The New York Post and others report that America's wealthy are already looking for ways to pay their way to the front of the line for the Covid vaccine. Presumably that also goes for the rest of the world's elite. We should have no doubt that they will succeed, one way or another. As a class they are extraordinarily well resourced and connected, and have repeatedly shown themselves willing to use those capabilities ruthlessly to advance their interests (and their children's interests) over and against moral norms and their society's carefully laid plans. However, although the rich always get what they want, it is possible to arrange things so that the rest of us can also get what we want. Our governments retain the capability to decide how the rich achieve their goal, and this allows us to turn their extraordinary dedication to pursuing only their own private interest into public benefits.
But first, a historical detour. During the Vietnam war rich Americans routinely bought their children's way out of the draft or otherwise out of harm's way by such means as paying the right doctors for certificates of extenuating medical conditions or exploiting connections to get them placed in National Guard units safely stateside. Obviously this was very unfair and caused a lot of resentment. It should be contrasted with President Lincoln's decision to sell draft exemptions for $300 (a labourer's wages for a year). Lincoln's government allowed the rich to escape their social duties - because they would have found a way anyway - but by a manner which helped fund the North's struggle in the civil war and hence brought closer the real goal of the war: winning it.
The lesson I take from the conscription case is that trying to treat the rich the same as the poor fails because the normal rules never apply equally to the rich (though that does not mean I support this state of affairs - previously). Lincoln provides a model of how to redirect the appalling selfishness of the rich into public service by charging them a price for it. It is Lincoln's logic we should apply to the case of which people should be the first to receive a vaccine presently still in scarce supply.
First, consider how things will play out if we pretend that rich people will respect the rules we come up with based on medical vulnerability (the most elderly) and medical value (frontline healthcare workers). The rich will simply buy their way ahead of those carefully considered ethical priorities by hook or by crook, just as they did to get hold of PPE and Covid tests when those were extremely scarce and supposedly reserved for others. If the rich fail in their initial efforts to bribe or cajole hospitals and their directors, they will pay doctors to certify to their greater medical needs, or they will employ agents to procure doses from bribed hospital employees or an emergent black market. At every level they are blocked, they will resort to dirtier means to get their way, and cause more disruption to the official distribution system.
Second, consider how things will play out if 1% of the available vaccine doses are set aside for the rich to bid for. The pressure that rich people put on the official distribution system will ease off, because they now have an easier legal way to get what they consider themselves entitled to. Moreover, rather than competing against the integrity of the official distribution system to get what they want, the rich will compete against each other to make higher contributions to society; and the more desperate or entitled they feel, the more they will end up helping those in greatest need. Specifically, those they will help are the poor, who have suffered very badly from the socio-economic disruptions surrounding Covid, but mostly won't benefit initially from the vaccine because they don't rank high on the priority list. (1 in 8 American adults reported going hungry in December, for example.) We should see the temporarily high price that the rich are prepared to pay for the vaccine as a special opportunity to benefit this otherwise neglected group of Covid victims.
It is true that there would be some costs to set against these benefits, but they are not so high. For example, losing 1% of available doses would cause a barely noticeable slowing down of the vaccination programme. Indeed, if sending the rich elsewhere successfully protects the integrity of the official distribution system, it might even speed it up!
However, I recognise that many people may disapprove of this proposal not because they disagree with my calculations of its net benefits, but because it is disgracefully unfair to privilege the rich in this way. Moreover, this unfairness can have consequences of its own, by corrupting the sense of reciprocity that underlies any society's cohesion and our ability to respond to crises like Covid together.
I do not think that this is so. We need to bear in mind that our actual choice is not between
- Allocating vaccines by moral priority alone
- Letting the rich buy their way to the front of the line
This is because option 1 was never possible! The rich were always going to get hold of the vaccine. The real choice is between
- Watching the rich illegally buy their way to the front of the line
- Allowing the rich to get to the front of the line by competing to help the neediest in society
It seems to me that 3) is significantly more unfair than 4). With option 3 the rest of society watches helplessly as the asshole elite rampages through our carefully ethically tuned vaccine distribution system, trashing it together with the moral principles of mutual reciprocity and care that it (and all our other cooperative schemes) depend on. Option 3 is the corrupting one. With option 4 we take back control and require that line jumpers do more good than harm. That is a fair principle on which to run things because it is one that we can all rationally endorse (no matter if we were rich or poor). Moreover, we could have a shared confidence that the official system (99% of distribution) was treating people exactly as we had collectively decided they deserved to be. Option 4 thereby supports rather than undermines the sense of reciprocity on which our cooperative efforts to overcome Covid ultimately depends.
Update 8 Jan: Fun as it was to write this, it seems that my starting assumption was misplaced: the behaviour of the rich was irrelevant. 1 month after the first person was vaccinated (using a Western licensed vaccine) only Israel has managed to distribute its vaccines remotely according to plan. I was worried about the rich looting our public distribution systems when I should have been worried about the extraordinary incompetence (bureaucratic disinterest?) that so many governments have shown in setting up and managing those distribution systems. I wonder if things might have gone better if we had adopted an entirely market approach to Covid: Allow the pharmaceutical companies to do everything and just pay them according to some formula involving reductions in (global) excess morality and infection rates.