The defining problem of 2021 will be disseminating Covid-19 vaccines to the most vulnerable around the world. Whilst some countries are seeing the light at the end of the tunnel, some have suffered disproportionately more, and will have a much more drawn-out recovery for a variety of distinct reasons. The situation for many of the poorest and least secure nations has continued to deteriorate during the past year, with more challenges showing up daily.
The impact of Covid-19 has been very ‘uneven’ between and within countries; more prominently so when considering the vaccination programs. This will have effects for decades, and the stark global injustice is clear. The Economist Intelligence Unit has predicted when countries will have mass vaccinations, and with most of Africa not being protected until 2023, questions will arise as to how richer countries can help in some of these areas as it becomes a humanitarian crisis.
The map shows a pattern of economic privilege, with Europe and the USA being the first to gain access, middle income countries next, and poorest trailing behind. There are a few interesting anomalies, where the picture is slightly more complex.
Geographically challenging regions
In Kashmir, insufficient resources and planning alongside a particularly harsh winter have caused snowfall to be extremely disruptive, blocking highways and flights. The unrelenting snowfall has resulted in people having to carry their dead or debilitated members many miles to reach hospitals as roads are blocked, and citizens face an inability to access basic necessities like water. While India is manufacturing the Oxford AstraZeneca vaccination, which is expected to provide 90% of their vaccinations, transporting the vaccine to remote places and distributing it will be challenging, on top of the political delays in the vaccination process.
Areas controlled by armed groups
Around 66 million people around the world are under the control of armed groups. They are some of the most vulnerable to Covid-19 due to malnourishment, lack of medical facilities and overcrowded living spaces. While they have the right to vaccinations under international law, this is fraught with difficulty. The states in which these people live have an obligation but often not the ability to provide this, either due to a lack of resources or the fact that international aid frequently is given on the condition of zero contact with the terrorist groups. It’s a Catch-22 situation: countries are obligated by international law to provide vaccines for people they cannot access due to the same countries hindering their ability to provide vaccines through restricting contact. This is the fate of those living under Al Shabaab, Boko Haram, Al Qaeda and Hamas, and a future where they are secure from Covid-19 will be very challenging to achieve.
Vaccines as a tool for political conflict
Concerns have also been raised about the equality of Israel’s vaccination process. Despite having the most rapid vaccination program in the world, currently having vaccinated over 18% of their population, they have refused to provide for any Palestinian, claiming a lack of responsibility and jabs. The WHO have called for them to provide assistance, as Palestine’s healthcare system is close to collapsing, with thousands of healthcare workers having contracted Covid-19 and not a single one being vaccinated. Amnesty has called Israel’s approach ‘institutionalised discrimination’, citing Article 56 of the Fourth Geneva convention to remind Israel of their responsibility toward Palestinians. Those living under Hamas rule will also have to rely on the slow Covax program.
'Heads I win, tails you lose'
A revealing New York Times article shows the stark unfairness in the global system, telling the story of a South African factory preparing to make around a million vaccinations, only to have every one shipped to European distribution centres. Many countries fall through the gaps of Covax for ‘not being poor enough’ and the program’s complexity means dangerous inefficiencies for such a time-sensitive crisis. For many South Africans, their best option to acquire a vaccine is to try and get on an over-subscribed clinical trial for a vaccine which, if successful, will go to the developed nations who have pre-ordered millions of doses, effectively crowding out the market for these poorer nations.
Middle-income countries also feature stark within-country inequality which is threatening the majority of citizens’ access to vaccinations. In South Africa, concerns about the governments’ vaccine plans have led to the threat of potential legal action from their Health Justice Initiative (HJI). Fatima Hassan from the HJI called the global situation a ‘global vaccine apartheid’ and warned that South Africa’s vaccination program could follow the same problems as it did with AIDS denialism, unless the country takes a more proactive role. She highlights that although the WTO and 140 world leaders have called for the Covid-19 vaccine to be free and available to all, systemic global shortages will ultimately require rationing, potentially in the form of pricing, making it unattainable for many of the poorest.
Care and diligence must be taken in the coming months to prevent needless death and suffering because of a capitalist system in crisis, where the line between health as a human right and health as a commodity is being blurred. In the long run, those more fortunate to receive vaccinations and recover from this pandemic should be attentive to the experiences of these people, and what can be done to help put it out of headlines and into history books as soon as possible.
Quote in the title is from Mtshaba Mzwamadoda, 42, South Africa