Political economy of covid-19: extractive, regressive, competitive
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n73 (Published 22 January 2021) Cite this as: BMJ 2021;372:n73Read our Covid-19: The Road to Equity and Solidarity collection
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Dear Editor,
Covid-19 has sharply delineated longstanding inter- and intra-national inequities that are grounded in unequal and exploitative power structures. Death and destitution has been concentrated among systematically disadvantaged groups whilst elites are emerging relatively unscathed.[1-3] Rich countries have benefitted from trials conducted in the global south, but are refusing to share the first waves of vaccines until their own populations are completely covered.[4, 5]
Bump and colleagues apply the prism of colonialism to explain how nationalistic ‘me first’ approaches are propagating global inequalities along familiar contours.[6] Colonial extraction is grounded in beliefs of cultural and racial superiority. Whilst - sadly -xenophobia remains alive and well, an additional set of motivating beliefs are being mobilised to justify unjust (and self-defeating) approaches to vaccine acquisition. Leaders from the US, UK, and Israel have framed their actions in terms of the primacy of the government’s duty to protect their citizens above any other concern.[4,5] This approach draws more on neoconservative themes of ‘fiduciary duty’ than cultural supremacy, exemplified in Yuli Edelstein’s defence of Israel’s refusal to vaccinate Palestinians: “Israel’s obligation is first and foremost to its citizens. They pay taxes for that, don’t they?”.[7]
Even by their own standards, rich governments are failing their citizens. In a globalised economy “no one is safe until everyone is safe”[8] and the marginal benefit of vaccinating British 30-year-olds (with a ~0.0006% risk of death)[9] needs to be weighed against the significant risks from failing to cover high-risk groups in other countries before 2022. Not only is it morally right that the first doses are distributed according to clinical need, failure to do so will lengthen the global recession,[10] and potentially increase the chances that dangerous new variants emerge (and re-infect rich nations),[11] destabilise fragile states,[12] and cede soft power in the face of Chinese ‘vaccine diplomacy’.[13]
Matt Hancock has defended Britain’s zero-sum approach by pointing to impressive COVAX donations.[14] Whilst the UK’s leadership in this area should be lauded, the most pressing issue is how to distribute the limited doses manufactured in 2021.
Bump and colleagues call for far reaching supranational governance reforms to redress pernicious power imbalances. We would supplement their call with a more short-term and concrete demand: that no low-risk group is vaccinated anywhere until all high-risk groups have been vaccinated everywhere. For the UK and other rich nations, that means sending all pre-purchased doses overseas once high-priority groups have been vaccinated, and not progressing until all high-risk groups have been covered internationally.
The north’s current strategy belies the globalised nature of the pandemic. In his inaugural address, Biden reminded the world that “We will get through this together. Together.”[15] By hoarding early doses, rich countries are trashing international solidarity, condemning poorer nations, and shooting themselves in the foot. In the words of Dr Tedros, “Vaccine equity is not just a moral imperative, it is a strategic and economic imperative”[16]
Dr Luke N Allen
Director, Healthier Systems
GP Academic Clinical Fellow, University of Oxford
Atousa Bonyani
Associate, Healthier Systems
Cervantée WIld
Associate, Healthier Systems
Olivia Leventhal
Intern, Healthier Systems
Dr Jonny Currie
Public Health and Primary Care doctor, Public Health Wales
References
1. World Bank. Poverty and Shared Prosperity 2020: Reversals of fortune. 2020. https://openknowledge.worldbank.org/bitstream/ handle/10986/34496/9781464816024.pdf
2. BBC News. BBC poll suggests stark divide between rich and poor countries. 10th September 2020. Available at: https://www.bbc.co.uk/news/world-54106474 [Accessed 26/01/2021].
3. Oxfam. The Inequality Virus. Briefing paper. January 2021. Available at: https://oxfamilibrary.openrepository.com/bitstream/handle/10546/621149/b... [Accessed 26/01/2021].
