The easiest exercise in the moral philosophy book

Peter Singer, in the parable that came to represent his whole worldview and that of the effective altruism movement more generally, asked us to imagine that we could save a drowning child at the cost of jumping into a lake and ruining an expensive new suit. Assuming we’d do that, he argued that we do in fact face an ethically equivalent choice; if we don’t donate most of our income to save children in the Third World, then we need to answer for why, as surely as the person who walked past the kid thrashing in the water.

In this post, I don’t want to take a position on Singer’s difficult but important hypothetical. I merely want to say: suppose that to save the child, you didn’t even have to jump in the water. Suppose you just had to toss a life preserver, one you weren’t using. Or suppose you just had to assure the child that it was OK to grab your life raft that was already in the water.

That, it seems, is the situation that the US and other rich countries will increasingly face with covid vaccines. What’s happening in India right now looks on track to become a humanitarian tragedy, if it isn’t already. Even if, as Indian friends tell me, this was a staggering failure of the Modi government, people shouldn’t pay for it with their lives. And we in the US now have tens of millions of vaccine doses sitting in warehouses unused, for regulatory and vaccine hesitancy reasons—stupidly, but we do. We’re past the time, in my opinion, when it’s morally obligatory either to use the doses or to give them away. Anyone in a position to manufacture more vaccines for distribution to poor countries, should also immediately get the intellectual property rights to do so.

I was glad to read, just this weekend, that the US is finally starting to move in the right direction. I hope it moves faster.

And I’m sorry that this brief post doesn’t contain any information or insight that you can’t find elsewhere. It just made me feel better to write it, is all.

45 Responses to “The easiest exercise in the moral philosophy book”

  1. David Karger Says:

    In the main I agree with you, but here’s one wrinkle: the vaccine surplus we’ve built up doesn’t (yet) represent more vaccines than people. It represents vaccine hesitancy. So we’re in a more complicated situation of, “if a child is drowning over there, but *your neighbor’s child* is drowning over here but refusing your help, do you save the one who wants help, or do you try to save the one you know?

  2. Pku31 Says:

    My understanding is that IP actually isn’t much of an issue here – moderna (and maybe some others?) Have explicitly said they’re waving their IP rights and made their tech publicly available – it’s just hard to copy and build new factories.

    (But aside from that, yeah)

  3. JC Says:

    How much does the morality/altruism based argument weaken when one takes into account the millions of maskless people voluntarily gathering for Kumbh Mela, a religious festival, just weeks ago in the middle of a pandemic?

  4. Michael Says:

    I agree, with one caveat. There’s some concern about the Astra Zeneca vaccines that were made at the Emergent plant:
    https://nationalpost.com/news/canada/more-than-half-canadas-astrazeneca-vaccine-came-from-u-s-plant-accused-by-fda-of-quality-control-problems
    We already sent some of those vaccines to Canada and Mexico and they may be issues of quality control.

  5. Scott Says:

    David Karger #1: In your hypothetical as in real life, I say unequivocally and with all my heart, you save the one who wants help.

  6. Scott Says:

    JC #3:

      How much does the morality/altruism based argument weaken when one takes into account the millions of maskless people voluntarily gathering for Kumbh Mela, a religious festival, just weeks ago in the middle of a pandemic?

    Not very much, when we consider that the majority of Indian victims probably won’t have taken part in this festival (and may have considered it irresponsible), even if the festival helped cause their infections.

  7. James Gallagher Says:

    What’s even more damning about the US selfishness on vaccines is that their insistence on the original three week 2-shot roll-out doesn’t seem to have produced results as good as in the UK with a prioritisation of 1-dose (second dose delayed to 12 weeks rather than 3 in the US).

    For comparable population sizes, US should be seeing 5x the case numbers and deaths of the UK, it is rather over 20x.

    Looks like the 1-shot strategy which has vaccinated 95% of over 50s in the UK was the better one, rather than US hoarding most of the world’s Pfizer vaccine and going for glory with 2-shots to everyone, leaving far more over-50s unvaccinated.

