Vaccine Politics: global inequality during the COVID-19 pandemic

TW: racism

Nothing can be of national or international importance without being imbued with the edge of politics. An event as impactful as the pandemic, which has afflicted an estimated 81.5 million, and led to 1.78 million deaths to date, was always going to be politicized; leveraged for gain, superiority, and influence over other countries. The war against the virus comes hand-in-hand with an international propaganda war. 

In the case of the pandemic, wealthy and powerful countries like the United Kingdom, the United States, Russia and China are able to use the virus for political gain. Vaccine nationalism is employed to gain influence and wield power among their national populations, as well as against other countries, while vaccine diplomacy is used to mend coronavirus-induced tensions and to curry favour among potential allies. 

Less developed countries face a different set of problems, wherein their vulnerability to economic downturns caused by lockdowns around the world, and their lack of an infrastructure to deal with such a health crisis were already threats to their populations. This is exacerbated through phenomena such as vaccine hoarding, wherein only the wealthiest of countries reserve the bulk of the life-saving vaccines being produced. Internationalist movements such as COVAX are attempts at reducing global inequalities in terms of access to these vaccines. Hence, nationalist and internationalist approaches to the pandemic coexist in a world where a deadly threat provides new opportunities for actions to be taken on the political stage. 

Nationalism

A resurgence in nationalism can be seen recently in trends in Europe, the US, and other countries worldwide, notably rising in association with and concurrent to right-wing parties and leaders. Nationalism is the sentiment of one’s country being superior to others, with their interests deserving to come before those of others. From Germany’s AfD, to Spain’s VOX, to America’s President Trump’s “America First” mantra, perhaps the rise in political nationalism primed the world for vaccine nationalism. 

The two main culprits of nationalist behaviour are the US and the UK. These are two of the countries most affected by COVID-19, but counterintuitively so. They are relatively sufficiently developed, wealthy, and have the organisational capacity to have confronted the pandemic in a way which would have mitigated its subsequent overwhelming spread. Yet, even the leaders- the global representatives- of both of these countries fell to the coronavirus, in a stroke of irony that was not lost on anyone. The UK and the US still made sure to manipulate the events of the pandemic for political gain. 

The most glaring case of “vaccine nationalism” is exemplified in the race for the vaccine, as countries raced to be the first on the moon five decades back, and as they scrambled to snatch up regions in Africa at the turn of the century. It is not a novel phenomenon; he who gets there first is able to laud it over the others. It is a source of national pride. Being the first, the biggest, the best, has always been the aim of governments in competition both domestically, with other parties, and internationally, with other states. This has often manifested itself through proxy competitions, seemingly unrelated to a state’s political strength. Nationalist competition can even be found in sports, as, during times of heightened political tensions, countries vie for first place. This was the case in the 1936 Berlin Olympics, with national athletes acting as vehicles for their governments as countries tried to prove national supremacy in the lead-up to a World War. 

Furthermore, vaccine nationalism is not just reflected in attempts to produce or approve a vaccine first, but more importantly, it is fundamentally about which country is able to provide for its citizens by securing sufficient doses of the vaccine so as to halt the rising death toll. According to the Duke Global Health Innovation Center, higher income countries had collectively reserved nearly 5 billion vaccine doses by the 8th of December through bilateral “advance market commitments”. The US has entered into six of these deals, thus securing more than 1 billion doses, a surplus of vaccines to ensure that if any of the trials fail, the other trials can offer them some security. However, the problem this poses is that vaccine production cannot keep up with global demand, therefore, for some years, many less-wealthy countries will be bereft of vaccines while the coronavirus continues to spread. From a scientific perspective, the global dissemination of COVID will be tackled most effectively if vaccines are distributed equitably, so that all countries can  inoculate populations so as to achieve some degree of herd immunity while vaccines continue to be produced. A nationalist stance, therefore, will only prove to be deleterious in time. 

