Consider this thought experiment, retold in Jewish, Christian, and Islamic texts:
Balmy weather turns to scorching heat after weeks of desert travel. The terracotta terrain slowly blends together as the toll of trekking wears down the migrants’ vision. Two people, each from separate cities, brave barren land in search of water.
One night, the travelers happen upon each other and decide to camp together for the evening. Just before bed, one of the travelers decides to double-check their supplies for the next day.
There is only one canteen of water left between the both of them.
If they both drink from it, both will die in the desert heat of thirst. If one keeps it for themself, the other will most likely perish.
Do they decide by a coin toss, surrendering the decision to luck? Does the traveler who suffered the most in the desert deserve the life-saving water, making their troubles worthwhile? Or do they both perish in the name of equity?
These same questions apply to the moral and ethical issues surrounding traveling for a COVID-19 vaccine. In an unprecedented time of global suffering, the worldwide inequalities of healthcare systems are more pertinent than ever.
Now that we have all traveled through a painful desert of the pandemic, who deserves the “cure” first, or at all?
What if one of the travelers spent their days in paradise solely due to their unearned wealth while the other faced imminent death every day? The rich traveler drinking the water first, or at all, would almost certainly be immoral: if the poorer traveler is more at-risk from being exposed to the elements longer, there is a good case for their preference in relief.
These pressing moral questions rarely get the attention they deserve as the world’s rich travel around the wait for the vaccine in the global queue. For instance, an Indian travel agency began taking registrations of Indians with valid visas for their COVID-19 vaccine package — a four-day trip from Mumbai to New York City, London, or Moscow with a coronavirus shot included.
The cost? Around $2,000. With India’s GDP per capita in 2019 at $2,100, the average Indian citizen would need to spend all of their income on a ticket.
This implies that immunity to the coronavirus has a price tag. And it does — an inaccessible and discriminatory one.
This pattern of discrepancy continues worldwide: Canada’s Mark Machin, now former CEO of one of Canada’s largest investment companies, received a COVID-19 vaccination while on a “very personal” trip to Dubai. He promptly resigned amidst the public backlash. Before modified travel policies, 61,875 out-of-Florida residents from countries like Argentina have received the COVID-19 vaccine out of a total of 2 million people.
The rich and powerful have a direct line of access to post-COVID normalcy: one where the virus no longer acts as a threat to their lavish lifestyles. As desert travelers, the wealthy need not worry.
But what if the wealth gap between the two travelers was less significant?
If the wealth difference was smaller, the distinction becomes much less simple. Suddenly, both travelers suffer to a similar extent.
Even for people in less prestigious economic situations, the ability to travel long-distance is one of the best ways to cut the wait for the vaccine. They’re not as rich as a Canadian CEO, but they’re still skipping the line.
For example, more than 27,000 people have traveled to Ohio from out-of-state in order to get the COVID-19 vaccine. Americans drove in their cars for hours, rather than spending minutes in a private jet, to finally ease their worries about the virus.
Is it still unfair to travel, perhaps across state lines, even if the people traveling aren’t rich and powerful? Moral philosophers provide varying answers.
Utilitarianism, a theory, first postulated by Jeremy Bentham, argues that a decision is “moral” if its actions produce the greatest good for the greatest number of people.
If one of the travelers was a doctor who would develop a drug that would save millions of lives in the future, utilitarianism would say that they deserve to have the water because most people in the world would benefit from their survival. In the ethical issue here at stake, if individuals traveling for vaccines means the population gets vaccinated faster as a whole, traveling is probably permissible, even if made possible by massive wealth.
Hastening the pace of vaccinations would benefit the most vulnerable community members, too. Especially for people who can’t get vaccinated, people on immunotherapy or some people with AIDS, everyone needs to surround themselves with as much protection as possible. The greatest good for the greatest number means the most vaccinations, regardless of how far someone travels to get it.
Now, consider if one of the travelers had an illness that increased their chances of dying without water tenfold compared to the other traveler and made travel impossible.
This modified scenario demonstrates the most problematic part of “vaccine tourism,” a term referring to the new practice of traveling to receive a COVID-19 vaccine. The same conditions that lead to higher COVID exposure and worse outcomes — such as crowded housing or pre-existing medical conditions — also make it harder to travel.
Even if the water did save the life of the healthier traveler, the weaker traveler would still die. Therefore, not giving the water to the traveler that needs it more would make their already high risk higher still.
Drinking the water would protect the healthier traveler, but leaves the weaker traveler behind simply because they aren’t as adept to travel.
With the coronavirus, travel can both worsen disparities and save fewer lives because having the resources to travel is a good indicator for being less at risk of suffering from COVID.
Since this traveling inequality potentially contradicts the utilitarian mindset to do the greatest good for the greatest number, the separate theory of deontology could explain what the “moral” decision would be. Deontology, first introduced by Immanuel Kant, suggests that an act is morally right depending on the intentions of that act.
If the healthier traveler drinking the water would result in the death of the sick traveler, deontologists would deem that act inherently immoral.
Unlike utilitarianism, which considers the outcomes of an action, deontology considers the means and motivations. If an act is known to poorly affect someone who is disadvantaged, for example, the act itself is immoral — regardless of its outcomes.
With a deontological mindset, vaccine distribution might unilaterally prioritize those who are most vulnerable to COVID, regardless of the benefits of herd immunity.
There are setbacks to deontology, too. The theory might suggest that no traveler can take the water to prevent intentionally taking the life of the weaker traveler. In the vaccine space, deontology would imply that a rich person ought to bring a disadvantaged or at-risk person to get a vaccine before receiving their own — all in the interest of protecting the least-advantaged of society.
All these questions and examples create two potential worlds. The utilitarian world says more vaccines means more immunity. The deontological world, on the other hand, prioritizes helping the most vulnerable. Both question how ethical it is to travel and take away a vaccine from someone else.
While it seems like an impossible decision, both frameworks include a third situation that may provide the most moral outcome.
One traveler drinks all of the water. It doesn’t matter which one. With the canteen, the traveler makes all the way back to their city. Feeling particularly conflicted about what happened in the desert, the traveler decides to start a program that provides enough water so no one in their city ever is thirsty again.
In this situation, the traveler made the decision to keep the water for themselves and atoned for it by dedicating their life to an altruistic act. Under the utilitarian framework, this act would provide the greatest good to the greatest number of people by saving thousands from dehydration while still keeping in mind the means-oriented morality of deontology by prioritizing the most at-risk.
Israel, the UAE, and England, for example, have prioritized vaccines for the most widespread risk group, the elderly. As such, death rates have improved because their policies take into account the most vulnerable. However, these countries also allow for people to travel across borders to get vaccinated, increasing herd immunity.
If you happen to travel to get the vaccine, even though you may take away a shot from someone in a high-risk group, you can still make an ethical choice to take it: only if you’re willing to advocate for a better system in the future where the vaccine will get to the most vulnerable more efficiently and effectively.
When we’re forced to make unethical decisions, we have to demand better of the people in power. Asking for inherent inequalities to benefit the least-advantaged requires both acknowledging that these inequalities exist and that they have feasible solutions.
Though the desert we are slowly leaving behind us felt dangerous and daunting, it is little compared to the rainstorm of conflicting ethics we are braving. If all travelers protect themselves while simultaneously advocating for others, we can collectively relish in the revitalizing rainwater that will cleanse us of our precarious pilgrimage.
In policy, that means petitioning those in charge to recognize and create substantial change to combat the inequity of vaccine distribution. Only then is it ethical and moral to travel around the world for a COVID-19 vaccine.