the rest of the population is left to fend for themselves. On the occasion of a particularly extravagant masked ball, the party is disturbed by an unfamiliar, grim figure cloaked in red. An angered Prospero chases the figure madly throughout the castle, only to be slain by one stroke of the figure’s hidden dagger. The rest of the courtiers then throw themselves at the figure and are shocked to discover the absence of any physical form behind the mask and costume. They die one by one at the hands of what they now recognize as the Red Death, the plague itself.
In other news, the world is currently under assault by a different deadly virus, COVID-19. Vaccination has been hailed as the only way to end the pandemic, but today, almost a year after the first COVID-19 vaccine was made available for distribution, 51.3% people worldwide remain unvaccinated. The problem is most acute in lower income countries where the rate of vaccination is approximately 3.1%. Nevertheless, the US has already begun distributing booster shots to its population. This decision is the latest example of pandemic nationalism, a policy approach which proves destructive for the nation implementing it and for the world at large. Instead, the United States ought to adopt a policy that balances domestic distribution with donating to the world, a goal which actively conflicts with booster shot distribution.
The term “pandemic nationalism” can be used to refer to a wide range of policies adopted by governments to prioritize the distribution of resources to fight a disease in their own countries at the expense of others. At least 69 countries (including wealthy nations such as the United States, Britain, France and Germany) have adopted policies to ban the export of protective equipment, medical devices or medicines at some point during the pandemic. In April 2020, for instance, President Trump used the Korean War-era Defense Production Act to ban the export of domestically-produced masks and try to force American companies to send masks produced in other countries back to the United States. Mariangela Simao, assistant director general for medicines and health products at the World Health Organization in Geneva, condemned export bans, stating that they “could disrupt supply chains of some products that were actually needed everywhere.”
The problem of pandemic nationalism didn’t disappear with the arrival of coronavirus vaccines. COVID-19 vaccine development occurred in wealthy nations, giving them an outsized influence over distribution. The United States and Britain both signed deals with vaccine producers temporarily preventing the export of domestically produced vaccines. The United States went further, conditioning subsidies to suppliers of resources needed to create the vaccines on the US having first access and instituting a rigorous approval process for exports of syringes and hypodermic needles. According to the Coalition for Epidemic Preparedness Innovations, these restrictions have led to vaccine resource shortages outside the US.
Enter booster shots. On August 18, 2021, the Biden administration announced a plan that would give boosters to all fully-vaccinated adults in the US eight months after their initial shot(s), with the rollout starting in mid-September. The public statement came before the FDA had officially authorized the Pfizer booster shot; Moderna had not even submitted an application for FDA approval. Both the FDA and the CDC expressed concerns about this time frame, stating that they likely would not be able to thoroughly review the evidence regarding the booster efficacy by the prescribed date. Furthermore, this announcement came amidst heated disagreement within the scientific community about the necessity of booster shots.
Some evidence from Israeli studies seemed to suggest a significant decrease in vaccine efficacy over time, prompting the Israeli government to begin rolling out booster shots. However, many experts found the studies insufficient and cited the fact that all of the COVID vaccines were still very effective at protecting people from severe disease. The World Health Organization specifically decried the Biden administration’s decision as unecessarily nationalistic.
Ultimately, the plan did not emerge intact. After a few weeks of confusing messaging, the FDA advisory panel authorized and the CDC recommended the Pfizer booster shot for the elderly, those with higher risk for severe disease, and those with high-risk jobs. This move led to more controversy about the vague phrasing of the term “high-risk jobs.” The approval of the Moderna booster for the same three groups and the Johnson & Johnson booster for all adults who had received the Johnson & Johnson vaccine originally. A mix-and-match option was also approved.
In response to worries that the US vaccine booster rollout would detract from the objective of vaccinating the world, White House Press Secretary Jen Psaki assured journalists that the US could “do both.” This is, of course, a classic political platitude. Every vaccine dose that remains stockpiled in the US to serve as a booster shot is one less vaccine dose that could be sent abroad. The United Nations-backed global vaccine distribution program COVAX has repeatedly struggled to meet its goals as the wealthiest nations resorted to vaccine-hoarding. In early September, it had to reduce its goal by 25%. In moving forward with booster shot distribution, the United States’ message was clear: like Prince Prospero, it intended to use its wealth to insulate itself from the virus while the less fortunate suffered.
But even from the perceived safety of his secluded abbey, Prospero could not escape the deadly wrath of the Red Death. Similarly, if the COVID-19 epidemic continues to spread in poorer nations, wealthy nations will face the impacts. One form this will likely take is variants.
If a virus is allowed to thrive and spread, it frequently evolves into new, more contagious variants. Several COVID-19 variants have already been identified since the original strain, the most widespread of which is the Delta variant.
Of course, one could imagine a situation where high income nations used their resources to produce new vaccines year after year to protect their populations against new COVID variants. This situation may be inevitable, but there are many reasons to consider it suboptimal. First, developing new vaccines takes time. Consequently, some citizens of these countries will still face the latest variant without defenses, resulting in hospitalizations and deaths. Second, many western countries have a significant and growing portion of the population who mistrust vaccines in general and refuse to get vaccinated. The problem is particularly egregious in the United States. The recent announcements of booster shots only galvanized the vaccine skeptics who took it as evidence that the vaccines didn’t work in the first place.
In a scenario where new versions of the COVID vaccine were released regularly in order to fight off variants, an important minority would remain unvaccinated, preventing the achievement of herd immunity. If we truly want to protect Americans from COVID, our best chance is to vaccinate the world.
But beyond pragmatics, there is also a principled reason to favor vaccinating the world over maximizing the immune protections of people in one’s own country. Most people recognize that a person’s birthplace is arbitrary, and, as such, not morally significant. In other words, a person has equal moral worth whether they were born in the United States or Bangladesh. Of course, the question of moral obligation becomes more complicated at the level of government policies. People pay taxes and elect their national governments to serve their interests, so their governments have a special duty to them.
Nevertheless, most wealthy western governments (at least nominally) acknowledge some duty to the world at large. Military interventions are typically framed in humanitarian or human rights-related terms. But, as the recent debacle in Afghanistan demonstrates, the task of tangibly improving in people’s lives through military action is extremely difficult. Even other forms of involvement like international charity organizations frequently suffer from a lack of complete information about the regions they’re supposed to aid and thus fail to properly allocate funds. Distributing the vaccine, on the other hand, gives us a clear opportunity to do good- and we should fully use it.
What would balancing national interest with global responsibility actually look like? One proposal put forth by ethicists in the essay “How Many Vaccine Doses Can Nations Ethically Hoard?” uses the flu as a guide. They point out that the US currently allows its population to take certain risks related to the flu (not having to wear masks, no vaccine mandates). Under the flu standard, a country would only prioritize its national interests insofar as they helped the country approach the same level of danger for COVID-19 as for the flu. Because the overwhelming majority of the cases of coronavirus occur in the unvaccinated, rolling out booster shots would not be included in this approach.
The appeal of booster shots is not difficult to understand. For members of the population who take COVID-19 seriously, boosters offer a feeling of additional security from a virus that destabilized their lives and likely killed many in their communities. For politicians, they offer the political advantage that comes with projecting a nationalist image; in the midst of a crisis, it is critical to appear to put one’s voters first. But wealthy nations cannot hide away in a castle during a pandemic, and to the extent that booster shots prevent us from vaccinating more of the world, they are a mistake.