To Each According to their Need: The Morality of Vaccinations

The accelerating roll-out of COVID vaccines has stirred optimism among Canadians that the pandemic may be entering its last stages. An interesting dimension of the roll-out is the strong consensus among Canadians that the most at-risk Canadians should get vaccinated first: older Canadians, residents of long term care facilities, front-line workers, Indigenous people, prisoners, and others. In this commentary, a version of which was originally published in the Toronto Star, Jim Stanford considers the implications of this moral position – and wonders why we don’t apply the same principle (“To Each According to Their Need”) in other areas of economic life.

By Jim Stanford

Excitement over the rollout of COVID vaccines in Canada is at fever pitch, and understandably so. After a year of lockdown, effective vaccines are the light at the end of the tunnel. Other than a small mob of anti-vaxxers, most Canadians are eager to get the jab – and start to put the pandemic behind us.

At first, after several manufacturing delays, this yearning sparked public anger. Critics claimed Ottawa had “bungled” the roll-out, hoping to damage the federal government’s popularity. But now, as distribution accelerates (and evidence shows the vaccines may be even more effective than hoped), the emotional tide is turning. If the roll-out continues smoothly, expect an outbreak of national optimism.

Amidst all the excitement, one underappreciated aspect of the roll-out says something powerful and positive about Canadian society. Every province and territory has announced a plan to distribute the vaccine, giving it first to those who need it most: older people (especially in long term care facilities), health-care and essential service workers, and others at particular risk of infection (variously including indigenous communities, those with other health challenges, and prison staff and inmates).

This explicit goal of vaccinating the most vulnerable first goes completely against the conventional rules of distribution that usually govern capitalism. Normally, when demand for something exceeds its supply, money – not need – determines who gets served first. The price rises, and those who can afford it go to the front of the line.

In fact, competition is always devising new ways for people with money to jump the queue: separate lines for check-in and security clearance at the airport, early access to concert tickets, and even segregated line-ups for midway rides. The old-fashioned idea of waiting your turn has been steamrollered by the disequalizing logic of financial privilege.

This makes it all the more noteworthy that there’s virtually no disagreement over the decision to give scarce vaccines first to the most vulnerable. At most, there have been small skirmishes over precisely who is most deserving – like when Conservative leader Erin O’Toole said prisoners should go last (and was quickly denounced by public health and legal experts).

But on the whole, the premise that vaccines should be given out first, to those who need it most, is enthusiastically and almost universally endorsed. Casino boss Rob Baker and pension CEO Mark Machin learned this the hard way when they tried to jump the queue – and lost their jobs as a result.

Why do we feel so differently about vaccines, compared to other commodities? It partly reflects our general support for universal health care. We also understand that herd immunity depends on widespread vaccination, so giving vaccines to everyone (rich or poor) is actually an act of collective self-interest, not charity. But on some deeper level, we are also expressing a strong moral proposition. In a national emergency, rich people do not have a greater right to survive.

Imagine if we then applied this same philosophy – “to each according to their need” – to other essential products and services. If we agree that every Canadian deserves access to essential things that permit life, and that providing that access makes us all safer, then there are many other places the same logic should apply.

An obvious example is housing. The health consequences of homelessness are probably even worse than catching COVID. Studies estimate homeless people experience mortality rates up to 30 times higher than the housed population. People experiencing homelessness die, on average, before they are 50. And the health, social, and fiscal consequences of homelessness are not confined to those without homes: they impose real costs and risks on all of us.

For reasons that exactly parallel our approach to vaccines, therefore, Canada should commit to eliminating homelessness (like Finland has done). Indeed, we could go further and prohibit (or at least heavily tax) ownership of second homes for vacation or investment purposes – until such time as every Canadian has one. After all, school cafeterias work the same way: nobody gets seconds until everyone’s had firsts.

Where vaccines are concerned, Canadians almost unanimously reject the idea that having money justifies special treatment. It’s time to start questioning that insidious assumption in other areas of life, too.