2020 is the year that brought us COVID-19 — but as Danielle Groen explains in The Walrus, the battle against viruses is not a new one. In the 1600s Chinese doctors were attempting to vaccinate against smallpox by grinding a “scab into a powder” and blowing it up the patient’s nose, and the basic principle has not changed to this day — teaching the immune system how to fight a virus if it is infected. The difference with COVID-19 is the need to vaccinate the whole world, fast. Developing the vaccine is still the first hurdle, but what comes next is going to be just as complicated, with every country in competition for supplies. 

Making a successful vaccine is one challenge. Making enough of it to satisfy world demand is another. There are, of course, all sorts of regulations and standards concerning how to go about production: “I can’t head into my basement and start brewing up a vaccine,” says Curtis Cooper, president of the Canadian Foundation for Infectious Diseases. Every facility needs to conform to Good Manufacturing Practices (gmp), which are exceptionally specific rules set out by the WHO that ensure quality control. You want consistency over time so that each successive batch is precisely the same.

… the UK reserved 100 million doses of the University of Oxford’s vaccine while the US secured another 300 million—that’s nearly a quarter of Oxford’s projected annual supply gone. By mid-August, preorders of COVID-19 vaccine candidates were reportedly stretching toward 6 billion doses, almost all of them claimed by wealthy nations. None of these vaccines has yet been proven to work.

This raises the question of whether it will be the wealthy countries that dominate the vaccine supply, and other ethical questions also lurk beneath the surface. 

Do you vaccinate to prevent mortality? In that case, for this virus, the elderly need to be prioritized. Do you vaccinate to reduce transmission and spread? There are some house-partying twentysomethings in Kelowna who could get the jab. Or do you vaccinate widely in an attempt to achieve herd immunity? NACI advises that front line workers be prioritized because they’re at a greater risk of infection based on the work they do. But that’s not axiomatic: “There’s no commandment in the bible of pandemic response that health care workers go first,” Upshur says. “You have to make arguments, and those arguments are based partly on data and partly on ethics.” We know that racialized and low-income people are infected at rates wildly disproportionate to their populations, not for any epidemiological reason but because of historical and economic disadvantages. This inequality persists for those working in the health care system itself: The Lancet published a study of almost 100,000 front line health care workers in the UK and US, which found that racialized workers were nearly twice as likely as their white colleagues to come down with COVID-19. Should decision making about vaccine prioritization be based on structural social causes instead?

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