    They could have given millions of those second doses to other countries, while Pfizer easily re-stocked for a 12-week second dose in the US

  8. JC Says:

    #6. I agree that a small fraction of total population would have actually attended. People are claiming 3.5 million in one state. And vaccines, if they are unused and sending is simple enough, should be sent. But what if I tell you around half the country will vote for the politicians who moved the festival year from 2022 to 2021? The festival has happened every 12 years and last one was in 2010. My point is that moral arguments at population = 1 (innocent child drowning) do not work as simply when population is larger and is not homogeneously innocent. There should be some way to say do not re-celebrate next year.

  9. John Baez Says:

    Here’s an argument for less altruistic Americans: failing to stop an enormous spread of coronavirus in India will increase the chance that a dangerous new variant will arise there and then come here.

  10. Lior Silberman Says:

    Worth noting that Biden has given Canada 1.5 million doses from the AstraZeneca stockpile, and is in discussions to repeat the favour.

    https://www.cbc.ca/news/world/biden-trudeau-vaccines-1.5996615

  11. Bill Kaminsky Says:

    [I think an earlier version of this comment got stuck in moderation due to having many links to NYTimes and BBC news items, as well as a Baylor College of Medicine press release. Sorry for any moderation inconvenience, Scott.]

    I may be wrong, but it seems to me that India was super-duper well-positioned in regard to COVID-19 vaccination, in that Indian companies have manufactured most of the world’s Oxford/AstraZeneca doses and they’re in the process of making most of the world’s Russian “Sputnik V” doses.

    That’s to say Indian companies — especially the world’s #1 vaccine manufacturer by volume, The Serum Institute — manufactured something like 500 million doses of AstraZeneca by early February or so of this year, of which at least half got exported. Plus, Indian companies are supposedly on track to make over 850 million doses each of those 2 vaccines this year.

    Last but not least supply-wise — and speaking of Oxford/AstraZeneca vaccines as of early February — the Indian gov’t might have had access by then to over 250ish million doses for distribution within India!

    BUT (there was obviously going to be a “but”):

    1) Vaccine distribution has been horribly slow. A recent BBC article I saw said the declared goal now is to vaccinate 250 million Indians by July. [Both the Oxford/AstraZeneca and the Sputnik V are 2-dose vaccines… so I think there might be uncertainty from news reports of whether quotes of either manufacturing targets and/or jabs-in-arms targets should actually be divided by 2. I mean the safe thing is to imagine X doses manufactured means X/2 people vaccinatable, but claims “our gov’t plans to have X people vaccinated by MM/DD/YYYY” means X people get at least 1 dose… and probably just 1 dose. But maybe that July vaccination goal is 250 million fully-2-dose-vaccinated Indians.]

    2) Due to the admittedly national-pride-worthy fact that India really does manufacture most of the world’s vaccines, it was only decided this very week by the Modi government that India should seek to import Pfizer, Moderna, and J&J vaccines.

  12. Québec Says:

    Lior Silberman #10 & the USA. Yes. My brother and sister just had one dose from your stock of AstraZeneca. Thanks, bros! It’s good to have you back.

  13. Jon Tyson Says:

    Here’s another way to deal with the problem of vaccine hesitancy causing a domestic glut: Those Americans don’t agree to get vaccinated don’t get their government covid check. And claw back back the prior ones. People perpetuating an epidemic shouldn’t get paid for doing so with government handouts.

  14. Sam Says:

    In India, unlike many countries, the second wave came quite late. Many were saying herd-immunity was achieved there, yet the second wave rocked the state Maharashtra, which was hit badly in the first wave too. We need to understand the reason behind this. If immunity wanes in 6 months to 1 year, vaccines would be needed this winter as well and as the spread of infection is faster than vaccination rate, vaccinated world would be doomed again unless they remain vigilant.

  15. Ted Says:

    David Karger #1: Vaccine hesitancy is probably the most important reason for the U.S. vaccine surplus at this point, but it isn’t the only one – inefficient distribution within the U.S. is also a factor. I myself live in the U.S. and would very much like to get vaccinated – but despite having signed up for four different waiting lists as soon as I became eligible, and also keeping an eye out for walk-in clinics in my area, I still haven’t been able to get vaccinated. I know many other people in the same boat. I may soon give up and go to another state that doesn’t check IDs for residency, which really should not be necessary at this stage.