UK

Expressions of vaccine nationalism

With two American companies (Pfizer-BioNTech, Moderna) and an English one (AstraZeneca, in collaboration with the University of Oxford) in the lead, this particular race has always been intolerably tight. Even though Pfizer was able to get approved by the UK, the EU, and the US, in a similar timeframe, the UK could still take pride in being the first to sign a deal with them and be the first to distribute the vaccine, thus “lead[ing] humanity’s charge against this disease”, as a tweet from Alok Sharma, Secretary of State for Business, Energy and Industrial Strategy, read. This does not go to say that the English agreed with this sentiment, as the top commenters retorted with “Lose the jingoism – it’s not even a UK vaccine” and “alternatively they’ll remember the UK having one of the worst death rates and the worst economic impact due to poor governance”. The UK was also the first country to approve the Oxford-AstraZeneca vaccine on the 30th of December 2020, coinciding with a period which has seen daily COVID cases in the UK at an all-time high: on December 29th, there were 53,135 new cases. 

Therefore, vaccine-related nationalist narratives were a tool used by the UK government to salvage some public support and credibility. The methods with which this occurred was through public statements: Health Secretary Matt Hancock and Tory MPs Jacob Rees-Mogg and Nadine Dorries all made the claim (on either Times Radio or Question Time) that the rapidity with which the vaccine was approved was a result of no longer being constrained by the European Medicines Agency. Education Secretary Gavin Williamson has publicly stated “I just think we have the very best people in this country and we’ve got the best medical regulators. Much better than the French have, much better than the Belgians have, much better than the Americans have. That doesn’t surprise me at all, as we’re a much better country than every single one of them, aren’t we?”. The Tory government have engaged in discussions about branding vaccine kits with the Union Jack–a potent national visual symbol that makes it very obvious who the British citizens should thank. In line with such symbolism, the UK called it’s immunisation programme “V-Day”, alluding to the language used for their victory in the Second World War, thus further inciting patriotic fervour around the topic of the vaccine. 

Political incentives 

The current Conservative government stands to gain from setting up the quick approval of a vaccine as a metric for a successful state. This is a strategy that can be described as setting milestones at accessible points, and celebrating when they have been achieved. This is to detract from the recent highly-publicised political losses the UK government has seen, both on the domestic and international fronts. On its local stomping-ground, the Conservative party has been accused of having failed to tackle the coronavirus crisis with any semblance of competence, with charges ranging from spending extortionate amounts (£12 billion) on a sub-par Track and Trace system which yielded few returns, to discriminatory lockdown regulations being placed on northern cities such as Manchester, compared to London, with only a fraction of the financial support. The government has further come under fire for failing to address child food poverty, limiting free school meals over vacations and obligating UNICEF to provide aid for these English children for the first time, undermining the UK’s credentials as a leading developed global power. The UK appears to onlookers as though it has been overwhelmed by a global health crisis disproportionately to other- potentially less wealthy and well-equipped- countries. 

Internationally, the UK was seen to be hurtling towards the 31st of December–the date of the final deadline for a Brexit deal with the EU–without a deal in sight. In the worst-case-scenario of a no-deal-Brexit, there were fears of the Pfizer-BioNTech vaccines being held up due to disruptions in the movement of goods between Belgium and the UK, which would be an issue given that these vaccines must be refrigerated at -70C. While the Conservative government, under Prime Minister Boris Johnson, was able to negotiate a deal at the eleventh hour, issues with trade and borders made the government appear as though they are frantically trying to make momentous, wide-reaching decisions with little time and little bargaining power. 

Most significantly, in the UK, the vaccine has become yet another battleground for Brexit: a vessel for the anti- or pro-European sentiments held by nationals. Depending on who you ask, British rapid vaccine rollout is either a national triumph, resulting from Britain removing themselves from the shackles of tedious European Union bureaucracy and legislation, or, alternatively, it was only made possible through international collaboration (BioNTech is a German company, and the drug will be produced in Belgium, the home of the EU headquarters). 

Implications 

Attempts to import politics into the vaccine may have adverse impacts. Firstly, according to Stephen Reicher, a social psychologist at the University of St Andrews, the stance of those who are hesitant or against the vaccine is informed by mistrust of politicians, who are accused of lying about the vaccine for political or monetary gain, and such propaganda only confirms these suspicions. Furthermore, in the eyes of those who give more credence to science, these government spokespeople are exposed as either being scientifically illiterate-having very poor knowledge of how the vaccine-rollout process occurred- or being prepared to lie about it for political gain, which does not inspire particular faith in them. This can have both negative effects on attempts to finally end the pandemic, as well be counterproductive for the government, politically. 

