Inequity and health security: will the poison that blinds, open our eyes too?

Shobha Shukla, Bobby Ramakant *

"There are poisons that blind you, and poisons that open your eyes" had said famous Swedish author August Strindberg. COVID-19 and monkeypox have not only exposed the inequity which poisons our health systems but has also caused avoidable human sufferings, including deaths.

Even though inequity has been ailing our health and development model since long, the privileged class has remained numb and blind to it. But COVID-19 has proven that even the rich and powerful cannot remain firewalled from outbreaks of infectious diseases. Is it not high time that we open our eyes and rebuild equitable health and social security for all?

Inequitable health systems have caused diseases that could have been prevented, and untimely deaths that could have been averted. We must also keep in mind that these same broken health systems serve the best corporate interests of those who mint profits from illnesses through the so-called ‘health industry’. For a larger part of human population, health is a fundamental human right, and cannot be an ‘industry’

Sadder is the reality that despite two and a half years of battling the COVID-19 pandemic, we have not learnt from our mistakes and have not sufficiently addressed inequity in global health security. The monkeypox virus is once again drilling the same message: fix inequity if we want to ensure health security for all. But will our governments put people before corporate profits?

Attention to monkeypox is 50 years delayed

It was only when the rich nations were threatened with a possible monkeypox spread, that a global hue and cry began. Attention to monkeypox is just fifty years too late. Because the fact is that monkeypox is not a new virus but has been plaguing African nations for more than fifty years, and people who got infected with it have dealt with unnecessary human suffering for so many decades.

Is it not shocking to know that smallpox vaccines, which also work against monkeypox, still remain stockpiled by rich nations and global health agencies but they were not used for those in need of them in Africa where monkeypox is endemic?

Now, when the monkeypox threat looms large - with 257 confirmed and around 120 suspected cases of monkeypox reported from 23 non-endemic countries since May 2022 - rich nations and other global health agencies are putting their heads together if they can use these stockpiled vaccines against monkeypox. Should not we ask why they did not use them earlier for people in Africa who were at risk of monkeypox for fifty long years?

While the global outbreak of monkeypox has once again highlighted global health inequities, it has also brought much-needed attention to this disease that has been smouldering in Africa since the 1970s.

"This year there have been more than 1400 suspected cases of monkeypox in Africa – this virus has been circulating and killing people in Africa for decades. It is an unfortunate reflection of the world we live in that the international community is only now paying attention to monkeypox because it has appeared in high income countries. The communities that live with the threat of this virus every day deserve the same concern, the same care, and the same access to tools to protect themselves,” said Dr Tedros Ghebreyesus Adhanom, Director General of the World Health Organization (WHO), the United Nations health agency.

Inequity failed us in COVID-19 vaccine rollout too

This may sound cliché, but it is deeply true for perhaps all the diseases that have inflicted human beings since long. While the COVID-19 pandemic has jolted the rich and poor alike, its impact has been the severest on the poor and marginalized people worldwide, said Dr Sandeep Pandey, Ramon Magsaysay Awardee who spoke with CNS (Citizen News Service).

COVID-19 exposed the raw fault-lines in our inequitable and socially unjust health and social security systems.

Wishful thinkers may dream that pandemics like COVID-19 may make the rich, elite, and the powerful lean more towards redistributive justice. But if we look at the COVID-19 response, and ‘recovery’, the answer on the wall is clearly a big NO.

Not only did these 1% rich and elite mint more money while the remaining 99% of the global population reeled under economic and humanitarian crises (and continues to do so), but the COVID-19 vaccine rollout was also deeply unjust and inequitable.

Who is responsible for the 'pandemic of the unvaccinated'?

Science was clear since the early days of the COVID-19 pandemic that the only possible way out of the pandemic could be by ensuring that full vaccination reaches every eligible human being on the planet in a time bound manner so that no one gets severe COVID-19 disease, no one needs hospitalization or ICUs, and no one dies untimely. But breaking the chain of infection transmission continues to remain the central cog in the wheel for any infectious disease response, including COVID-19.

Rich nations have vaccinated their eligible populations many times over (three to four times) whereas there are several low-income nations that are yet to reach the target of 40% fully vaccinated people (a target which rich nations had crossed more than a year back).

“Almost 18 months since the first vaccine (against COVID-19) was administered, 68 countries have still not achieved 40 percent coverage” confirmed Dr Tedros Ghebreyesus Adhanom. Globally, on an average, about three-quarters of the health workers and people aged over 60 have been vaccinated, but these rates are much lower in low-income countries.

“Truly shameful. 18 months since COVID-19 vaccinations began, only 16% of the people in low-income countries have received at least one dose”, tweeted global health leader Dr Madhukar Pai.

Dr Tedros added: “the perception that the pandemic is over is understandable but misguided. More than 7000 people lost their lives to this virus last week (first week of June 2022). That is, 7000 deaths too many! A new and even more dangerous variant could emerge at any time and vast numbers of people remain unprotected. The pandemic is not over, and we will keep saying it - it's not over - until it is.”

In a world with over 7 billion people, 12 billion vaccine doses have been administered – around 152 shots for every 100 people worldwide.

There are nations like Cuba where this ratio is more than double of the global average: 330 doses administered per 100 people. People in rich nations have got three to four doses whereas those in middle and low-income nations got fewer or none (and in many cases, they got it late).

Moreover, people in rich nations have been vaccinated against COVID-19 ten times faster than those in low-income nations.

People in low and middle-income countries not only got fewer vaccine doses and/or got them very late (if at all), but also at times, vaccines reached their countries close to the expiry date. For example, a reputed medical journal (BMJ) reported recently that by the end of 2021, Nigeria had agreed to receive 2.6 million doses of COVID-19 vaccines from WHO’s Covax facility (an initiative set up for equitable distribution of vaccines globally). But these vaccines-most of which came from Europe - were close to expiry. Nigeria could administer 1.53 million doses, while the rest (1.07 million doses) were thrown away as they could not be administered within the expiry date period.

"Nigeria, Rwanda, Kenya, and Indonesia have destroyed vaccines received from Europe and North America because they arrived close to expiry" reported BMJ two weeks ago.

Heavy cost of inequitable vaccine rollout

We saw it clearly last year in 2021 that countries (like Israel), which were way ahead in vaccinating their populations fully, were showing very low hospitalization and ICU admissions among those infected with the virus. Yet, we failed to scale up vaccination equitably. As a result, when the Omicron variant of the corona virus hit us, the pandemic primarily became a ‘pandemic of the unvaccinated’. More than 90% of those who got infected with Omicron and needed hospitalization, ICU or ventilator or died, were unvaccinated. Who is responsible for this avoidable human suffering and pain, and untimely deaths?

As of now, the WHO reported on 8th June 2022 that the number of reported COVID-19 cases globally continues to decline but it also warned that there is not enough testing and not enough vaccination.

Socially just and ecologically sustainable health system for all

Noted writer and activist Arundhati Roy had said, “There is really no such thing as the 'voiceless'. There are only the deliberately silenced, or the preferably unheard.” A socially unjust and/or ecologically unsustainable health and development model is unacceptable. We have no choice but to work collectively towards ensuring health and social security for all, where those who are most at risk, come first.