    I’m certainly not arguing that the U.S. shouldn’t be exporting many more vaccines – we absolutely should be! But in parallel, we should be working on improving the internal distribution within the U.S. to make the vaccines more easily available to those who want them.

  16. Steve Huntsman Says:

    FWIW, India is in a pretty good position to manufacture vaccines
    https://en.wikipedia.org/wiki/Serum_Institute_of_India#COVID-19_vaccine_development

  17. fred Says:

    Also, it’s in everyone’s interest (the whole world) to make sure that covid doesn’t run freely in huge populations like India/Brazil/Africa, which are very young and with immune systems that are more used to a wide variety of diseases than western countries. It’s the perfect recipe for evolving a way more lethal strain of the virus.

  18. fred Says:

    To add to my previous post.

    I’ve heard reports that the new wave in India is also affecting children/the youth way more (but I couldn’t find actual facts on this).

    Ironically, wide vaccination is also another way to accelerate the emergence of a more dangerous strain of the virus.
    But it’s basically only a matter of time before this happens, no matter what we do.
    And this is why social distancing and masks will still be needed for a while.

    On the bright side, a virus and bacteria can only evolve in a finite number of ways – they’re stuck in a local maxima of virulence because mutations can’t be too radical (it’s just like solving an optimization problem using local gradient descent). Which is probably why pandemics always do die down after a few years.

  19. Rahul Says:

    @Sam #14

    There is no evidence that immunity waned in 6 months.

    I live in Bombay and there’s no indication that this wave is comprised of patients that had previously acquired immunity.

    I am skeptical of all those reports that India had reached herd immunity earlier. They were pretty much speculative based on the lack of the 2nd wave so far. But now we have it.

    Most privious sero surveys too indicated not more than 20 to 30% sero prevelance.

  20. Rahul Says:

    @Bill #11

    I think you are right on both of those points.

    Distribution is something majorly messed up.

    I think it’s just insane, populist policy on many grounds. First by keeping commercial distribution networks out you are losing at least 100% capacity if not more. India had a huge network of private sector companies and entities which run the medical distribution network.

    Even the smallest of Indian villages have a decently stocked pharmacist thest days. It’s amazing what capitalism can achieve. Its just a mistake to assume you can make a beauraucratic centralized planning structure work as efficiently by diktat.

    Secondly very little was done to give vaccine manufacturers commercial incentive to scale up. As compared to what the US government pumped in to corporates the Indian government did very little.

  21. Rahul Says:

    @Fred #18

    I don’t think we have enough evidence to conclude that the new wave is affecting younger people more.

    Couple of confounding factors at play:

    One, there is a selection bias: it makes a much more sensational media story to report on 25 year olds dying. A 75 year old ain’t news any more.

    Secondly, the older cohorts have had vaccination possibilities for a while now. 60+ vaccination was on since 2 months and 45+ since one month. So proportionately more of the younger cohort is unvaccinated.

    Finally, when you have a billion people even low probability cohorts accumalate enough cases to get noticed.

    Overall, I would be skeptical thst we have any data so far that shows that the age incidence is any different from earlier.

  22. fred Says:

    Rahul #21

    What I saw was some very distressed old man helping out at a hospital, saying lots of very young people were struggling too. So it’s impossible to say if that’s a thing or not.

    It seems that the most urgent need right now is for oxygen. Extra oxygen is enough for most of the serious patients to recover. It’s only when this doesn’t work that respirators are used (and at that point the outcome is rarely good).

  23. mak Says:

