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Vaccinating the global poor is a moral problem that requires a political solution

Summary:
Writing in The Atlantic in May 2021, Hoeg, Prasad, and Ghandi argued that the United States should delay vaccinating children against COVID-19 until vulnerable adults are vaccinated in poorer countries around the world.  A similar argument could now be made for delaying boosters, at least for people who are not at high risk.  An unvaccinated elderly person in India or Africa is thousands of times more likely to die from COVID-19 than a healthy, middle-aged, vaccinated-but-unboosted American.   As a matter of personal morality, I find this argument compelling.  I avoided the virus for most of 2020, but late in the year, before vaccines were available, I spent a few hours in an emergency room and left with COVID-19.  During the initial vaccination

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Writing in The Atlantic in May 2021, Hoeg, Prasad, and Ghandi argued that the United States should delay vaccinating children against COVID-19 until vulnerable adults are vaccinated in poorer countries around the world.  A similar argument could now be made for delaying boosters, at least for people who are not at high risk.  An unvaccinated elderly person in India or Africa is thousands of times more likely to die from COVID-19 than a healthy, middle-aged, vaccinated-but-unboosted American.  

As a matter of personal morality, I find this argument compelling.  I avoided the virus for most of 2020, but late in the year, before vaccines were available, I spent a few hours in an emergency room and left with COVID-19.  During the initial vaccination campaign in the spring of 2021, I delayed getting my shots because supplies were limited, and it seemed likely that I was less vulnerable than others my age due to post-infection immunity.  More recently I have resisted getting a third shot because it troubles me that millions of lower-risk Americans are getting boosted while many more vulnerable people in other countries remain completely unvaccinated. 

And yet . . . as an economist I cannot avoid suspecting that small moral gestures like mine are unlikely to protect poor people overseas.  Pharmaceutical companies will not produce vaccines for people who cannot afford to pay for them.  To get the global poor vaccinated, we need to pay for their vaccines, not merely delay our boosters.  Moral problems sometimes demand political solutions.

Unfortunately, politics is the art of the possible, and foreign aid has long been unpopular in the United States.  The rise of nationalist sentiment and polarization only makes this problem worse.  As I write this it seems likely that Congress will refuse to help poor countries pay for vaccines, even though vaccinating the global poor may prevent new variants from arising and help the world economy recover from COVID-19.

Is there anything we can do to get around this problem, either now or in the next pandemic?

It seems clear that money for a global vaccination campaign should have been included in earlier COVID-19 funding packages, along with money for anti-virals, rapid tests, masks, and other pandemic tools.  Failure to appropriate funds for these purposes was a serious legislative error, and understanding why it occurred and how mistakes like this can be avoided in the future should be an important focus of researchers studying our pandemic response.

Another approach is to create a program that relies on the voluntary generosity of individual Americans.  To do this, Congress could authorize the purchase of enough vaccines to give every American adult two booster shots a year.  Then President Biden could ask healthy Americans to voluntarily delay their boosters for the sake of vulnerable people overseas, and unused vaccines would be made available to immunize the global poor.  Each dose sent abroad could be supplemented with a small payment to help cover the costs of getting vaccines into arms.

Under this approach tax dollars are used to give each American an entitlement to booster shots, not to benefit people overseas.  The decision to help vaccinate the global poor is one that each of us makes based on our own values and circumstances.  This might be less controversial than appropriating money directly for foreign aid, and giving Americans a low-cost opportunity to help the global poor may prompt Americans to re-think their attitudes towards humanitarian assistance. 

For now, however, perhaps it is time for me to roll up my sleeve and get boosted.

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