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The (vaccine) hoard heard around the world The world has confronted racist global health policies before. We can do so now. Vidya Krishnan IN a world where pandemics are the norm, medical apartheid has become the civil rights issue of the 21st century. With most deaths occurring in 20 Black and Brown nations, about 14.9 million people died between 1 January 2020 and 31 December 2021. The highest number of deaths are in India, despite, or perhaps because of, it being the pharmacy of the world. The predicament of people dying of COVID-19 despite viable vaccines exemplifies the malignancy in the bone marrow of global health structures. This is not due to a dearth of resources or expensive technology, but because of racism: We must hold governments responsible for mismanagement, underinvesting in health systems, and allowing misinformation to spread – but not before we address vaccine inequality. Nothing has prolonged the coronavirus pandemic more. Humanitarian aid organisations Doctors Without Borders and Human Rights Watch have called on the administration of US President Joe Biden to use the legal leverage afforded by the Defense Production Act (recently invoked to tackle the US baby formula crisis) to get pharmaceutical companies to share vaccine technology with the World Health Organization (WHO)’s ‘tech transfer hub’. This would allow the speedy scale-up of manufacturing in developing nations. Former heads of state and Nobel laureates recently urged Biden to exert more forceful leadership in the global pandemic response. The urgency is real: It has been a year since India’s traumatising second wave in which, by conservative estimates, 2.7 million people died in a four-month period. These staggering losses are unconscionable, especially given that COVID-19 was, by then, a vaccine-preventable disease. Here, in my home country, lower-caste communities were unequally affected by COVID-19 much the same way as African American communities or refugees and immigrants in Europe, the United States, Canada and Japan: 80% of COVID-19 vaccines were administered in the 10 richest countries last year, leaving nearly three billion people – about half of the world’s population – waiting for their first shots. Globally, we are witnessing parallel pandemics, repeating historical mistakes of letting racism prolong curable infectious disease outbreaks. The denial of vaccines to poorer countries in the Global South, post-colonial nations in Asia, Africa and Latin America, is a deep violation of every code of bioethics arrived at in the aftermath of World War II when medicine became an extension of politics, used as a weapon to maim the most vulnerable. Universal crime meets universal justice After the war, a first-of-its-kind international military tribunal made up of judges from the four allied powers, the United States, Britain, France and the Soviet Union, brought Third Reich leadership to justice. The first of the Nuremberg Trials charged 23 defendants for conducting unethical medical experiments, such as removing bone, muscle and nerves, including whole legs, to transplant to other victims. The case led to the Nuremberg principles, a landmark document in medical ethics. These trials are one of history’s shining examples of a universal crime being met with universal justice. And the code created a set of ethical research principles for human experimentation that massively influences global health practices, including in the US. These trials were also an exercise in overwhelming hypocrisy: Over a decade before, and for three decades after Allied forces dispensed death sentences to Nazi doctors, Black US citizens were denied life-saving medicines to treat syphilis as part of the Tuskegee Syphilis Study. History is replete with examples that systematic denial of salve to Black and Brown bodies is not an accident but a feature of the White medical establishment. Medicine has once again become politics writ large and the US government is, once again, taking a hypocritical stand despite being in a unique situation to get vaccines to people around the world. In May 2021, when the Biden administration backed a World Trade Organization (WTO) proposal to temporarily waive intellectual property rights claims on COVID-19 vaccines, drugs and diagnostic technologies, called a TRIPS waiver, the world heaved a sigh of relief. Follow-through would have made the flow of vaccines to majority-Black and -Brown nations a real possibility. Since then, nothing has been done to change the status quo in a world where pandemic response leaders, Big Philanthropy and Big Pharma (raking in record profits) have us headed into yet another wave of a preventable disease. Global health czars and institutions in wealthy, White countries have been mulling over the subject with spectatorial passivity, as if this were a rare and theoretical matter that must not set a precedent. It is not rare for patients in less-wealthy countries condemned to die from treatable illnesses because life-saving remedies remain locked in patent monopolies. No one who lived in Delhi during the second wave, as the city ran out of beds, ambulances