Tim Hodgson

This article critically examines the inequities in the access to COVID-19 vaccine and the lessons for global health law. Despite the rapid development and approval of COVID-19 vaccines, the rollout exposed severe systemic failures rooted in preexisting economic distortions and market inefficiencies. The article argues that addressing vaccine inequity requires more than improved distribution and solidarity, but effective reinvention of the global vaccine supply chain through evidence-based and meaningful market-shaping measures. It calls for a transformative approach to global health governance, emphasising the need for a comprehensive, human rights-compliant policy framework to correct structural problems in international markets, moving beyond superficial exhortations to equity.

This study used fMRI to investigate the neural substrates of moral cognition in health resource allocation decision problems. In particular, it investigated the cognitive and emotional processes that underpin utilitarian approaches to health care rationing such as Quality Adjusted Life Years. Participants viewed hypothetical medical and nonmedical resource allocation scenarios which described equal or unequal allocation of resources to different groups. In addition, participants were assigned to 1 of 2 treatments in which they either did or did not receive advanced instructions about the principles of utilitarianism. In all cases, participants were asked to judged the proposed allocations as “fair” or “unfair.” More brain activity was observed within the superior parietal lobe, angular gyrus, middle temporal gyrus, and bilateral caudate nucleus when participants viewed scenarios depicting equal divisions of resources. Conversely, unequal resource divisions were associated with more activity in the inferior frontal gyrus and insula cortex. Furthermore, instructions about the principles of utilitarianism led to significant activation differences within the inferior frontal gyrus and the middle frontal gyrus. Significant differences in activity were also found within the inferior frontal cortex and anterior insula between medical and nonmedical scenarios. The implications for cognitive control mechanisms and the cognitive and neural bases of utilitarian ethical judgment are discussed.