US

Vaccine hesitancy

President Trump’s methods to use the vaccine for political advantage are exemplified in his attempt, in the early days of the pandemic, to ensure that the CureVac vaccine would be “only for the USA”, in exchange for $1 billion. In an act akin to this one, the US was accused in April of diverting mask shipments meant for Germany for itself, in a scramble for scarce PPE in the midst of “mask wars”.

It is important, however, to place such actions within the context of American vaccine scepticism. All efforts to secure vaccines for the entire population are futile if the internal political implications behind the vaccine are not dispelled. This debate is wrought on a grassroots level. Within the wider conversation about whether the government and these big pharma companies are to be trusted- which has been waged on adjacent battlefields, such as that of mandatory mask-wearing and on the oppressiveness of the lockdown restrictions- the vaccine has not gotten through without intensive scrutiny. With a massive anti-vax movement having already taken root in the US, the coronavirus vaccines are treated with suspicion, especially given that vaccines are known to take up to a decade to produce. Operation Warp Speed, the name given to the US efforts to funnel billions into vaccine research and cut through red tape during this time of urgency, significantly expedited this process, thus inciting unease among sceptics. Only 60% of Americans have indicated they plan on being vaccinated, while 21% are reluctant to do so under any circumstances. Cynics wondered whether the October target for the completion of the vaccine would be rushing it unduly (and potentially dangerously) for the sake of having it out before the elections in November.

The link between the vaccine and politics is bidirectional; not only does the existence and supply of vaccines inform whether or not a government is perceived as effective or successful, but the inverse also holds true. When high-profile public figures and politicians put their weight behind the vaccine, this inspires faith in it among a dubious public. When individuals such as president-elect Joe Biden receive the vaccine on public television, this contributes towards the reduction of vaccine hesitancy. That being said, someone who is deeply convinced by the conspiracy theories is unlikely to be swayed by such a display; radical groups are always equipped with some response to rebut any information that runs counter to their beliefs. 

RUSSIA

In August, the Russian government claimed to have created a successful vaccine, which, in a propagandist nod to the aforementioned space race, is called “Sputnik V’. On its website, it claims to be “the first registered vaccine against COVID-19”, establishing itself as the winner of this implicit competition. This did not go without significant resistance, however, as the US, the UK, and Canada accused Russia of sending hackers to steal vaccine information from their drug companies and research groups. Russia responded by calling this a smear campaign, attempting to undermine what could “potentially be the most effective vaccine out there”.

It must be noted that President Putin had a political incentive to make this announcement prematurely, and to have produced a vaccine first even if – by scientific standards – it was not ready (skipping Phase-3 trials, it had only been tested on 100 people). Currently, his trust ratings are experiencing one of their deepest troughs, and he just passed the constitutional amendment to presidential terms which would allow him to stay in power indefinitely. If he is to be around for a while, he has to be well-liked. It is a regime-preserving strategy, akin to those employed by other non-democratic governments. Furthermore, in an exigent parallel to the Cold War, this can be perceived as a move for Russia to stake itself as an alternative pole of power, to carve out its own sphere of influence in a competition that so far has been dominated by Western countries. The fact that the vaccine was only to be released on a limited-scale (for healthcare workers and at-risk populations) seems only to indicate that it was done for political gain, and not because the vaccine was actually safe and ready for distribution.  

CHINA

COVID-inspired anti-Chinese racism 

The final key player is China. The source of what is dubbed by people like President Trump the “China virus”, or “Wuhan virus”, many are thus made fully aware of who to blame for the pandemic and this wanton loss of life. The tale of the virus having originated from “bat soup” provides the context for which people can attribute tragedy to foreign customs. The virus acts as a guise, which enables racist behaviour. Asian Americans are subjected to virulent hostilities. Justin Tsui was told to “go back to [his] country”, Abraham Choi was spat on, called a “Chinese f-ck”, and that “all of you should die, and all of you have the Chinese virus.” Jay Koo was threatened with murder by strangers on the street, which he closely escaped by coughing and pretending to have the virus. In America, those of Chinese descent have historically been accused of bringing disease, with landmark legal cases like that of Jew Ho v. Williamson revealing how pandemia and racism go hand in hand. This is an age where political tensions between the US and China are at an all-time high, as signified by the breakdown of diplomatic relations in July with the US ordering China to close its consulate in Texas, and China doing the same with the US consulate in Chengdu. In this modern Cold War, both countries paint the other as the evil counterpart to their force of good, as they vie for global influence through diplomacy, military force and mercantilism, the coronavirus is just another means through which this animosity can be manifested. 