    The current batch of vaccines are still hard to scale up due to their reliance on global supply chains for specialized equipment and raw materials. The Serum Institute CEO was complaining that their manufacturing was hampered by the lack of raw materials that the US had placed a ban on exporting. It is nice of the US to relax this ban. The problem extends beyond India though. Bangladesh, Pakistan and Iran in the neighborhood are all having a similar surge, but their absolute numbers are relatively small, so its not making headlines.
    Also, the Serum Institute is supplying vaccines worldwide, so this surge in India impacts the vaccine supply to other countries as well. For example, SI was contractually obligated to supply 30 million doses to Bangladesh, which they had paid for in full. They have delivered 10 million doses so far before the Indian government apparently restricted exports. They are now scrambling to find other suppliers. Hopefully Serum will be able to scale their manufacturing in time.
    Further to Rahul #20 comment, the Indian government has been penny pinching spending on the vaccine. The SI CEO reportedly claimed they could profitably manufacture the vaccine at about $2 per dose, but they are charging the Indian government close to $8 per dose. Even then, $8 x 1 billion = $8 Billion is a small price to pay relative to the impact on lives and the economy.
    It seems the root cause of all this was hubris that India had overcome the virus, perhaps by achieving herd immunity. Scott had raised the question of why countries had been reluctant to accelerate vaccine approval and rollout. Now this second wave emergency in India has forced the government’s hand. They have recently accelerated approval of a number of vaccines beyond the two currently approved in India.
    One encouraging piece of news amidst all this gloom is the ongoing progress in developing a scalable, low-cost vaccine, that uses chicken eggs like the regular flu shot, which is still required to combat the virus worldwide. So grateful for the researchers (from UT Austin, no less) who continue developing these alternatives even when most people might be content to rest easy amidst the numerous existing vaccine candidates.

  24. DR Says:

    Hard questions. Beautiful essay. These types of questions used to be mere thought experiments at one point.

    How does a govt prepare for worst case scenario when it appears that cases are waning rapidly? Should America be prepping even harder when things are relatively ok?

    India’s healthcare system has had too few beds per capita, even before 2020.

    During the 1st wave, there was excellent messaging and enforcement of mask and distancing mandates etc.

    In the 2nd wave, I see so much fatigue all round.

    It is partly the UK strain and increasingly, a new strain called the double mutant Indian variant. I’m eager to know if the Indian vaccines (Covishield, Covaxin) and mRNA vaccines we have here, protect from this. Does anyone know?

  25. metacelsus Says:

    Pku31 #2

    >My understanding is that IP actually isn’t much of an issue here – moderna (and maybe some others?) Have explicitly said they’re waving their IP rights and made their tech publicly available – it’s just hard to copy and build new factories.

    Moderna only waived their patents, which are necessary but not sufficient to replicate their vaccine. They still have lots of other IP under the category of “trade secrets” which they’re not releasing.

  26. matt Says:

    I’m going to go out on a limb here and guess that if younger people in the US hadn’t been told for months “wait your turn, first we’re going to give it to these people, then those people, then those other people, then that other group in tier 1A subsection 3, and then eventually you can get it if you wait until we say so, which could be sometime in the fall. Uh whoopsie, you know, you can all sign up now!” then there might be a little less vaccine hesitancy.

  27. asdf Says:

    This article is very critical of Modi and I found it interesting, though I don’t know anything about Indian politics so I have no idea what the counterclaims might be:

    https://www.nakedcapitalism.com/2021/04/the-covid-19-catastrophe-in-india-keeps-growing.html

    Meanwhile I believe the US is going to send around 60M doses of AZ to India. That’s a significant number but India has a billion people, so a lot more is needed. And there are lots of other places that need it too.

    The amount of oxygen being used is really surprising. Apparently India has redirected all of its industrial oxygen production (such as from steel mills) into medical treatment, and there still isn’t enough. That is a bulk commodity though, so I wonder if China or Russia can help. There is also apparently a shortage of oxygen cylinders and not just of the gas itself.

  28. Naman Pujari Says:

    Hi, everyone I am from India. I am a 22-year-old B.Tech. student at IIT Bhilai, India. As you guys already know the situation is pretty bad here.
    Thanks for the love and support! I have been a frequent reader of this blog and it is heartwarming the see that Scott cares about others, not only American citizens.
    It was pretty sad to see the lukewarm support by the Biden administration towards the Indian plea with a ban imposed on the export of necessary medical supplies and raw material for vaccines. This made me question the left and humanity, and remember the days of the Trump administration, at least I did not expect them to do the right thing. But after reading this blog I can say that people do care. Thanks for the support. This blog post by Scott gives me hope that other countries will do the right things to support us. Peace!

