In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

What experimental game theorists may have demonstrated is not that people are systematically irrational but that human rationality is heavily scaffolded. Remove the scaffolding, and we do not do very well. People are able to get on because they “offload” an enormous amount of practical reasoning onto their environment. As a result, when they are put in novel or unfamiliar environments, they perform very poorly, even on apparently simple tasks. -/- This observation is supported by recent empirically informed shifts in (...) philosophy of mind toward a view of cognition as (to cite the current slogan) “embodied, embedded, enactive, extended.” Andy Clark and others have made a very plausible case for the idea that a proper assessment of human cognitive competence must include environmental components. To limit our attention to what lies within the skin-skull boundary is, in effect, to miss the big story on human rationality. Insofar as we are rational, it is often because of our ingenuity at developing “work-arounds” to the glitches in the fast-and-frugal heuristic problem-solving capabilities that natural selection has equipped us with. And these work-arounds often involve a detour through the environment (so-called offloading of cognitive burdens). -/- When it comes to practical rationality, things are no different. Yet in many discussions of “the will,” there is still a tendency to put too much emphasis on what goes on inside the agent’s head. Our objective in this chapter is to articulate this conception of “the extended will” more clearly, using the strategies that people employ to overcome procrastination for the central set of examples. Procrastination, in our view, constitutes a particular type of self-control problem, one that is particularly amenable to philosophical reflection, not only because of the high volume of psychological research on the subject but also because of the large quantity of “self-help” literature in circulationa literature that provides an invaluable perspective on the everyday strategies that people use in order to defeat (or, better yet, circumvent) this type of self-defeating behavior pattern. In general, what we find is that the internalist bias that permeates discussions of the will gives rise to a set of practical recommendations that overemphasize changing the way one thinks about a task, while ignoring the much richer set of strategies that are available in the realm of environmental scaffolding. In the concluding section, we highlight some of the policy implications of this, particularly regarding social trends involving the dismantling of support structures. (shrink)

Politics, Philosophy & Economics, Volume 21, Issue 2, Page 165-189, May 2022. It is generally acknowledged that a certain amount of state intervention in health and health care is needed to address the significant market failures in these sectors; however, it is also thought that the primary rationale for state involvement in health must lie elsewhere, for example in an egalitarian commitment to equalizing access to health care for all citizens. This paper argues that a complete theory of justice in (...) health can be derived from a commitment to correcting market failure, or in other words promoting Pareto-efficiency, in the domain of health. This approach can address familiar problems around access to care, as well as problems related to resource allocation and rationing, the control of health care costs, and the foundations of public health. Egalitarian theories of justice in health cannot make sense of the depth and pervasiveness of state involvement in health and health care; only a theory rooted in the need to correct market failure can. (shrink)