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Vaccines: The Challenge To Ensure Fair, Equitable and Inclusive Access To Technology

Vaccines: The Challenge To Ensure Fair, Equitable and Inclusive Access To Technology

Vaccines offer an effective way to protect against many deadly diseases. Photo: CDC/ Wikimedia Commons.

The fair and equitable access to vaccines has emerged as a major issue. Government bodies in various countries, the WHO and various other organisations are working on this problem, and are developing guidelines and ethical norms.

The idea of equitable access requires policymakers to think beyond equal access to vaccines and develop criteria for equitable access as well. A committee appointed by the US National Academy of Sciences has identified maximisation of benefits, equal regard, mitigation of health inequities, fairness, evidence and transparency as foundational principles for the equitable allocation of vaccines.

It’s difficult to translate these attributes into practice – but not impossible. Everyone who needs a vaccine needs to receive it. Access to medical technology and essential medicines is becoming more important, and contentious as well. And just as a lack of access to the internet precipitates a digital divide, ensuring equitable and inclusive access bridges this divide. The same is true of vaccines as well.

Access, equity and inclusion codify some important principles that often don’t find explicit mention in the scientific literature. Setting aside considerations of whether science and technology are scale-neutral and/or value-neutral, as a paper published in 2011 stated, the “notion of an ‘equitable society’ does not assume equal allocation or even optimal allocation of goods, services and values. Rather, it assumes the provision of basic needs and allocation schemes based in part on public benefit rather than exclusively on economic efficiency and private entitlements”.

This way, equity means fairness in the distribution of resources and the fulfilment of essential needs. The paper also points out that the distributional impacts of science and technology need to be assessed in terms of equity and inequity. Put differently, equity depends on the fair allocation of benefits or gains from science and technology, and can’t be divorced from distributive justice. The paper’s authors developed their model against the backdrop of science-society linkage in the US, but it is relevant for developing countries like India as well. In similar vein, and with similar implications, equity also has important gender and diversity dimensions.

Given the widening gaps between different sections of society, many institutions – including UN agencies like UNESCAP and UNCTAD – have started paying more attention to the linkages between equity and inclusion, as well as to science, technology and innovation policies. For example, a 2018 report from UNESCAP asks (p. 64):

“Policymakers seeking to ensure that technology contributes to, rather than undermines, equality face challenging questions: What role has technology played in creating and addressing inequality, in terms of income, opportunity and environmental impact in Asia and the Pacific? How will future technologies potentially reshape trends in inequalities in the region?”

In turn, the report proposes inclusive technologies and policies as solutions to address inequalities. It also cautions that “while the market is a key determinant of technology development, governments have influence in the direction of technology change”. But this is an unrealistic statement because the capacity of the governments to have an impact on the direction of technological change is limited.

It is possible to think of various solutions, ranging from inclusive innovation to targeted R&D to address basic needs and equitable access to the fruits of science. Similarly, it is feasible to ensure that the outcomes and gains are allocated fairly and equitably among different people. To this end, policies can incentivise inclusive innovation, applying the results of R&D to specifically meet the needs of the marginalised, and to promote equitable access to education, research and careers.

In India, the Department of Science and Technology is addressing these needs through different schemes to enhance participation of women and to promote equity in opportunities among them, and to promote innovations that meet the needs of specific groups, like tribal communities.

While the terms access, equity and inclusion are new, debates on using science and technology for national development and societal transformation have tried to address them in different terms. When the Centre’s erstwhile Five-Year Plans and various schemes promoted self-reliance, they were in one way or another paying attention to access, equity and inclusion.

Scientists like C.V. Seshadri, A.K.N. Reddy and J.C. Kumarappa have drawn inspiration from the philosophy of M.K. Gandhi to pioneer solutions to address basic needs of the people.

To assess whether emerging technologies will also be accessible, equitable and inclusive, or if they will widen the existing gaps instead, researchers need to undertake case studies and review projects, funding and outcomes. One option is to bake concerns related to access, equity and inclusion into the project from the formulation stage itself, and use that to assess outcomes.

Concepts like ‘responsible research and innovation’ and ‘real-time technology assessment’ could help direct R&D in emerging technologies towards innovations that enhance equitability or address concerns of exclusion. For example, INBOTS is a European project to study the ethical, legal and socio-economic impact of interactive robots and strives to develop technology under a ‘responsible research and innovation’ paradigm.

Similarly concerns about biases in algorithms have resulted in thinking on fairness in algorithms and artificial intelligence. A project floated at the Massachusetts Institute of Technology “examines the intersection between AI and inclusion, and explores the ways in which AI systems can be designed and deployed to support diversity and inclusiveness in society.”

Although there aren’t many such projects, current discussions on ethics in AI and robotics, and concerns over the long-term impact of AI, robotics and the so-called fourth industrial revolution, on jobs and employment can draw more attention to access, equity and inclusion as well.

Krishna Ravi Srinivas works at Research and Information Systems for Developing Countries, a policy research think-tank. The views expressed here are the author’s own.

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