  29. Eitan Bachmat Says:

    Seems like your wish is Baiden’s command. From my experience with healthcare projects in third world countries (in healthcare that includes the US sometimes) the real problem is usually not in the availability but organizational issues in delivering to patients

  30. Scott Says:

    Naman #28: Take care! This post is a rare example where US policy changed substantially for the better the very day after I wrote it.

  31. DR Says:

    There’s a new article in Nature on the suddenness of the spike in India.

    Wanted to share some data.

    Until early April, we were all wondering how India had got through this relatively easily. And in the next 2 weeks, hospitals in multiple states were demanding 10 to 100 times the oxygen they were demanding before April. That’s a sudden nonlinear extreme spike.

    How on earth are you supposed to anticipate this demand?

    Ppl have trouble understanding non-linearity. They think everything changes linearly. This was not a gradual change.

    We can store 2 weeks worth water for an emergency or even 4 weeks worth if rich and super prepared, but how can anyone afford to store 1 year’s worth of water, speculatively, IN CASE it was needed? Hind sight is 20/20. Remember that the 1 year worth of water would come from resources otherwise used to buy other essentials.

    Another analogy. If we had to build only buildings in CA that were earthquake proof to 9 on the Richter scale, we would have to stop doing other essential things, like eating. And might be left with one building in all of CA.

    There is a tradeoff to be considered. I think this is the right way to think about this situation in India.

  32. DR Says:

    I had 2 friends return from India recently. Both were required to show an RT-PCR negative test to the airline, test taken 72 hours before boarding.

    However, there was nothing required of them after they returned.

    Hong Kong requires all passengers from India to not only get the rest 72 hours before boarding, but also quarantine 3 weeks after flying from India.

    At the 3 week point (not 10 days, not 14 days) they found many ppl on the flight tested positive for the double mutant Indian variant. They’d all tested negative 3 days before flying.

    We have no idea yet if this virus breaks through U.S vaccines. It shows some similarity to the Brazilian and South African variants, in where the mutations have occurred.

    Should this flying arrangement continue as is? I think something needs to change.

    One of the articles I found on the Hong Kong flight passengers :
    https://nypost.com/2021/04/20/dozens-of-passengers-test-positive-for-covid-on-flight-from-india/

  33. Boaz Barak Says:

    DR 32: The article you mention does not mention the variant, but as we wel know you don’t need new variants for “super spreader” events. If such an event happened on the flight (where one of the passengers tested negative 72 hours before but was in incubation period and then infected many people on the plane or in the airport) then we would expect people to develop Covid during the quarantine period and still test positive at its end.

    Overall this is a very sad situation and I am hoping very much it gets better soon. I am happy that the US policy did improve. Seems that the most urgent need right now is not vaccines but other supplies.

  34. DR Says:

    Somewhat reassuring news from India. Both Indian vaccines seem to protect from B.1.167, the new Indian variant. The other one causing havoc there is the UK variant, which these vaccines are known to work again well.

    PRELIMINARY report only though.

    https://twitter.com/AnuragAgrawalMD/status/1387035975751143427?s=20

  35. DR Says:

    Boaz 33:
    I just want people traveling from India to the U.S to self-quarantine for 3 weeks (the CSC recommends only 7 days, regardless of country) and then get tested at not only the 3-5 day point as the CDC recommends, but also again at the 3-week point. They could be asymptomatic carriers of this new variant. Hong Kong has stricter standards, that we must adopt even if they are not required by the CDC.

    There are some online groups that are all about strategizing safe travel between India and the U.S during covid, specially for people with a death or serious illness in their family in India. I posted this suggestion there and many people seem to like it.

  36. HASH Says:

    @Naman Pujari #28
    a) Biden is not Leftist neither Democratic Party of US.
    b) Before Kumbh Mela started; daily death by Covid in India was 150, after that 3300/day:
    You should question your country right wing politician and clerics who encouraged people to become “pilgrim”.
    Of course, as a Leftist I want all human being get access to vaccine free!

  37. Michael Ball Says:

    Hi Scott, firstly sorry for the completely off topic comment. Anyway, you mentioned a while back in passing that some students of yours were writing a quantum complexity text book. Is this book available on the web?