4. Department of Health and Social Care and The Rt Hon Matt Hancock MP. Health and Social Care Secretary's statement on coronavirus (COVID-19): 11 January 2021. Available at: https://www.gov.uk/government/speeches/health-and-social-care-secretarys... [Accessed 26/01/2021].
5. Reuters. Trump to order priority access to U.S. COVID-19 vaccines for Americans. 7th December 2021. Available at: https://www.reuters.com/article/uk-health-coronavirus-vaccines-trump/tru... [Accessed 26/01/2021].
6. Bump JB, Baum F, Sakornsin M, Yates R, Hofman K. Political economy of covid-19: extractive, regressive, competitive. bmj. 2021 Jan 22;372.
7. The Independent. Israeli health minister says not country’s job to give vaccine to Palestinians in occupied territory. 25the Jan 20201. Available at: https://www.independent.co.uk/news/world/middle-east/coronavirus-vaccine... [Accessed 26/01/2021].
8. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 18 August 2020. Available at: https://www.who.int/director-general/speeches/detail/who-director-genera... [Accessed 26/01/2021].
9. Clift AK, Coupland CA, Keogh RH, Diaz-Ordaz K, Williamson E, Harrison EM, Hayward A, Hemingway H, Horby P, Mehta N, Benger J. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. bmj. 2020 Oct 20;371.
10. World Bank Global Economic Prospects 2021. Available at: https://www.worldbank.org/en/publication/global-economic-prospects [Accessed 26/01/2021].
11. Kim JH, Marks F, Clemens JD. Looking beyond COVID-19 vaccine phase 3 trials. Nature Medicine. 2021 Jan 19:1-7.
12. UN Security Council press release SC/14296. Weakest, Most Fragile States Will Be Those Worst Affected by COVID-19 in Medium, Long Term, Humanitarian Chief Tells Security Council. 9th September 2020. Available at: https://www.un.org/press/en/2020/sc14296.doc.htm [Accessed 26/01/2021].
13. Aljazeera. Vaccine diplomacy and the US-China rivalry in Africa. 7th November 2020. Available at: https://www.aljazeera.com/opinions/2020/11/7/africa-vaccine-diplomacy-an... [Accessed 26/01/2021].
14. BBC News. Covid vaccine: WHO warns of 'catastrophic moral failure'. 18th January 2021. Available at: https://www.bbc.co.uk/news/world-55709428 [Accessed 26/01/2021].
15. White House. Inaugural Address by President Joseph R. Biden, Jr. 21st September 2021. Available at: https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/01/20/ina... [Accessed 26/01/2021].
16. WHO. WHO Director-General's opening remarks at 148th session of the Executive Board. 16th January 2021. Available at: https://www.who.int/director-general/speeches/detail/who-director-genera... [Accessed 26/01/2021].
Competing interests: No competing interests
Politics, economy, covid-19, competition and fact
Dear Editor,
The take home message from the publication "Political economy of COVID-19: extractive, regressive, competitive [1]" that "Competitive attitudes by some countries have undermined the international response" and "Progress in public health requires governance reforms at multilateral institutions and international redistribution mechanisms" are very interesting. Whether this is a fact or not is the first question.
Managing the pandemic is not a sport or a game, and there should be international collaboration, not competition. However, it seems that some nations might overtly act and try to be the model for the others in disease management, despite the fact that there is no country in the world that can successfully contain the outbreak.
Whether there is a hidden agenda linked to the local political purpose, aiming at local popularity, is usually a simple question. Proper reaction, without over-reaction, is required. Standard public health management is appropriate. Too much or too little attempt is not acceptable. COVID-19 is not the single problem in any country. There are many problems to be managed, and good vision from a good governance system will lead to success.
References
1. Political economy of covid-19: extractive, regressive, competitive BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n73
Competing interests: No competing interests