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 Jan. 1, 2020 and Dec. 31, 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 organizations Doctors Without Borders and Human Rights Watch have called on the Biden administration to use the legal leverage afforded by the Defense Production Act (recently invoked to tackle the U.S. baby formula crisis) to get pharmaceutical companies to share vaccine technology with World Health Organization’s (WHO) “tech transfer hub.” This would allow the speedy scale-up of manufacturing in developing nations. Former heads of state and Nobel laureates recently urged President Biden to exert more forceful leadership in the global pandemic response.
The urgency is real: It has been a year since India’s traumatizing 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 3 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 U.S.
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 U.S. 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 U.S. 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 lifesaving 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 fulfill its role as the pharmacy of the world but not at the cost of its own vaccine programs.
When India and South Africa asked for a WTO waiver, The Wall Street Journal questioned those nations’ ability to produce enough, calling it “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).