Tragic Choices, Government Actions and the ‘domino effect’ the Case of the COVID - 19 Syndemic and the Italian scenario

Author(s): Matteo Cati

The Covid – 19 pandemic has become in a few time a syndemic, or in other words a complex of patholgies that not only is harming the health but also the economic, social, cultural and relational fabric of the nation’s hit by it. It is the first time in a century that the fate of many nations, not only in terms of collective health but also of economic performance and social stability, is closely linked to the identification and to the ability to produce and distribute enough doses of an effective, and affordable for all, vaccine. This article addresses an important question: in such a scenario is the scarcity in the vaccine, particularly at the initial stage, inevitable? The answer is that it is not and that its shortage is itself derived from a number of what Calabresi and Bobbit, in their masterpiece Tragic Choices name “first order” decisions, made by the various nations in their dealing with the relevant pharmaceutical companies. In other words scarcity is the result of a ‘domino effect’, a chain of decisions taken in succession whose dynamics is difficult to control and of which only upon the manifestation of the effects, in this case deleterious, does one realize the gravity of the situation. In doing so some remedy to the 'domino effect' is prospected and the italian scenario is described.