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The Pandemic of Global Inequality

As rich countries stockpile Covid vaccine doses and protect the interests of Big Pharma while poor countries are forced to wait years for treatments, it's never been clearer how global injustice threatens all of our health.

In March, South Africa stood at the precipice of its first wave of Covid-19 infections. Rapidly rising cases threatened to overwhelm the health system; in response, President Cyril Ramaphosa issued a national shelter-in-place order. The month-long lockdown confined all South Africans, except essential workers, to their homes.

‘While this measure will have a considerable impact on people’s livelihoods, on the life of our society and our economy,’ Ramaphosa warned at the time, ‘the human cost of delaying this action would be far, far greater.’ He was right – but the worst of the damage incurred by the South African economy will not be mirrored equally by countries the world over.

Equity in the Time of Scarcity

When the World Health Organisation (WHO) declared the H1N1 flu a pandemic in 2009, wealthy countries producing jabs refused to export them until firms met domestic needs. To promote fairer distribution during Covid-19, the WHO proposed initial vaccine doses be allocated to ensure every nation could inoculate 20 percent of those most at risk. Doing this, the WHO argued, would prevent deaths, but also reduce the already unequal social and economic consequences of the pandemic.

The United States, the United Kingdom, and the European Union could achieve the WHO’s initial target more than 20 times over, a September analysis by Oxfam senior policy advisor Mohga Kamal-Yanni shows. According to global civil society consortium the People’s Vaccine Alliance, Canada alone could vaccinate every one of its citizens five times if all the experimental jabs it pre-bought are successful.

While not all of the almost six dozen Covid-19 vaccines currently in human trials will be proven effective, the Alliance also states that rich nations representing just 14 percent of the world’s population have bought up half of the most promising vaccines so far.

Stockpiling Risks

And they may have the option to buy even more, South African Health Minister Zweli Mkhize says.

‘Some countries have opened up to us about the number of the vaccines they have bought, and indicated that they have options of buying additional stock,’ Mkhize explains. ‘There’s no justification for the well-resourced countries to hoard. […] They have to consider releasing that stock.’

South Africa has not secured any bilateral deals for Covid-19 vaccines, as of early January 2021. If it cannot muster an agreement, it will have to rely on an initiative called Covax for doses, like most Global South nations.

Led by the public-private vaccine partnership Gavi, Covax pools nations’ purchasing power to secure a minimum number of affordable jabs for participating countries. The world’s poorest nations will receive partially subsidised vaccines, while upper-middle income countries—such as South Africa—must self-finance.

The UK, the EU, and Canada have all pledged to financially support Covax – which senior economist at global policy thinktank RAND Europe Marco Hafner says is ironic, given that their bilateral deals arguably undermine Covax’s efforts toward vaccine equity.

A Chance to Share

There is an alternative. In October, India and South Africa submitted a proposal to the World Trade Organisation (WTO) that would waive some intellectual property rights on Covid-19 medical commodities for the pandemic’s duration, enabling those in the Global South to use existing provisions without incurring retaliatory pressure from pharmaceutical companies.

Allowances like this for public health emergencies are already permitted within international trade law, but remain difficult to use in practice for many emerging nations, explains Fatima Hassan, founder of South Africa’s Health Justice Initiative. The US threatened to use these same flexibilities in 2001 to override patent protection and procure affordable medicine to treat anthrax attack victims – but US trade officials have looked less favourably on other nations doing the same.

The US, the UK, Canada, the EU, and Japan—all countries with early access to Covid-19 vaccines, in part due to domestic pharmaceutical industries—have opposed the waiver, as of October.

A New, More Unequal World

The International Monetary Fund predicts that Covid will lead the world to experience the worst recession since the Great Depression. But bilateral deals and the ability to reserve locally produced vaccines for the domestic market may enable the United States, Canada, the UK, and the EU to be among the first to reach vaccination levels high enough to control local outbreaks, sparing both lives and jobs. These countries are now also among those simultaneously opposing Global South efforts to secure affordable Covid-19 vaccines, medicines, and equipment, and will help decide what kind of economic relief poorer nations receive.

The consequence of this, according to Trinity College Dublin associate professor Martin Sokol and research fellow Leonardo Pataccini, is that the pandemic will exacerbate inequalities between, and even within, the Global North and the Global South. If outbreaks in poorer, vaccine-scarce countries take longer to contain, nations may be subject to more prolonged and repeated lockdowns, which, Pataccini warns, may also lead states to face impossible choices between jobs and lives.

‘What we are seeing, for example in many Latin American countries, is that due to the negative economic effects of the lockdowns, governments are opting for opening their economies even when conditions are not safe,’ Pataccini explains. ‘Thus the costs of hierarchical access to the Covid-19 vaccines will not necessarily be accounted for in greater GDP declines due to longer lockdowns but, rather, in human lives due to hasty re-openings of economies.’

And the economic consequences of just one lockdown in South Africa have been severe: three million workers lost their jobs between February and April 2020 – losses which hit women and rural workers the hardest. Three months after its lifting, only half of furloughed workers had returned to work. Among the most impoverished workers, the gender pay gap had increased by a factor of five. The number of households running short of money for food is now double what it was in 2016, despite the increased government welfare grants.

Reproducing Historical Power Imbalances

‘This is what the WHO has been warning about – all of this is worsening global health inequality,’ Fatima Hassan says. ‘It’s a perfect example of how rich countries actually don’t care about poorer countries, or their trade partners, or their former colonial subjects.’

Sokol and Pataccini also say that, unsurprisingly, the pandemic is reproducing power dynamics the Global North built on historically uneven footing and embodied in financial flows.

The economies of colonised nations, particularly in Africa, were designed to feed the metropole raw materials and, in return, consume its manufactured goods; today, many African economies remain overly-dependent on raw commodity exports. This dependence, amid pandemic declines in demand and prices, has jeopardised some countries’ ability to service debt, Director of the Africa Programme at Chatham House Alex Vines says.

In April, G20 finance ministers endorsed a programme to allow some nations, including 40 African countries, to suspend debt repayments until at least July 2021. The G20 includes the

US, UK, and EU, alongside South Africa, India, and Turkey. But Vines points out pausing repayments does not reduce the net value of debts.

‘A number of African countries are more or less out of money – they’re not producing enough,’ he says. ‘Postponing repayments may not be the solution. You need to consider debt cancellation.’