In an article for International Affairs in June 2023 Dr Andreas Papamichail of the Centre for Public Health and Policy explores the importance of health policy in addressing “deep-rooted racial inequities”. Dr Papamichail draws on theories of racial capitalism in suggesting that to prepare for future disease outbreaks we must identify and respond to these inequities in our experience of the COVID-19 pandemic. Here we examine the role of vaccine production and distribution, but we encourage readers to access the full article if interested.  

Nothing new to see here 

Dr Papamichail acknowledges that the “highly inequitable global distribution of vaccines” of the pandemic is “not a new phenomenon”. This is demonstrated by the global experience of diseases like HIV/AIDS. Indeed, during the COVID-19 pandemic as mpox spread internationally beyond its conventionally endemic regions, it became apparent that we had failed to learn from history. 

However, Dr Papamichail suggests that there was “initial optimism” for “new policy space” and subsequent changes to international IP laws. For example, the COVIAX initiative, established in March 2020, promised to encourage equity. Alas, this hope was short lived for many as this effort has since been described as a “failure” or “useless”. Furthermore, it “served to entrench precisely the global structures it was supposedly aimed at counteracting”.  

“Rather than prevent states who signed up for the initiative from circumventing it and striking bilateral deals with pharmaceutical companies, COVAX in fact enabled these as a concession to get wealthier countries to join the initiative.” 

The article contrasts “staggering inequities” with the profit margins of key vaccine producers in evidence of what some describe as “vaccine apartheid”.  

“No one is safe until everyone is safe” 

The COVID-19 pandemic was host to a range of rhetorical exercises, but Dr Papamichail suggests that one in particular “rings hollow”: “no one is safe until everyone is safe”. He suggests that some of the organisations contributing to this narrative are “deeply embedded and invested in the perpetuation of the system that enables this vaccine apartheid”.  

The article explores three dynamics that contribute to racialised inequity: 

  1. “The obvious inequity created by the profit incentives of pharmaceutical companies which shape the prioritisation of health issues and the distribution of life-saving vaccines and medicines according to the profitability rather than harm, and the ways in which the global IP regime entrenches these inequities.” 
  2. “The consequences of the maldistribution of medical products and technologies are obviously racialised, implying that racial differentiation is a necessary condition for acquiescence to such a brazenly inequitable system.” 
  3. “The way in which acts of charity like those emblematised by COVAX become the only possible exception to the legacies of exclusion entrenched by global IP regimes.” 
What can we do? 

Dr Papamichail suggests that the three dynamics of the COVID-19 pandemic “laid bare multiple interlocking and co-constituting processes”. He emphasises that “domestic and global hierarchies” create “surplus subjects and stratified layers of expendability”, giving the example of the “exposure of the racialised ‘essential worker’ to illness and death”.  

“The combined dynamics of expendability, exclusion and inclusion, and maldistribution, which have characterised the pandemic are emblematic of the workings of global racial capitalism, given that they arise out of a system that privileges some forms of labour, some forms of movement, and certain parts of the world over others.”  

The conclusion demands greater analysis of race and racism in scholarship on the “intersections between global health and international politics”. Fortunately, Dr Papamichail states that the “sheer scale of inequity” and its pandemic prominence might create “challenges and resistance”.  

“Decolonising is not just about reading lists, methods and sites of research, or discourses of global health, but about the material structures (of racial capitalism) that uphold global hierarchies of worth.” 

Some “concrete actions” are offered to policymakers and activists, and the most pertinent to vaccines is the call to “challenge” the idea that “IP protections are legitimate” in the light of public funding being able to “de-risk investment”. 

Do you agree with the issues raised and this emphasis on IP regimes? Let us know your thoughts on the article if you read it here, and don’t forget to subscribe to get more vaccine updates!