Vaccine diplomacy 

China is determined to utilize vaccine diplomacy to rectify the negative image the coronavirus has tainted them with. Their leading vaccine (among nine candidates), aptly named Coronavac, is borne from biotech giant Sinovac. China intends to utilise this as a tool with which to endear themselves to other countries: Brazil, which was the country third-worst affected by the virus, has been promised 6 million doses of the vaccine by January. 

Terms native to the field of international relations can be imported into discourses around vaccine politics, which have presented themselves as a new channel through which to exercise power. Along with “vaccine nationalism” and “vaccine diplomacy”, one also encounters accounts of China attempting to become a “vaccine superpower” by providing vaccines for masses of people. In May, President Xi Jinping promised to share the vaccine with the world, setting China up to be favourably compared to the US, where President Trump was preoccupied with buying up a large bulk of production of new vaccines in a nationalist, protectionist move which only antagonised other countries. Another example of vaccine diplomacy can be seen in China’s proposal to prioritise distribution of their vaccine to Brazil, Indonesia, Pakistan, Russia and the Philippines, in a clear attempt to take advantage of the health crisis to forge or strengthen alliances. 

Internationalism 

Economic interdependence 

Nationalism does not characterize the efforts to create and distribute a vaccine in their totality. Internationalist sentiment can also be found, such as in the early days of the coronavirus, when the EU donated protective equipment to China, and later on, when China did the same for Italy. These displays of international cooperation and solidarity can be taken as evidence for a more liberal or idealist conception of international relations: not only is cooperation possible between countries; in cases such as a global pandemic, it is arguably necessary. It is rare that a country can isolate itself from the effects of the pandemic taking place in the rest of the world, as Australia and New Zealand have done. Ultimately, the fact that there is a global movement of people and products means that a country that is especially suffering from the coronavirus cannot just be left to fend for itself. This can be seen in the Kent lorry crisis, this December, which occurred at the border of the UK and France upon the announcement of the emergence of a new strain of COVID. However, it is not only the virus that can seep into a country. Given that countries are not self-sufficient, economically, and in terms of national production, a necessary corollary of international trade is that if a trade partner’s economy and production are stunted from the effects of the pandemic, it is likely this will have an adverse impact on your country too. The RAND corporation has found that vaccine nationalism can actually harm rather than benefit the countries in question: high-income countries such as the UK and the US stand to lose $119 billion per annum if less affluent countries do not promptly receive a sufficient share of the vaccines. It would only cost $25 billion to do so, thus yielding an overwhelming net gain.

Developing Countries

Economic vulnerability 

Lockdowns around the world are expected to result in “the worst economic downturn since the great depression”. The International Monetary Fund and the World Bank are offering billions in financial aid to countries struck by COVID, which, in less economically developed countries, can have the crucial effect of limiting the risk of civil conflict, which is observed to result from negative exogenous fiscal shocks. This is a problem that is not often included in western calculi of the impacts of the coronavirus. UN Secretary General Antonio Guterres claims that these economic effects will spillover and undermine responses to the pandemic: “most African countries lack the financing to adequately respond to the crisis, due in part to declining demand and prices of their commodity exports.”

Vulnerability to the health crisis and “guinea pigs” for vaccine testing 

The experience of the pandemic has been generally different in the Global South compared to the Global North which dominate news and discourses on COVID. Nepal has less than 500 intensive care unit beds in the entire country, despite a population 28-million-strong. This is a problem that threatened even developed countries like Italy. Brazil is one of the countries most affected by the virus, following only the US and India. This is suspected to be because they lacked both the infrastructure to institute a robust testing and tracing system, as well as sufficient PPE. Political infighting and institutional incompetence have resulted in Brazil lacking a comprehensive vaccination plan.

