Global Distribution of COVID-19 Vaccine: Mine First
Carlo Chiurco
Round 1
Reviewer 1 Report
I have read the article “Global distribution of COVID vaccine: Mine first” with much interest. This paper reviews areas where the distribution of the COVID-19 vaccines failed to be globally fair. It also makes some recommendations for the future. Although a much-needed work, in order to add a new perspective, the present paper has to be more thorough and comprehensive so that it exceeds what is already known and has been repeatedly discussed elsewhere. In this route, please see the following recommendations:
Major revisions:
11. Lines 54-55 says: “There was clear pressure from national public opinion for vaccine-producing countries to keep the vaccines within their borders”. This was certainly not the case; there are various evidence from high-income countries suggesting that public in these countries expressed their willingness to share their supply of vaccines e.g. see https://doi.org/10.1016/j.vaccine.2021.03.027, https://doi.org/10.1007/s40258-021-00696-8, and more.
22. The section “3. Lessons learned for the future”, the title is not in line with this section context and also the rest of the paper as the following sections (section 5) still discuss other barriers so a conclusive point has not been reached at this point. This section mainly highlights some issues at the recipient countries e.g. lack of infrastructure. Therefore, the section title needs to be changed to reflect this important issue and also this topic needs to be more thoroughly addressed. There are other issues discussed in this section that are repeated in other sections so really not clear what is happening here.
33. Some of the problems noted in section 3 in regards to the capacity are then repeated in section 6 “The question of capacity” that indicates the need for restructuring of the whole paper. I would suggest that the paper is broken into first, an in-depth discussion of what went wrong (each issue clearly listed), then a clear future solution proposed for each point raised in the first part indicating how previous mistakes can be addressed, and also a limitation section, declaring areas that the present proposal is not able to cover and remain to be addressed.
44. The issue of vaccine nationalism is repeatedly raised under various sections. Once reported, it does not add further information to repeat it in other sections that are discussing other issues.
55. Those complexities that led into COVAX missing its targets need to be looked into more in-depth e.g. see https://doi.org/10.1016/S0140-6736(21)01367-2 (and its counter argument https://doi.org/10.1016/S0140-6736(21)01544-0), https://doi.org/10.1080/17441692.2021.1987502, and more.
66. The topics of patent and intellectual property have been somewhat mentioned but these are more complex than presented here e.g. see https://doi.org/10.1136/bmj.o304 and https://doi.org/10.1080/13543776.2021.1945581.
77. The novel suggestion of the paper, that the future programs should take into account criteria such as capacity and urgency, although valid points, misses to indicated that how these criteria should be standardized and defined. Moreover, what is the guaranty that under this new proposal, any international authority would not become another COVAX? For this, the study needs to be more thorough and exceeds stating the obvious.
88. The paper proposal for the future does not address vaccine nationalism and issues around intellectual property. For this, the study needs to be clear what its proposal covers and what it does not under a study limitations section.
9Overall, many of the issues noted in this paper have been extensively expressed elsewhere. To be novel, the paper needs to dig deeper in many issues noted. Also, it has to make a more robust case and a clear structure that indicates why their proposal for the future is a solution to the existing problems and what is new about it.
Minor revisions:
19. The title (and in places elsewhere) “-19” is missing from the complete name “COVID-19”.
110. The numbering of subsection 6 is repeated twice.
111. The written English needs revision; e.g. the use of term “not only” in lines 100 and 141 needs to be revised.
Author Response
Dear reviewer,
Thank you very much for your detailed and thoughtful review. We have taken your comments into consideration and have made the following changes:
Major revisions
1. Lines 54-55 says: “There was clear pressure from national public opinion for vaccine-producing countries to keep the vaccines within their borders”. This was certainly not the case; there are various evidence from high-income countries suggesting that public in these countries expressed their willingness to share their supply of vaccines e.g. see https://doi.org/10.1016/j.vaccine.2021.03.027, https://doi.org/10.1007/s40258-021-00696-8, and more.
As you rightly point out, some high-income countries expressed their willingness to share vaccines. This certainly leads us to be unable to state categorically that all rich countries were pressured not to "share" vaccines and we have deleted that paragraph.
2. The section “3. Lessons learned for the future”, the title is not in line with this section context and also the rest of the paper as the following sections (section 5) still discuss other barriers so a conclusive point has not been reached at this point. This section mainly highlights some issues at the recipient countries e.g. lack of infrastructure. Therefore, the section title needs to be changed to reflect this important issue and also this topic needs to be more thoroughly addressed. There are other issues discussed in this section that are repeated in other sections so really not clear what is happening here.