and oxygen, then wood for funeral pyres and fabric for shrouds, will consider this a theoretical matter. A vaccine-preventable illness decimated the capital of India, which was making vaccines for the rest of the world. India must fulfil its role as the pharmacy of the world but not at the cost of its own vaccine programmes. When India and South Africa asked for a WTO waiver, The Wall Street Journal questioned those nations’ ability to produce enough, calling it a ‘global COVID vaccine heist’. But they have since proved more than able to do the manufacturing, so long as they have the information and legal permission. Still, vaccines are being made in India at a fraction of the cost but being denied to the poorest among us. Antiracist policy can heal the world The failure to arrive at a proportionate response to extending vaccines to the poorest countries is a failure of our moral imagination. The most immediate need is to stop the pandemic, which cannot be done without a total waiver of intellectual property on drugs and diagnostics, in addition to vaccines. Medical apartheid can only be addressed by an actively antiracist stand on vaccines. Instead, the Biden administration has passed on the burden to vaccinate the world to India. While the people of wealthy nations in the Global North are boosted and impatient with an irrational longing to go back to a world before pestilence, the rest of us are waiting for vaccines to arrive. The reality of being global citizens means the world is one family. The pathogens see that. We should, too. Vidya Krishnan is a global health reporter who works and lives in India, and author of Phantom Plague: How Tuberculosis Shaped History (PublicAffairs, 2022). The above article was originally published by The Emancipator, a collaboration between Boston University and The Boston Globe. Visit theemancipator.org. SUB-ARTICLE Anti-racism body decries skewed distribution of vaccines The following is the text of a statement on the lack of equitable and non-discriminatory access to COVID-19 vaccines issued by the Committee on the Elimination of Racial Discrimination on 25 April during its 106th session. The Committee is the body of independent experts that monitors implementation of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) by its member states. THE Committee on the Elimination of Racial Discrimination, meeting in Geneva at its 106th session from 11 to 29 April 2022, Acting under its Early Warning and Urgent Action Procedure, Concerned about the devastating disparate impact of the COVID-19 pandemic on individuals and groups vulnerable to racial discrimination as defined in Article 1 of the Convention, in particular persons of African or Asian descent, those belonging to national or ethnic minorities, Roma communities, Indigenous Peoples, non-citizens, living in both global north and south countries; Concerned further that the disproportionate impact of the pandemic on those groups protected by the Convention in terms of higher levels of morbidity and mortality is in significant part attributed to consequences of the historic racial injustices of slavery and colonialism that remain largely unaccounted for today and the contemporary racially discriminatory effects of structures of inequality and subordination resulting from failures to redress the effects of racism rooted in slavery, colonialism and apartheid; Acknowledging that failures to redress these injustices have impeded the ability of communities to enjoy fully the right to life, health and health care, and the capacity of States to address entrenched structural inequities which have been exposed and deepened by the pandemic and enduring practices of discrimination and exclusion; Further concerned that across the globe higher rates of COVID-19 morbidity and mortality have been reported among persons and groups protected under the Convention due to little or no access to vaccines as well as living conditions, with limited or no access to clean water and sanitation facilities, healthcare, medication, medical services, social security and social services; Reaffirming that States must protect against and mitigate the impact of the pandemic on individuals and groups subject to structural discrimination and disadvantage on the basis of the grounds in the Convention, taking into account the gender-related dimensions of racial discrimination; Reaffirming further that States have an obligation to ensure equal access to lifesaving healthcare services, including testing, vaccines and medical treatments, which have been key in order to prevent the spread of COVID-19 and reduce fatalities as a consequence of infection with the virus; Deeply concerned that the vast majority of COVID-19 vaccines have been administered in high- and upper-middle-income countries and that, as of April 2022, only 15.21% of the population of low-income countries has received even one vaccine dose,1 creating a pattern of unequal distribution within and between countries that replicates slavery and colonial-era racial hierarchies; and which further deepens structural inequalities affecting vulnerable groups protected under the Convention; Deeply concerned that the pattern of