Vaccine Diplomacy: Global Health Inequities Exacerbated by COVID-19 under Capitalism

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A year after the World Health Organization’s declaration of a global pandemic, people are experiencing transnational difficulties in accessing the COVID-19 vaccine. With over 100 million cases and 2.6 million deaths worldwide as of March 2021, around 547,000 deaths within the United States, the coronavirus has proven to have an immense impact on people’s livelihoods. Since the onset of the pandemic, there have been increasing socioeconomic disparities throughout a multitude of countries, with billionaires getting richer, and the working class experiencing devastating levels of unemployment. With a public health crisis comes the inequalities in access to health resources and medicine on a local and international scale.

The varying approaches to the outbreak of COVID-19 reveal the ways capitalism upholds health as a commodity. Under neoliberal policies, health has been privatized, stripping the working class from access to their basic needs. In 1978, UNICEF and WHO called for “Health for All in the Year 2000!” A couple decades later and society is far from universal health equity due to the rise of global capitalism and its ties with big pharmaceutical companies. The slogan reflects the Primary Health Care (PHC) Movement which advocates for health as a human right and an avenue for social and economic development. The 1978 Alma Ata Conference defined primary health care as such and highlighted the need to amplify access to health services, education, and nutrition. However, international interests shifted in 1980, with the expansion of the World Bank and the International Monetary Fund that marked the beginning of privatization of health services and medical and pharmaceutical supply. The era of conservatism and market fundamentalism which followed the Reagan and Thatcher administrations further drove the gap between social classes for the next forty years.

In the 21st century, governments have continued to enact health policies which favor investment. Meredeth Turshen and Annie Thébaud-Mony discuss how the World Bank has “subjected the public health budgets of even the poorest countries to austerity policies, hastening the turn to the private sector to meet people’s needs for health care.” The COVID-19 vaccine authorization process led by WHO reveals its ties with mega pharmaceutical companies like Pfizer. The organization’s policy responses demonstrate the flawed international system, which has continued to favor corporate power interests over time. When international institutions and national governments focus on profit over public well-being, they endorse and comply with corporate control and private health insurance. Moreover, the relationship between governments and for-profit providers has removed the resources for progress on disease prevention and public health programs for social welfare. The inefficient policy responses and short supply of resources in the Global South are due to the focus of vaccination campaigns on the populations of the Global North. The international top-down discourse on coronavirus action disregards health disparities in local regions and within the marginalized communities which are most at risk.

On March 11, South Africans protested outside of Pfizer and Johnson & Johnson buildings following the World Trade Organization’s (WTO) decision to block a proposal waiving intellectual property rights related to coronavirus vaccines. Fatima Hassan calls attention to the coalitions from different communities around the world, including the People’s Vaccine campaign in South Africa, which has called out the pharmaceutical companies for practicing vaccine apartheid. Big Pharma’s refusal to give up their intellectual property rights and the opportunity to scale up manufacturing capabilities for the Global South jeopardizes millions of lives. Achal Prabhala discusses how the Euro-American pharmaceutical industry has failed to address the needs of 85% of the world, putting global and regional immunity at risk. Following the development of vaccines from China and Russia, middle-income countries all over Latin America, the Middle East, and South Asia have been able to obtain health resources. However, as Prabhala points out, Euro-American dominated organizations are in a state of denial that these vaccines exist and are useful for the pandemic long term, due to misconceptions about non-Euro-American systems and medicine. Consequently, the vaccines from Russia and China have been waiting for WTO approval, while Euro-American vaccines were given the green light much faster. The shock portrayed by Euro-American news outlets on the coverage of African countries that handled coronavirus with less struggle exposes how the media plays into the Euro-American constructed stereotypes of Africa and the Global South. Moreover, many vaccines were tested on people in counties of the Global South, where now, the individuals do not have access to the vaccine.

The limited access to wealth and resources within public health policymaking illustrate how health inequities are systemic, going beyond vaccine diplomacy. The financialization of basic needs such as water and food have compounded the spread of diseases, especially in the Global South. The fall in demand for commodities has led to declining revenues and increasing debt, impacting food security, malnutrition, and illness faced by food producers and workers throughout the pandemic. These issues impact women in the Global South disproportionately, due to the increased burden of unpaid labor while under lockdown. In addition, economic instability, hardship, and inaccessibility to health services have worsened domestic violence rates. Reports show how violence against Indigenous women, Afro-descendant women, and women with disabilities has been particularly high throughout the pandemic in Latin America. LGBTQ+ communities are also one of the most vulnerable groups, with limited access to healthcare and safe housing. 

The oppression of vulnerable groups within the Global South ties to the increased popularity of authoritarian politics and nationalism within states in recent years, which has been further revealed by the pandemic. Hyper-masculine populist political leaders and right-wing administrations have repressed individuals through isolation. As a result of state-mandated lockdowns, individuals in power have implemented stricter authoritarian rule with more arrests and targeting of marginalized groups, in countries such as India, the Philippines, Paraguay, and Kenya. 

Kenyan activist Awino Okech argues that Euro-American feminists need to engage in transnational solidarity led by grassroots activists in the Global South. Okech points out the importance of abolitionist networks during the pandemic but also that, “We are not all in this together, and the consequences of COVID-19 are not felt the same way everywhere.” The pre-existing infrastructures weakened by global capitalism through limited access to healthcare, education, and resulting mass unemployment in countries of the Global South are predicted to only worsen throughout the pandemic.