We have rephrased the order of the paper as you suggested and believe that it is now more coherent. The new order tries to 1) identify the problem and point out what was done wrong and 2) pose a response to the problem.
The title also changes reflecting the importance of the issues at the recipient countries.
Changes in text:
1. Title: Problems in recipient countries and other lessons for the future
2. Reordering of sections and information
3. Some of the problems noted in section 3 in regards to the capacity are then repeated in section 6 “The question of capacity” that indicates the need for restructuring of the whole paper. I would suggest that the paper is broken into first, an in-depth discussion of what went wrong (each issue clearly listed), then a clear future solution proposed for each point raised in the first part indicating how previous mistakes can be addressed, and also a limitation section, declaring areas that the present proposal is not able to cover and remain to be addressed
As mentioned in the previous paragraph, all the problems have been grouped under section 3.
4. The issue of vaccine nationalism is repeatedly raised under various sections. Once reported, it does not add further information to repeat it in other sections that are discussing other issues.
It is true that at some point we recapitulated information about vaccine nationalism. However, we believe that this is relevant to maintain the sense of the text. Even so, the commentary has been taken into account and the text revised in relation to the comments.
5. Those complexities that led into COVAX missing its targets need to be looked into more in-depth e.g. see https://doi.org/10.1016/S0140-6736(21)01367-2(and its counter argument https://doi.org/10.1016/S0140-6736(21)01544-0), https://doi.org/10.1080/17441692.2021.1987502, and more.
This comment is very interesting and valuable. We have included a small clarification and the quotes in our paper.
Change in text: Although the absence of COVAX would probably have determined an even more inequitable, COVAX can be considered a failure, not just because it did not achieve its objectives, but also because it did not take into account the aforementioned issue of capacity[30,31]. (p.5)
6. The topics of patent and intellectual property have been somewhat mentioned but these are more complex than presented here e.g. see https://doi.org/10.1136/bmj.o304and https://doi.org/10.1080/13543776.2021.1945581.
Throughout the text, we have rephrased some parts to try to better clarify this issue. In addition, the papers have been very valuable to complete our information on the subject.
7. The novel suggestion of the paper, that the future programs should take into account criteria such as capacity and urgency, although valid points, misses to indicated that how these criteria should be standardized and defined. Moreover, what is the guaranty that under this new proposal, any international authority would not become another COVAX? For this, the study needs to be more thorough and exceeds stating the obvious.
We assume as a limitation the inability to know if our proposal could fall into errors similar to COVAX. Therefore, and taking into consideration your comment, we have added a section on limitations in which we acknowledge that this limitation is a limitation of our proposal.
Changes in text: Our proposal brings some novelties regarding how to distribute the COVID-19 vaccine in a more equitable way globally, however, we assume our limitations: the deepening in detail of, on the one hand, how to constitute and articulate international institutions with executive power in future pandemics and, on the other hand, how to make an equitable and efficient management of vaccine patents require explanations of international law that exceeds the objectives of this paper.
8. The paper proposal for the future does not address vaccine nationalism and issues around intellectual property. For this, the study needs to be clear what its proposal covers and what it does not under a study limitations section.
As with the previous comment, we have added consideration in this regard in the limitations section.
Changes in text: Our proposal brings some novelties regarding how to distribute the COVID-19 vaccine in a more equitable way globally, however, we assume our limitations: the deepening in detail of, on the one hand, how to constitute and articulate international institutions with executive power in future pandemics and, on the other hand, how to make an equitable and efficient management of vaccine patents require explanations of international law that exceeds the objectives of this paper.
9. Overall, many of the issues noted in this paper have been extensively expressed elsewhere. To be novel, the paper needs to dig deeper in many issues noted. Also, it has to make a more robust case and a clear structure that indicates why their proposal for the future is a solution to the existing problems and what is new about it.
Our objective with this paper lies in the proposal related to point 4. We believe that we do bring novel issues related to capacity and urgency. Even so, we understand and accept the comment.
Minor revisions
10. The title (and in places elsewhere) “-19” is missing from the complete name “COVID-19”.
We have added -19 in all the places where we referred to COVID-19.
11. The numbering of subsection 6 is repeated twice.
We have corrected the numbering so that it is not repeated.
12.The written English needs revision; e.g. the use of term “not only” in lines 100 and 141 needs to be revised.
We have revised the English, paying special attention to the "not only" that you point out.
Again, thank you very much for your detailed review and for your time.
Reviewer 2 Report
The paper addresses the issue of national and international responses to the COVID-19 pandemic, exposes shortcomings in these, and suggests ways in which future pandemics or global emergencies can be dealt with more effectively.