unequal distribution of lifesaving vaccines and COVID-19 technologies between and within countries manifests as a global system privileging those former colonial powers to the detriment of formerly colonised states and descendants of enslaved groups; Recalling that under established ICERD provisions and practice, States are obligated to eliminate all forms of racial inequities whether they are by purpose or effect, de jure or de facto, and ensure substantive equality without discrimination on the grounds of ‘race, colour, descent or national or ethnic origin’; Noting that most of the vaccines approved are subject to an intellectual property rights regime and that the insufficient supply of vaccines due to unequal global distribution necessitates urgent measures in relation to the intellectual property regime; Noting also the proposal within the World Trade Organization (WTO) on a temporary waiver on part of the Trade-Related Intellectual Property Rights Agreement (TRIPS) for COVID-19 vaccines and treatment, supported by the Committee on Economic, Social and Cultural Rights2 and a number of special procedure mandate holders of the Human Rights Council,3 and noting the Report of the United Nations High Commissioner for Human Rights to the Human Rights Council on the human rights implications of the lack of affordable, timely, equitable and universal access and distribution of coronavirus disease (COVID-19) vaccines and the deepening inequalities between States;4 Noting that the States parties of Germany, Switzerland, the United Kingdom of Great Britain & Northern Ireland have opposed a request spearheaded by India and South Africa in October 2020 at the WTO to temporarily waive intellectual property protections on healthcare technologies concerning COVID-19 prevention, containment or treatment imposed by the TRIPS Agreement (later revised in May 2021) and in addition, Germany, Switzerland, and the United Kingdom of Great Britain & Northern Ireland have failed to mandate technology transfers by nationally based pharmaceutical companies that insist on guarding their intellectual property monopolies on COVID-19 healthcare technologies; Noting further that, while the State party of the United States of America has declared support for a narrow vaccines-only waiver, it has failed to use all its available tools, including activating its Defense Production Act, to mandate COVID-19 healthcare technology transfers from nationally based pharmaceutical companies; Recalling its Statement of 7 August 2020 on the ‘Coronavirus (COVID-19) pandemic and its implications under the International Convention on the Elimination of All Forms of Racial Discrimination’;5 1. Reiterates its call on States parties to ensure, including through international cooperation, effective and non-discriminatory access to COVID-19 vaccines and treatment technologies taking into account the situation and needs of groups which are marginalised and subjected to discrimination; 2. Reiterates further its call on States parties, in particular Germany, Switzerland, the United Kingdom of Great Britain and Northern Ireland and the United States of America, to combat the COVID-19 pandemic guided by the principle of international solidarity through international assistance and cooperation, including by supporting the proposal of a comprehensive temporary waiver on the provisions of the TRIPS Agreement, and taking all additional national and multilateral measures that would mitigate the disparate impact of the pandemic and its socioeconomic consequences on groups and minorities protected under the Convention. Endnotes 1. Global Dashboard for Vaccine Equity – UNDP Data Futures Platform (last accessed on 25 April 2022). 2.
See: ‘Statement on universal affordable vaccination against coronavirus
disease (COVID-19), international cooperation and intellectual property’,
23 April 2021. Available at https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download.aspx? 3. See: ‘COVID-19: UN experts urge WTO cooperation on vaccines to protect global public health’, 1 March 2021. Available at www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26817&LangID=E; statement by United Nations human rights experts, ‘Universal access to vaccines is essential for prevention and containment of COVID-19 around the world’, 9 November 2020. Available at www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=26484&LangID=E; statement by United Nations human rights experts, ‘States must prioritize health and equality over profits and vaccine hoarding, UN experts say. Omicron and other new variants underline urgency to act’, 29 November 2021. Available at https://previous.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=27875&LangID=E 4. Report A/HRC/49/35. Available at https://www.ohchr.org/en/hr-bodies/hrc/regular-sessions/session49/list-reports 5.
See ‘Statement on the Coronavirus (COVID-19) pandemic and its implications
under the International Convention on the Elimination of All Forms
of Racial Discrimination’: https://tbinternet.ohchr.org/_layouts/15/treatybodyexternal/Download.aspx? *Third World Resurgence No. 351, 2022, pp 6-9 |
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