  38. Ira Glazer Says:

    @PKU31 #2

    Could you please provide documentation for this. I’m genuinely interested. India, South Africa, China and basically every developing country — except for Brasil (surprise surprise) — has asked for a TRIPS waiver on IP, something which all wealthy countries have refused. If Big Pharma was ok with waiving their patents, it’s a pretty good bet that the U.S. and other wealthy countries wouldn’t be refusing. But I’d like to see your evidence.

  39. DR Says:

    I was discussing with a friend, why the U.S does not mandate the quarantine and testing for incoming international travellers. Our conclusion :

    Many countries can mandate this at the national level. America cannot do that legally. It can only be done at a state or county level. We are not sure which.

    There is a prisoner’s dilemma like situation for American counties, even states, mandating things like quarantine for incoming international travelers.

    County mayors who impose this cannot stop people from other counties from entering and leaving their county (There can be no walls or checks around Austin.)

    So, mayors would look silly mandating something that is not going to work. No one wants to look silly.

  40. Topologist Guy Says:

    Scott,

    India doesn’t have the infrastructure to distribute the Pfizer vaccine, so that’s off the table entirely. Even advanced industrial economies are struggling to expand the cold chain infrastructure necessary for storing and distributing Pfizer (we’re talking 100 below zero temperatures). There is no way India could distribute this vaccine on any scale. Even Moderna would be extremely difficult to distribute in India. Their best option is one of the adenovirus vectors, like J and J, that require one dose and can be stored at room temperature.

    And I think the moral analogy is flawed. A better analogy would be this: you drive past a lake with an infinite sea of drowning children. Every time you pull a child out of the water, there’s more children waiting. Do you spend your whole life pulling kids out of the lake?

  41. Mark J Says:

    Also press for TRIPS waivers https://www.hrw.org/news/2021/04/27/nearly-400-meps-and-mps-join-chorus-voices-calling-trips-waiver-covid-19-vaccines

  42. ira Says:

    @Topologist Guy (#40)

    1 The Serum Institute of India — the world’s largest vaccine manufacturer (by a pretty good margin) — is already producing the AZ vaccine (they call it Covaxin). Originally much of the production was slated for export to mostly poor countries but those plans have probably been altered by the horrific situation domestically. Also, there are plans to produce massive quantities of the Sputnik V vaccine, And, finally, a home-grown vaccine — Covaxin — will be produced also in massive quantities (preliminary data from Phase III showed 81% efficacy).

    https://www.bbc.com/news/world-asia-india-55748124

    2 If they were your kids I assume you would people to keep pulling children out of the lake.

  43. DR Says:

    Ira #42:

    There are 2 vaccines bring made in India.

    Oxford’s Astrazeneca is called Covishield, made by the Serum Institute. The other, Covaxin, by Buarat Biotechnology, is 100% Indian, including the type of vaccine (attenuated or killed virus is injected).

    The situation is still crazy there. The strains are super contagious. It has spread to the city where most of my family is (Chennai). All I can do is try to keep friends cheerful as they hear about multiple deaths in their family.

    I wish Biden had stopped flights from India a long time ago. The U.S is allowing citizens and permanent residents back even after May 4th when the ban for other travelers goes into effect. Australia has been far stricter with a 100% ban. Maybe they know the vaccines here are protective enough.

    The situation is exposing India’s very poor health infrastructure, even pre-covid. It was possible to get top-notch care there, with brilliant doctors and good hospitals, if you could afford it. Now, there’s no room anywhere.

  44. DR Says:

    Correcting a typo in my comment #43 : Bharat Biotech.

    And, here is a good interview with an Indian virologist, Shahid Jameel, about what others can learn from Infia’s 2nd wave :

    https://www.bloomberg.com/opinion/articles/2021-05-02/the-big-question-can-india-find-a-way-out-of-its-covid-nightmare

  45. Michael Says:

    @DR- when Trump announced the travel ban in Europe in March, American citizens mistakenly thought it applied to them. The result was thousands of people hurrying home, which actually helped spread the coronavirus:
    https://www.foreignaffairs.com/articles/canada/2020-05-15/why-travel-bans-fail-stop-pandemics
    Biden wants to avoid a similar disaster.
    Also, there’s the moral aspect- Human Rights watch criticized Australia for not letting its citizens return home.

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