Ask 10 people how COVID-19 vaccines should be distributed, and you will get 10 different answers. But ask those people whether the current plan for distribution is fair, and you will likely get two different answers: Those who have received their vaccinations tend to say “yes;” those who have not tend to say “no.”
The truth is, we have a hard time applying the principle of fairness to complex problems involving large groups of people. That doesn’t mean we shouldn’t try.
At first glance, fairness seems simple enough. We use the concept all the time and have a pretty good idea what it means. We believe it is right to use the same standards, or laws, or policies for everyone — unless, that is, there are certain significant, relevant differences among those affected. In those cases, we should make exceptions. And that’s where the problem comes in.
When it comes to vaccine distribution, we are talking about a very large number of people with a practically incomprehensible number of differing conditions. And because both the virus and the vaccines are new, health professionals still do not know everything they would like to about which of those conditions are most important and why.
Take age, for example. Just about everyone agrees older people should be vaccinated before younger people. The devil is in the details. Is it fair that someone who just turned 75 last week gets vaccinated while someone who is 74 has to wait?
And are we really sure older people ought to be vaccinated first? If the goal of the vaccine is to reduce the spread of the disease, perhaps we should vaccinate those age 18 to 29 first, because they have the highest rate of incidence.
Or if our goal is to reduce the strain on the health care system, we could prioritize those who are 55-74, since they account for more Covid-19 related hospitalizations than any other age group (nearly 40%).
Then again, an argument could be made for vaccinating everyone 45 and older, because the proportion of deaths due to COVID-19 is about the same for everyone over that age, whereas the proportion drops considerably for anyone younger than 45.
This is already getting terribly confusing, and we haven’t even started to talk about how to prioritize people with different kinds of health conditions or those who work in high risk and essential jobs.
The key thing to understand is that fairness is not about the outcomes, it is about the process whereby the outcomes are achieved.
That’s something we continually get wrong in talking about fairness. You will sometimes hear a person say something like, “Well, that’s fair for him but not for me.” Strictly speaking, that’s incoherent. Something is either fair for all concerned or it is unfair. Whether it’s a law, a policy, a system, or a specific decision, to be fair it must avoid partiality. That’s just what the word means.
But the problem isn’t just the way we talk about fairness; the bigger problem is how we perceive it.
We tend not to complain about fairness unless we experience some disadvantage. Whether it’s a football game or an election, the winning team does not complain about the officials’ decisions; the losers are the ones who complain. That’s because our perception of fairness tends to be highly biased.
None of this means we should not question the fairness of vaccine distribution. Whenever there are people holding the power of distributing broad and highly significant social goods, we should pay very close attention to how they use that power. But we should also recognize that our individual judgment, informed by limited knowledge and focused on our own benefit, is not likely to be trustworthy. As John Rawls, author of “A Theory of Justice” observed, “Many of our most serious conflicts are conflicts within ourselves. Those who suppose their judgements are always consistent are unreflective or dogmatic.”
So, what should we do? As citizens, who are both beneficiaries and trustees of a significant public good, we should ask three questions to ensure fairness:
- Are those charged with deciding the protocols for distribution competent?
- Are they free from conflicts of interest?
- Do they provide as much transparency as possible given the available facts?
And that is where our responsibility ends. Even if we disagree with particular decisions or procedures, as long as the authorities are competent, impartial and truthful, we should acknowledge that their judgment is probably as fair as we can reasonably expect.
That does not mean we have to be happy with their decisions. But one of our responsibilities as citizens is to know that our private discontents should only rarely be expressed as public dissent.
When we indiscriminately level complaints of unfairness toward those charged with a difficult task, we make it less likely that competent and reliable people will step up to do a similar task in the future. That is a pathway to making things worse, not better.
Richard Kyte is director of the D.B. Reinhart Institute for Ethics in Leadership at Viterbo University in La Crosse, Wis.