On Global Health Day: From medical apartheid to free vaccines for all

On this April 7, Gobal Health Day, the International Week of Anti-Imperialist Struggle is organizing an international campaign asking to stop the medical apartheid, abolish the patents on the COVID-19-vaccines and, in this way, guarantee free vaccines for all.

Today’s global pandemic politics is dominated by a vaccine nationalism that is increasing global health, social and economic inequalities. A few numbers clarify these tendencies: The Global North, with less than 14 percent of the world’s population, has secured three times more vaccines than their population, while poorer countries will not have vaccines for their citizens before 2023. Till today, only 1.5 percent of the world’s population of 7.7 billion people have been vaccinated, 80 percent of them are from only ten countries of the Global North. During 2021, 70 countries in the Global South will only be able to vaccinate one in ten people.

These global inequalities do not mean that within the countries of the Global North all are in the same boat either, on the contrary: marginalized, vulnerable and precarious working people, especially women and migrants, still remain excluded from many national vaccination programs.

It can be much better

The shameful wrangling in Europe about the various available vaccines shows the inability of “civilized” capitalist Europe and their neoliberal administrations to come out with a comprehensive, serious, consistent and, above all, coordinated set of policies aimed at combating the COVID-19 pandemic. The worst European performers can be seen in the table below:

What explains these high levels of COVID-19 incidence are: (a) systematic budgetary cuts in public health that began since the adoption of both the Maastricht treaty in 1992 and the Euro in 1999, and their drastic intensification with the banks-provoked 2008 ‘credit crunch’ economic crisis (b) persistent hesitancy by European governments to adopt proper lockdown and fully assume the financial consequences that went with it; under the pressure of capital, they kept adopting haphazard measures which, no sooner the COVID-19 contagion curve flattened, were relaxed, thus bringing about wave after wave of contamination, and (c) their slavish genuflexion to US foreign policy led them to reject purchasing the full basket of available vaccines including Russia’s Sputnik V and China’s Sinopharm. 

Women in the pandemic

The structural reforms of the public services became more evident during the ongoing pandemic: lack of personnel, saturation of services and precarious working conditions. Those changes have especially affected women who are an important part of the health system; in the European Union, eight out of ten health workers are women.

So it is fundamental to look at the infection rates from a gender perspective. In Spain – as in many other parts of the world – 78.8 percent of primary care nurses are women. For over a year of the pandemic, a huge part of the health care workers were insufficiently protected. 73.6 percent of the infected health care workers are women. This is also due to the fact that they work directly with patients, which means that lack of protection affected them more than the rest.

It is important to bear in mind the statements made by UN Women, which highlights the case of Spain due to the gender gap in frontline infections in a report entitled: “COVID-19 and gender: what do we know; what do we need to know?” However, these reports barely mention the problems of women working in sectors dedicated to care in other areas, such as female caregivers in private homes, women in home help services (servicios de ayuda a domicilios or SAD) or cleaners in hospitals and health centers. In these cases, the institutions continue to forget the most precarious workers, as they do not add to the gender approach, the class approach. These services, moreover, are usually managed by private companies, where economic benefits are more important than the quality of care or occupational health. 

SAD workers, for example, lacked any means of protection until the end of the first wave of infections, and to this day, they are still not widely and adequately protected. It is clear, therefore, how important it is to disassociate these precarious and feminized sectors from the private sphere. Care and health care cannot be the responsibility of those who prioritize economic profit.

On the other hand, the economic and social consequences of the pandemic will be felt most acutely by women, precisely because of the precariousness of labor, the wage gap, which results in lower contribution bases, influencing the collection of labor coverage, and because even today, women are still the ones who are mostly involved in family care – a burden that has increased during the pandemic.

Migrants: Excluded from national vaccination programs

In addition to women, migrants are mostly marginalized and excluded from adequate anti-COVID-19-protection and free vaccines. The Italian case is emblematic. The country is home to more than 500,000 undocumented migrants, that means people who live in the country but who do not exist from an administrative point of view. Those people can be homeless, living in reception centers, irregular migrants, people living in shanty towns or informal settlements, stateless people, Roma and Sinti in unofficial camps.

This population has had little or no access to screening and treatment for COVID-19 and now risks being left out of the vaccination plan. In a letter sent to the Italian health minister Roberto Speranza, social organizations and associations such as Caritas, Emergency, Doctors Without Borders, Association for Juridical Studies on Immigration (Asgi), Italian Society of Migration Medicine (Simm), and others are asking precise national indications for the inclusion of those 500,000 human beings in the National Vaccine Plan, emphasizing the need to establish the procedure that allows vaccination to those who are in Italy although they do not have healthcare card or other identity cards. In other words: a collective regularization of undocumented migrant workers is needed, as it is also demanded from many undocumented migrant movements all over Europe – the only way to ensure the public health for all.

It can be done differently

China’s comprehensive “Zero COVID” policy, coupled with rigorous lockdown, mass free tests, and robust state economic intervention to support people, companies and small enterprise, demonstrate that it is perfectly feasible to defeat the COVID-19 pandemic — with 101,801 cases with 4,841 deaths, China has pretty much returned to normalcy. 

Two other emblematic examples confirm that the successful battle against the novel coronavirus requires a different, non-neoliberal, non-capitalist approach, such as Venezuela and Cuba.

In Bolivarian Venezuela, the early adoption of lockdown; full national deployment of a well established public sector health service with free mass testing; daily TV information on the pandemic; full state support for people and enterprises; and, crucially, international collaboration has led to 162,730 cases with 1,969 deaths. 

Cuba, with decades of socialist experience in health, and being a biotechnology powerhouse, has a total of 77,353 cases with 429 deaths. Both countries, especially Venezuela, are under siege from a US-led criminal and fully comprehensive blockade, enthusiastically supported and supplemented by Europe, that illegally retains precious resources (USD 7 billion), which could be used to save lives.

Even worse, the cruel irony is that a recent motion (23/03/2021) presented in the UN Human Rights Council about the highly negative consequences of sanctions, was passed with the opposition of all European nations, including Italy, which benefited so much from the Cuba’s Henry Reeve Medical Brigade. 

Free licenses a utopia? No!

For months we have been arguing that the response to a global health problem such as the pandemic must necessarily involve the entire population of the world without excluding on the basis of class, ethnicity, status or gender.

Now, even in the scientific community these positions are presented. The prestigious medical journal The Lancet published a letter entitled “Free license of vaccines to end the COVID-19 crisis.” The scientists arguments are direct and simple: Despite the fact that pharmaceutical companies have received substantial public funding for vaccine research and development, governments have not been able to condition them to measures to implement the production and supply of the vaccines. The researchers identify a crucial role of vaccines and their global dissemination in the resolution of the pandemic. In fact, they state that delays in vaccine production and distribution will lead to repeated morbidity, mortality, and blockages with health and socioeconomic damage.

By consequence, the researchers call on governments to enter into agreements to give free access to patents of vaccines. However, in the absence of such an agreement, they propose the route of compulsory licensing, according to which, states should mandate companies that others can also access the knowledge bound by intellectual property and produce the drug, because of the ongoing public health emergency.

The deepening of social inequalities within the countries of the Global North is just another manifestation of the limits of a private and market-led management of the pandemic. What is needed is a radical turnaround in defense of life over profits.