By Sectors Co-Editors, Jeb Sprague, Preethi Krishnan, and Leslie MacColman
After a year of collective uncertainty, anxiety, and loss, the development of effective COVID-19 vaccines has offered a ray of hope. Yet, more than five months into 2021, the pandemic has not been contained. Instead, critical prognostications have materialized: the uneven roll-out of vaccines has enabled some countries, like the United States, to inoculate large parts of their population, re-activate the economy, and start “getting back to normal,” while others, like India and Brazil, which lag far behind in vaccination rates, are being ravaged by new waves and even more virulent strains of COVID-19.
Cross-national disparities in COVID-19 vaccination are stark. As of June 2021, over 51% of adults in the United States have received at least one dose. In the EU, this number is closer to 35%, whereas in Israel it tops 63%. Nonetheless, the world average hovers at only 12%1 and in dozens of countries, including South Sudan, Syria, Papua New Guinea, and Tajikistan, the vaccination rate is below 1%. Well into 2021, the United States, the United Kingdom, and a few other high-income countries dominated the global vaccine market, as poorer countries struggled to secure doses.2 Although this trend is slowly shifting, the world’s 27 wealthiest countries, which contain around 10.5% of the global population, still account for over 25% of all vaccinations.3 On the opposite side of the spectrum are countries like Nigeria which, despite being home to 2.6% of the world’s population, accounts for only .1% of all vaccinations.4
The pernicious effects of global inequities in COVID-19 vaccination may be evident, but their causes remain open to debate. To what extent have corporate profit motives or “vaccine hoarding” by wealthy countries generated an economy of scarcity in the Global South? To what extent have partisan infighting and weak state capacity contributed to low vaccination rates? Is widespread vaccine hesitancy among particular groups driven by reasonable skepticism about the efficacy of vaccines and the public agencies administering them or by disinformation intentionally propagated by competing geo-political powers? Finally, how have specific forms of US imperialism and economic warfare impacted the global distribution of vaccines and people’s access to them, particularly among targeted societies, such as Iran and Venezuela? These are important questions with no simple answers. Undoubtedly, as development sociologists, we will continue to analyze them for years.
This special Sectors symposium addresses some of these questions by examining the hows and whys of COVID-19 vaccine roll-out in four countries: China (Li), Brazil (Flynn), India (Jalali), and Kenya (Chorev & Mutwafy). As the authors make clear, each of these countries faces unique, local challenges based on factors like population size and distribution, infection rates, health system capacity, political configurations, and position within the world system. Yet their accounts also serve to highlight the dynamic interplay between local and global pressures and the complex causal chains that transcend national boundaries. Li describes how China was able to contain the spread of the pandemic within its territory, thereby prioritizing the export of Chinese-made vaccines to other countries. In striking contrast, Jalali describes how India – the world’s largest vaccine manufacturer – remains severely underprepared to produce and vaccinate its own people. As we go to press with this issue, India recorded the highest number of deaths due to Covid-19 in one day (June 11, 2021): 6,148 as reported by the national health ministry.5 The situation in India has parallels with that of Brazil, which currently has the highest death toll in the Western Hemisphere (after the United States). Flynn explains how political disputes have undermined coordination within the Brazilian state and how President Bolsonaro has actively sown doubts about the efficacy of the Chinese-made CoronaVac – the only vaccine available to most Brazilians. As evidenced by these accounts, domestic politics matter for vaccine roll-out. However, country-level responses cannot be understood without accounting for global and transnational processes. Using the case of Kenya, Chorev and Mutwafy draw attention to these processes, showing how vaccine diplomacy, health nationalism, and struggles to (re)define the “hierarchy of innovation” have influenced both the availability of vaccines and their perceived legitimacy among Kenyans.
All four pieces in this special Sectors symposia examine the local challenges of vaccine roll-out amidst the propagation of new variants and surging infection and death rates. These local challenges must be contextualized within a global capitalist system that has prioritized patents and profits over people. In October 2020, several countries from the Global South sought a waiver on patent restrictions for COVID-19 vaccines in the World Trade Organization (WTO).6 Presumably, this would have boosted global vaccine supplies and reduced per-unit costs, preventing many of the stark inequities we are currently witnessing. However, the patent waiver initiative was blocked by a coalition of powerful WTO members, including the European Union, Switzerland, Norway, Australia, Canada, Japan, Brazil, and, critically, the United States.7 whose political leaders argued in favor of protecting intellectual property rights with backing from major pharmaceutical companies.8
The patent waiver debate remains alive within the WTO, and there is no clear indication of what its outcome will be.9 Meanwhile, the export and sharing of vaccines remains essential for pandemic containment. Yet, vaccines (or their denial) have become a currency through which countries exercise power and influence in the world. Many countries in the Global South rely heavily on cost-effective vaccines from China and Russia. The United States has shared its vaccines through the COVAX system, but has simultaneously crippled the capacity of healthcare systems in countries such as Iran, Syria, and Venezuela to purchase both vaccines and medical equipment. As noted in the pieces by Chorev and Mutwafy and Flynn, Russia and the United States are competing over international markets for their vaccines. In sum, the manufacturing and distribution of COVID-19 vaccines helps illustrate how global capitalism intersects with geopolitics as various countries seek to retain and expand their influence, with the US regularly operating in a hegemonic role.
While life may be “returning to normal” throughout much of the United States, the COVID-19 pandemic continues to cripple many parts of the Global South, in part due to the slow roll-out of vaccines. As development sociologists, we need to keep asking hard questions about how and why this has happened – attending to the particularities of place, without losing sight of the international and global system. At the same time, we must be ready to grapple with the ethical questions that our empirical data can inform but, ultimately, cannot answer: Who should be prioritized for vaccination and associated public health investments? Who should absorb the costs? Who bears responsibility for the risks? And who should be empowered to make these decisions? Looking beyond the present moment, we believe these questions cut to the core of many ongoing debates about global development.
1 Coronavirus (COVID-19) Vaccinations https://ourworldindata.org/covid-vaccinations?country=OWID_WRL
2 Collins, Keith and Josh Holder. 2021. “See How Rich Countries Got to the Front of the Vaccine Line.” New York Times. https://www.nytimes.com/interactive/2021/03/31/world/global-vaccine-supply-inequity.html?smid=tw-share
3 “More than 2.42 Billion Shots Given: Covid-19 Tracker.” 2021. Bloomberg https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
4 “More than 2.42 Billion Shots Given: Covid-19 Tracker.” 2021. Bloomberg https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
5 Mishra, Manas and Neha Arora. 2021. “Indian state Sharply raises COVID-19 Death Toll Prompting Call for Wide Review.” https://www.reuters.com/world/india/india-records-6148-deaths-covid-19-past-24-hours-2021-06-10/
6 Usher, Ann Danaiya. 2020. “South Africa and India Push for Covid-19 Patents Ban.” World Report. 396(10265): 1790-1791. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32581-2/fulltext
7 “WTO TRIPS Council (October 2020): South Africa issues clarion call urging support for TRIPS waiver proposal.” 2020. Knowledge Ecology International. https://www.keionline.org/34235
8 Fang, Lee. “Pharmaceutical Industry Dispatches Army of Lobbyists to Block Generic Covid-19 Vaccines.” 2021. The Intercept. https://theintercept.com/2021/04/23/covid-vaccine-ip-waiver-lobbying/
9 Jimenez, Darcy. 2021. “Covid-19 Vaccine Inequity: The Debate Over Patent Waivers Intensifies.” Pharmaceutical Technology. https://www.pharmaceutical-technology.com/features/covid-19-vaccine-inequity-patent-waivers/