The dire shortage of COVID-19 vaccines across low- and middle-income countries is a strong indicator of global health injustice in recent times. Vaccine hoarding by affluent countries, for example the USA or Canada, is causing vaccine apartheid, and global policy responses thus far fall short in failing to save the world from this catastrophic moral failure. While the political and economic relationship of vaccine production and distribution is dominating the discussion, it’s the socio-cultural dynamics of the COVID-19 vaccine that put global governance in a fix.
The absence of a standardised treatment protocol and the current impossibility of eradicating the COVID-19 virus projects the COVID-19 vaccine as a new hope, not only for preventing infection, but also for restoring the sense of physical and mental wellbeing that was eroded when lockdowns were imposed and then extended worldwide. For society at large, vaccines promise a return to a free social, economic, and political life – the ‘old normal’. Thus, the vaccine represents a new type of ‘cure’ – one that would ‘fix’ all the pandemic-induced abnormalities in our daily lives.
This new ‘culture of cure’ has a profound impact on policy making at the national level. Ever since the search for a possible vaccine started in earnest last year, several vaccines have been developed, of which some are showing potential. But the vaccines are now being viewed and used politically as social medicines to ‘cure’ ‘pandemic ills’ that are largely linked to a life under lockdown. The vaccine when viewed as a social medicine creates a sense of confidence of being able to both prevent infection and also ‘unlock’ society that has been ‘imprisoned’ by pandemic-imposed restrictions. Therefore, in the policy-making process, a vaccine moves from being a preventive medicine to being a social medicine.
Vaccine nationalism and a return to sovereignty?
National leaders have taken this transformation as an opportunity to re-establish the eroded social contract in their jurisdictions. For political leaders, the large-scale vaccination of citizens signals a pathway toward combating pandemic-induced discontent. Vaccine nationalism, in which countries compete in arranging vaccines for its citizens, has become a way, especially for affluent countries, to ensure that citizens regain trust in governments. However, this competitive nationalism over the vaccine has been creating an abysmal shortage of vaccines in many other low- and middle-income countries.
The resulting vaccine inequity scripts the failure of global health governance in two distinct ways. First, it prevents nations from establishing a global coordination framework for the equitable distribution of vaccines. This is evident in the case of COVAX. Second, it fails to govern the market at the time of emergency to safeguard the interests of the people. The reluctance of a few pharmaceutical companies to share knowledge on vaccines with manufacturers, also those in developing countries, is a case in point. This means that the majority of vaccines are being developed and used in the Global North.
While vaccine nationalism has indeed had many ramifications when it comes to global ‘vaccine equity’, most of them negative, these two failures have created a new form of global mobilisation. This may only overtly appear as an alliance of less advanced countries pushing for a waiver of an agreement called TRIPS that currently upholds COVID-19 vaccine patents. The suspension of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) signed by World Trade Organisation members would help make the products and technologies needed to fight COVID-19 more freely available during the course of pandemic.
More importantly, the collective demand for the TRIPS waiver is also a new treaty-in-making that questions the role of knowledge in vaccine production and capital formation. This is a culture of counterpolitics in international relations that opposes the primacy of knowledge protection as an intangible asset over human lives.
Opposing vaccine inequity
Interestingly, this politics is not driven by national leaders as in the case of vaccine nationalism, but by the people themselves. Beyond the politics of a TRIPS waiver, there is a politics of breaking a knowledge monopoly that is instrumental in ideating a socially shared space of a pandemic-free territory. This imagined territory is for vaccinated people only. So those deprived of vaccines across the world have reasonably claimed that patented knowledge is a barrier in the ‘access to vaccine’ and thus ‘access to a pandemic-free territory’. This irrefutably triggers the current global outcry against ‘Big Pharmas’ and has been followed by domestic public actions. The Indian government for example had to halt vaccine exports despite diplomatic commitments to assuage the anger of people in the aftermath of second wave of the virus and a nationwide vaccine shortage.
But governments are also rallying to redress global vaccine inequity. Members of a bloc of some 62 countries (with India and South Africa driving it) are pursuing the sharing of vaccine-related knowledge. They are very well aware of the exclusiveness of pandemic-free territories in the current global order and are thus in the process of negotiating with international organisations and actors, especially the WTO, to be considered ‘entitled’ to the knowledge needed to manufacture vaccines.
This politics of vaccine entitlement is globally producing a new social category of vaccine citizens. Unlike vaccine nationalism, vaccine citizenship is a global citizenship not linked to nationality, with members from all over the world that collectively seek to quash the virus and its related social and economic effects by working together. Vaccine citizens are seen to struggle against the global knowledge-capital nexus.
Hence, vaccine nationalism driven by states is dividing the world, while vaccine citizenship driven by the general public who seem to be desiring a more equitable and accessible pandemic-free space that is not confined to state borders may help redress global inequities that have emerged alongside the COVID-19 pandemic. Only time will tell what the long-term effects of this people’s alliance will be in the global distribution of the vaccine. It might permanently change the global order. And rightly so!
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About the author:
Amitabha Sarkar holds a Ph.D. in Health from the Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University (JNU). He is a scholar of international development of health politics and is currently associated with the Transnational Institute (TNI).
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