Furthermore, significant testing for vaccines takes place in developing countries, which has often invoked an ethical debate, including criticism of individuals in these countries being used as “human guinea pigs”, with the implication that their lives are dispensable. The larger part of Coronavac testing is taking place in Brazil, with the New York Times calling the country the “ideal vaccine laboratory”. These attitudes are residual from imperial narratives about the “family of civilised nations”, with those not meeting the “standard of civilisation” being barbaric; read: subhuman. These narratives can subconsciously spillover into real-life policies regarding global vaccine distribution, risking a status quo wherein wealthy states are able to hoard vaccines while countries in the Global South are left waiting and wanting. With a global pandemic, time translates directly into human lives: the passage of a single minute signifies another death in the US alone. 

However, wealth and health have long been conflated. The endemic problem of diseases in developing countries remaining untreated despite the availability of treatment is omnipresent, even prior to the coronavirus. In 2015, 1.6 million people in African countries died of diseases such as HIV-related illnesses, malaria, and tuberculosis. Such deaths can be prevented through existing medicines, however, due to lack of funds, these countries lack the medicines to deal with health crises that developing countries have already overcome. 

COVAX and the EU

The COVAX facility is the response of higher-income countries to this question; an effort to make the global distribution of vaccines more equitable. This sentiment is echoed by Guterres, who requested that the vaccine be treated as a “global public good” as opposed to “private commodities that widen inequalities,” per WHO Director-General Dr Tedros Adhanom Ghebreyesus.  COVAX is a strong example of international cooperation: it is spearheaded by international non-governmental organisations such as Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO), and the European Commission. 172 economies are now engaged in discussions to potentially participate in COVAX, with 80 of these being self-financing countries which will be providing support to the 92 countries eligible to be supported by this programme. The aim of COVAX is to “discourage national governments from hoarding COVID-19 vaccines and to focus on first vaccinating the most high-risk people in every country” by “lower[ing] vaccine costs for everyone”. Dr Ghebreyesus has cited COVAX as being a direct response to vaccine nationalism. Only time will tell how successful the execution of this project will be. Similarly, the EU is acting in its capacity as an international organization to centralise and coordinate vaccine distribution, ensuring that “All Member States will have access to COVID-19 vaccines at the same time on the basis of the size of their population”. 

However, it is crucial that nations follow through on commitments to reduce vaccine inequality. The ACT-Accelerator Programme, developed by the WHO to quickly produce and fairly distribute vaccines, makes a desperate plea on its website: “Recent contributions bring the total committed to over 5.6 billion US$ – but an additional 3.7 billion US$ is needed urgently, with a further 23.9 billion US$ required in 2021.” The swine flu outbreak of 2009 is a prime example of vaccine nationalism gone awry, where developed countries hoarded large quantities of the vaccine in the early days, requiring the WHO to coordinate donations of 10% of the vaccine supplies of nine of these countries. However, even in this case, international cooperation was used to mitigate this issue. 

Conclusion 

Ultimately, however self-explanatory and simplistic such a claim may be, global cooperation is necessary when dealing with a global crisis. There is little room for nationalism, and little to be gained from a policy of “each man for himself”. The vaccine and the coronavirus, inextricably interlinked, have become channels through which national political interests can be realised, a new, shiny tool in the arsenal and war-chests of governments to wield power and gain political capital. There is something morally disquieting in extracting political gain from a tragedy that has robbed people of their lives, their jobs, and their livelihoods. However, it would not be the first time that death on a large scale has been politicised. An obvious analogy to this is war, yet it is also a non-comparative one; war is inherently political and nationalist, constituted of territorial disputes and invasions of countries’ borders and sovereignty. It is clear that this politicisation has negative consequences, as countries forgo correct procedures in a juvenile strife to be first, and keep vaccines to themselves, seemingly forgetting the principle of sharing. It is likely that cutting through (sometimes necessary) red tape would have occurred in any case, as doctors, biotech companies, and governments alike are doing everything in their respective powers to fasten the proverbial tourniquet and finally cease this incessant haemorrhaging. Hopefully, international cooperation will come to fruition, and the coronavirus can be tackled in one, concentrated, effective effort, as opposed to differentially, with LEDCs lagging significantly behind wealthy countries in terms of access to life-saving vaccines. 

Artwork by Mia Sorenti