Why the Covid-19 vaccine should be mandatory Why the Covid-19 vaccine should be mandatory  FAUZIAH ZEN
As governments, research organisations and
pharmaceuticals race to find viable
vaccines for the novel coronavirus, a
recent survey published in The Lancet
found that only 67% of the United States
population would accept a vaccine for
Covid-19 if it was recommended for them.
Within weeks of the survey, a major
vaccine trial at Oxford University was
paused after a participant fell ill. This
may confirm the suspicions of those afraid
of vaccinations; however the pause in the
development of the vaccine after one
participant out of 30,000 fell ill shows
that the researchers are following strict
safety protocols.
The question is: once the vaccines hit the
market, what then? From the perspective of
maximum social welfare, everyone should be
vaccinated.
Globally, as of Sept 10, there have been
more than 27 million confirmed cases of
Covid-19. Southeast Asia contributes about
5.1 million cases, exceeding Europe at 4.6
million cases. The death toll, over
899,0000, keeps rising. The estimates of
the cost to the global economy range from
$5.5 trillion (171 trillion baht) to $8.8
trillion, according to the Asian
Development Bank.
Nobody knows if or when humans can fully
control this pandemic, and the world can
return to normal. Prominent research
institutes and big pharma have been
working fiercely to develop the anti-
virus, and some of them are now reaching
phase III, the latest stage of clinical
trials.
The pandemic has significantly changed how
vaccines are developed and approved,
speeding development from years to less
than a year.
When a vaccine is ready to produce, the
world needs more than 7.5 billion doses.
And if each person needs two doses, that
figure is doubled. It is a massive demand
that producers cannot fulfil by 2021, even
if the vaccines obtain approval by the end
of 2020. Equitable allocation of vaccines
will be the most challenging task due to
short supplies.
Two critical questions emerge: Should the
government make it mandatory? How should
vaccines for Covid-19 be allocated?
For the first question, we can apply an
economic theory of "merit goods". Merit
goods are characterised by their
meritorious impact and despite the fact
that they are not typically public goods,
pubic funds may be used to provide them
for mass consumption (Musgrave, 1959,
1998).
Economic discourses may contest the
position of merit goods, but public policy
applies them in practices. Primary
education and healthcare are among the
most common merit goods recognised in many
countries, especially in countries with
substantial welfare states.
The arguments for coercion to consume
merit goods include the potential for
people's to act irrationally, increasing
consumption of important goods for the
beneficiaries, and maximisation of social
welfare.
Social welfare is the most critical
argument for the Covid-19 vaccine viewed
as merit goods. Anthony Culyer, a
prominent British health economist, argued
that externalities in merit goods could
serve as a justification for the
government to intervene in the market.
There are both positive and negative
externalities in imposing the Covid-19
vaccine. Positive externalities include
additional protection to large
populations, which can reduce infection
transmission, thus reducing health
workers' burden and freeing up spaces in
hospitals for non-Covid-19 patients. It
also reduces both private and public costs
for Covid-19 patients' treatment and
prevents productivity loss from infected
people.
On the other hand, negative externalities
of not being vaccinated mainly come from
negative impacts. A non-vaccinated person
potentially becomes a virus spreader and
infects others who are not yet vaccinated
and those who have been vaccinated, but
have yet developed the antibody.
Economic costs include: high treatment
costs, productivity loss, overwhelmed
health workers, and crowding out non-
Covid-19 patients. Mandatory vaccination
deals with social welfare maximisation. It
is not about the government overruling the
individual preference for the risk of
isolated impacts. There is no place for
selfish choice at this level of the
pandemic.
Each country also has a responsibility to
control the virus. Especially as global
connectivity is essential for economies,
while the period of immunity is still
unknown, failures to contain this virus in
one country means a higher risk of
triggering the next pandemic wave across
other countries.
The World Health Organization (WHO),
together with the Coalition for Epidemic
Preparedness Innovations (CEPI) and Gavi,
has formed COVAX, an initiative that aims
to accelerate the development and
manufacture of Covid-19 vaccines, and to
guarantee fair and equitable access
globally.
Some countries have secured purchasing
deals with several big pharma companies
currently developing the Covid-19
vaccines, through COVAX or independently.
However, given limited supplies and the
time-critical nature, there are still
concerns over the race between high-income
economies, and the risk of leaving low-
income economies behind.
Limited and incremental production of
Covid-19 vaccines poses difficult
challenges on "fair and equitable access"
criteria. Based on some assumptions, WHO
Chief Scientist, Soumya Swaminathan, is
hoping that there will be two billion
doses available worldwide by the end of
2021. To reach herd immunity, John Hopkins
School of Public Health said the portion
of the population with immunity should be
at least 70% to 90%.
In other words, at least 5.5 billion
people must be vaccinated for global herd
immunity, and if it requires two doses per
recipient, 11 billion doses will be
required. Eleven billion doses are not
likely by 2021. This constraint demands
close and genuine cooperation among
countries. The Covid-19 vaccines'
provision and distribution are a
collective responsibility because this is
not a race that produces only one winner.
Paying the vaccine price is a big obstacle
for many citizens in developing economies,
many of whom already struggle during the
prolonged pandemic. Another challenge
comes from the people who are unwilling to
take the vaccine shots because of their
beliefs. Combining both challenges means a
closed door to achieve herd protection.
This, in turn, will not only hurt people
through the disease but also through an
economic downturn.
Neither tourists nor the businesses and
investors will come to countries with high
Covid-19 infection rates. And citizens
from Covid-19 high-risk countries will be
banned from entering pandemic-free
countries. It also will drain the health
budgets of hard-hit countries because the
treatment costs are far higher than the
price of the Covid-19 shots. It is clear
that protecting the public's health is
interwoven with the goals of socio-
economic recovery.
Since the vaccine shots will be available
only incrementally, it requires an
effective way to allocate scarce goods to
maximise the transmission control and
minimise fatalities and treatment costs.
Country experts can build a multi-value
framework for allocating the resources,
including the Covid-19 vaccines, using
those ethical values as reference.
Governments should maintain or develop at
least three things: (1) transparent and
equitable vaccine allocation drawn from
the framework initiated by the experts
panel and open for public discussions; (2)
the vaccines' logistic system, which
includes production, storage, projection,
transport and distribution, and
contingency scenarios; and (3) completing
the regulatory compliance needed to work
on the planning and implementation phases,
including the involvement of subnational
governments, private entities, and
international communities.
For countries with challenging
connectivity, they should pay close
attention to distribution and storage.
Transporting and storing vaccines
typically requires a specific controlled
environment, which the responsible
stakeholders can prepare from now.
Governments may think of the best way to
set up the vaccines' logistic system. It
may also need to secure agreements with
potential contractors, build additional
facilities, and upgrade key people's
skills.
The clock is ticking, and amid health
emergencies, the government should keep
its focus on protecting the public's
health to protect the public's socio-
economic well-being.
Fauziah Zen, is senior economist, Economic
Research Institute for Asean and East Asia
(ERIA).
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