This is an interesting, original, and relevant question, and the authors analyse it competently. The paper will add depth to ethical discussion in this area.
The paper is well written and the text clear and easy to read, although a spell check might be in order.
The conclusions are consistent with the analyses and arguments presented and they address perfectly the main question posed.
Author Response
Dear reviewer,
Thank you very much for your comments and your positive feedback. We have revised the wording of the paper as you suggested.
Kind regards,
Reviewer 3 Report
The article tackles a very topical issue for ethics, politics and global health, i.e. how to respond to an unexpected global emergency as a global community. The author has a sound knowledge of recent literature on the topic. He analyses the inequality and lack of reciprocity in access to vaccines, highlighting consequences for both low-income countries and high-income countries. Finally, he suggests some criteria and guiding principles, considering global interdipendence as an undeniable framework of future political decision-making in health care.
The importance of the topic is wider than philosophical audience. I suggests to add in footnotes a brief clarification of Rawls' Principle of difference and Principle of efficiency in order to make the article more accessible to those lacking of philosophical skills and facilitate its dissemination.
Attention: Two paragraphs are numbered with 6.
Author Response
Dear reviewer,
Thank you very much for your appreciation and comments. We would also like to inform you that your appreciation is shared by another reviewer. We find your comment on the importance of deepening on Rawls's difference principle very important and we have therefore added a footnote explaining it in more detail. We have also corrected the numbering of the paper.
Changes in the paper: The theory of justice as fairness is fundamentally based on two principles: On the one hand, all people should be equally entitled to the greatest range of basic individual freedoms, provided that this range is compatible with the freedoms of others (principle of liberty). On the other hand, social and economic inequalities will have to do with positions accessible to all under conditions of fair equality and opportunity, and these conditions should be greater for the most disadvantaged members of society (principle of difference).within these principles, the first takes precedence over the second and the second part of the second principle takes precedence over the first. This means that the freedoms ensured by the first principle cannot be traded for greater economic advantages. Economic inequalities must be based, for their part, on the principle of fair equality of opportunity. (p.4)
Thank you and best regards,
Reviewer 4 Report
If the author wants to, but only if he does, he could compare the global impact of the pandemics to what is currently happening with global heating: no one is preserved from it. He makes the important point that denying help to poor people or countries does not adequately protect the rich ones; the same can be said concerning environmental problems, since national or social borders do not keep pollution and other major problems from affecting the whole population of the world. But this is only a suggestion that does not need to alter the paper, which is very good.
Author Response
Dear reviewer,
Thank you very much for your comment. We have taken it into consideration and added it in the text. We have made an analogy between COVID-19 and climate change and we think it is very accurate and brings an interesting point to the paper.
Changes in the paper: An analogy can be drawn between this problem and the issue of climate change, which is very topical in our time and which does similar damage. Although the richer countries are making efforts to combat it with zero-emission and pollution reduction policies, global action is needed to tackle it. Climate problems affect the entire population equally, and we must seek, as with COVID-19, an international strategy to prevent or at least mitigate the climate disaster. (p.3)
Thank you very much,
Reviewer 5 Report
The article may be published as it stands. What is lacking is a more detailed ethical argument: there is only one reference to Rawls' principle of difference, which is not thoroughly argument but only quoted. Such principle is not the only one: another (and, in my opinion, even stronger) argument for equality lies in vulnerability. Vulnerability not only defines humanity, but also provides the moral ground for the need of equality based on the interdependence it necessarily implies. As it stands, the article definitely benches more on sociology than moral philosophy. However, this is more of a suggestion (for further development of the author's research, for instance) than a criticism.
Author Response
Dear reviewer,
Thank you very much for your appreciation and comments. I would also like to inform you that another reviewer shares your appreciation. We find your comment on the importance of deepening on Rawls's difference principle fundamental and have added a footnote explaining it in more detail. We have also corrected the numbering of the paper.
Changes in text: The theory of justice as fairness is fundamentally based on two principles: On the one hand, all people should be equally entitled to the greatest range of basic individual freedoms, provided that this range is compatible with the freedoms of others (principle of liberty). On the other hand, social and economic inequalities will have to do with positions accessible to all under conditions of fair equality and opportunity, and these conditions should be greater for the most disadvantaged members of society (principle of difference).within these principles, the first takes precedence over the second and the second part of the second principle takes precedence over the first. This means that the freedoms ensured by the first principle cannot be traded for greater economic advantages. Economic inequalities must be based, for their part, on the principle of fair equality of opportunity. (p.4)
Thank you and best regards,
Round 2
Reviewer 1 Report
Thank you for the revisions and the clarity of manuscript has much improved.