Matthias Kennes shares their experience as a Doctors Without Borders medical advisor in the West Bank territory of Palestine, expressing how people are 60 times more likely to get a vaccination in Israel than in Palestine. As the current global leader in vaccinations, Israel has only just begun vaccinating Palestinians who work exclusively in East Jerusalem. However, the 5 million Palestinians in the West Bank and Gaza have not received the same opportunities. While the Palestinian Ministry of Health and the United Arab Emirates are sending vaccines to these territories, restrictions on the area and the lack of financial help from Israel, due to established interregional tension and ongoing military operations, have hindered accessibility to vaccines. Furthermore, as an occupying power, Israel has enacted institutionalized violence on Palestinians by withholding vaccine access, disregarding its responsibility to ensure health care and medical resources “necessary to combat the spread of contagious diseases and epidemics to the fullest extent,” under the Fourth Geneva Convention and international law. 

As the country with the highest recorded cases and deaths, the coronavirus vaccination process in the United States has only further added to the divisiveness of the nation’s politics. The logistical inconsistency that comes with disease prevention, differing vaccination strategies on local and state levels, and the exploitation of racial socioeconomic power structures has resulted in major disagreements and absence of a general societal awareness on the gravity of coronavirus. COVID-19 has disproportionately affected Black, Indigenous, and Latinx communities under structural racism: patients within communities of color are at higher risk for severe infection of chronic illnesses. Moreover, the inaccessibility of technology, affordable housing, food, transportation, legal status, and health education and insurance hinder communities of color in getting the COVID-19 vaccine. A recent report from Public Citizen reveals that about ⅓ of U.S. coronavirus deaths were tied to a lack of insurance. Due to the fact that many Americans depend on their employer for health insurance, the impacts of coronavirus on the unemployed stresses the need for Medicare for All. The socioeconomic disadvantages of Black and Brown folks collectively display the augmented risk of exposure to the coronavirus, with more detrimental health implications.

In California, the most vulnerable populations are not guaranteed priority vaccination. People with high-risk disabilities are having difficulties getting the vaccine, considering how many conditions are unquantifiable in medical data. Furthermore, the BIPOC working class, which makes up a large part of essential workers, are experiencing the brunt of vaccination disparities. The goal of medical efficiency with the vaccine rollouts has prioritized mass vaccination sites over the communities most in need. Particularly in Los Angeles, the neighborhoods in wealthy West LA have had as much as ¼ of residents already receive the first dose of the two-shot vaccine. In contrast, South LA and neighboring cities with a majority Latinx population have only 5% of residents vaccinated. The distinction between the two areas reflects racial capitalism, linked to long-standing issues with access to education and healthcare among Black and Brown working class folks. Compared to white people of the same age, Black and Latinx individuals are nearly three times as likely to be hospitalized and Indigenous people are almost four times as likely to be hospitalized. The COVID-19 pandemic has only further exposed the failure of governments to address and to overcome these socioeconomic inequities. 

Odilia Romero, a Zapotec interpreter and co-founder of Indigenous Communities in Leadership (CIELO), an Indigenous women-led nonprofit that has provided coronavirus relief for LA’s Indigenous communities, states: “I see Indigenous communities at the forefront. From the farm — from the agricultural fields to the hospitality industry to the cleaners, we are there. And we don’t have access to the vaccine.” According to Romero, the language barrier and the exclusion of undocumented Indigenous folks from the California relief fund has created a loss of lives and knowledge. Indigenous stories of migration and preservation of language have suffered as a result of the pandemic-induced vulnerability of the elder population.

Immigrants, the incarcerated, and individuals experiencing homelessness also face more extreme consequences under the American healthcare system. The incarcerated population in the U.S. is nearly five times as likely to test positive for COVID-19. The poor nutrition and inadequate living conditions already worsen the health of incarcerated people, who have limited access to medical care. The pandemic has illustrated the unacceptable American carceral system and the need for abolition of the prison-industrial-complex. The stigmatization of incarcerated people has made states, big corporations, and even the general public turn health away from jails, prisons, and detention centers. Ever since March 2020, ICE facilities have experienced some of the worst coronavirus outbreaks while conducting arrests and raids during a global pandemic. ICE’s inconsistency with CDC guidelines and infection management policies highlight the role of the organization and its for-profit subcontractors in spreading the virus among immigrants. In LA County, individuals without safe housing are 50% more likely to die from COVID-19. Now that recent vaccine qualification guidelines include people in need of shelter, the LA vaccine process must continue to prioritize supply of the vaccine to poor and unsheltered communities. Due to stigmatization and the complex and inequitable private health care system of the United States, these groups are systematically placed in unfavorable positions and are delayed medical care if any at all. 

Prevention of a disease like COVID-19 cannot depend solely on a vaccine; it also requires reducing and eliminating social inequities in health care. The current infrastructures of wealthy capitalist countries disregards health as a foundation to communal and individual well-being. Federal budgets continue to prioritize police states and the military rather than social welfare. The current system of privatized health focuses on the immediate emergency preparedness in the case of a pandemic. However, more changes need to be made in terms of the affordability of essential health services and who these services are being distributed to. The grassroots efforts and communities which have raised money and provided resources to community members have to be acknowledged within the discourse of health. The support from mutual aid and relief have assisted marginalized groups over the course of the coronavirus pandemic. International, national, and local actors must consider models of care to strive towards health as a human right and universal health coverage. The ability to pay or the value of one’s labor should not determine the difference between life and death.