A Covid-vaccine mustn’t be hoarded.

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On July 20, researchers at Oxford University’s Jenner Institute released preliminary Phase I data on the immune response of their vaccine candidate, ChAdOx1 nCoV-19, in The Lancet. These findings are helpful and bring a glimmer of hope that perhaps a vaccine could be found to prevent (severe) COVID-19, caused by the virus SARS-CoV-2. On the same day the World Health Organisation (WHO), cautioned the world that indigenous peoples in the Americas, the current epicentre of the pandemic, are particularly vulnerable to the virus and its severe ramifications. This only strengthens the urgency with which we must avoid hoarding a potential vaccine or treatment for COVID-19 away from the most vulnerable in the world.

As we have seen over the last months, this virus and the disease it causes does not hit every one of us equally. The epidemic’s epicentre has shifted from China to Europe, and is now currently in the Americas. What we have seen is that many vulnerable people have borne the brunt of the pandemic, with the burden of mortality mainly shouldered by minoritised and racialised communities in Europe and the United States and key workers in general (many minoritised and racialised communities are also more likely to be frontline workers), as well as those with lower socio-economic backgrounds. As mentioned in the previous paragraph, Dr Tedros, the Director General of the WHO, has recently mentioned how indigenous communities in the Americas are currently most at risk of suffering the effects of the Covid surges throughout the continent. Presently, the spike in SAR-CoV-2 infections in recently contacted indigenous peoples in the Amazon have raised alarm. Furthermore, although some countries with weaker health systems have seemingly been able to relatively contain the virus, it has nonetheless been a terrible strain, especially in countries that are also still dealing other communicable disease outbreaks such as a recent Ebola and measles outbreak.

Recently, the United States bought up most of the world’s supply of Gilead’s remdesivir which, other than the drug dexamethasone, is currently the only hopeful candidate treatment for COVID-19. Even though there is as of now limited evidence for remdesivir, and the cheap drug dexamethasone at time of writing seems more promising, the move by the United States sets a worrying precedent.

As I have stated so many times on this blog, health is a human right. To ensure accessibility and equity in healthcare we have to act accordingly. When countries with relatively strong healthcare systems and strong scientific infrastructure to research and produce vaccines and medicines to prevent or treat COVID-19 end up distributing, or even hoarding, these vaccines and treatments for their own populations, there is a strong possibility that countries with disadvantages, many incurred because of a history of colonialism and extractive capitalist exploitation, will end up holding the metaphorical baby. Within these countries the poorest and those made most vulnerable (including indigenous peoples) will suffer the most. Beyond vaccine hoarding, the selling of vaccines or treatments for profit by pharmaceutical companies will also disadvantage the world’s poorest and those in (mainly) Global South countries. Moreover, there are some concerns that neocolonial approaches to vaccine and medicine testing will end up using the African continent as testing ground.

Dr Tedros has reiterated in the daily briefing that a potential vaccine should be a public good. It must be continually emphasised that access to healthcare is a basic human right. Many countries have pre-existing issues with being able to reach their most vulnerable communities and provide them with appropriate healthcare, and while the pandemic has exposed the vulnerability of all of our health systems, some countries and some people will be more disadvantaged than others. It is imperative that countries with more advanced health systems do not return to an ‘each man for himself’ mentality, but act in the spirit of solidarity.

A post-Covid world could – indeed should – be one where healthcare is accessible, health is treated as a human right, and our approach to global and public health is one of internationalism and solidarity.

A vaccine or treatment must be freely accessible to all people. The importance of healthcare as a human right must underpin every step our governments take moving forward. The pandemic has shown us that in an increasingly connected world, our health systems are really only as strong as the weakest link. In a neoliberal capitalist world it is progressively common to see everything, including our human rights, through the lens of profit margins and winners and losers. Austerity, the privatisation of healthcare, and growing inequality have direct impact on global and public health. We cannot, then, in good conscience apply the ‘logic’ of the market to a global pandemic where many vulnerable people are needlessly losing their lives and suffering. A post-Covid world could – indeed should – be one where healthcare is accessible, health is treated as a human right, and our approach to global and public health is one of internationalism and solidarity. What better way to laud in the new world than to use these principles as the way out of the pandemic? What better way to increase equality, health access and diminish the possible catastrophic effects of a next pandemic than to work together to make vaccines and treatments freely accessible? It is not just a nice thought; I would go as far as to say that this is our moral duty. The time for complacency is over and the time for solidarity is now.

The shakiness of our foundations

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Karl Marx wrote that ‘the history of all hitherto existing society is the history of class struggle’. To many people the idea of class struggle seems archaic and belonging firmly to the 20th century. An equally 20th century idea is that of living through a deadly pandemic – a scenario that has for most of us only been conveyed through history books, and a scenario in which we have collectively been thrust by the once-in-a-century unprecedented COVID-19 pandemic. This current pandemic is exposing the problems within our current economic and social systems, and most importantly exposes the fragility of the human right to health. It turns out that the emperor is naked.

Inequalities in access to healthcare between Global North and Global South countries have, rightfully, long been the focus of conversation surrounding global health. Soon after the WHO declared a public health emergency of international concern (PHEIC), the Director General, Dr Tedros, pointed out that this virus could be most lethal and dangerous for countries with weaker health systems, largely (though not uniquely) corresponding to the Global South. Beyond ‘developing’ and conflict-heavy countries with weaker health systems, the current pandemic has exposed the health inequalities that exist within the Global North as well. In many Global North countries, in the years after the crashing down of the neoliberal order, austerity (to varying degrees) has been the go-to policy with public sector jobs being cut, and many people being thrust into unemployment and even poverty. This has had many consequences on health (both mental and physical) and has caused many of our countries to be woefully underprepared for something as catastrophic as a pandemic.

In recent weeks, governments have been calling on ‘essential workers’ and their skills. Many people across the world have been applauding their healthcare staff from their windows, balconies, living rooms and their palaces. We have, rightfully, been supporting ‘essential workers’, but what does that mean when essential workers have been devalued for years within our societies? When many of the people we have elected have been the ones to systematically cut funding for healthcare and the minimum wage is still not necessarily a living one. Many essential workers are in low-paying jobs, and additionally many essential jobs are traditionally feminised roles such as caring professions and domestic and service jobs. This exacerbates already exiting inequalities where they exist.

One of the most effective ways to slow the spread of infectious disease is through social – also called physical – distancing measures such as working from home, staying at home as much as possible, and avoiding close physical contact with other people not part of one’s household. However, for many people, many of whom economically disadvantaged and/or marginalised, this is nearly impossible, increasing the burden of mortality for this group. For many these people working from home is impossible because of the nature of their jobs, staying at home would mean a loss of income and livelihood, and there is a lack of paid sick leave and no (affordable) available childcare.

But beyond income inequality and depletion of resources for many of our health services and the low-wage nature of many essential jobs,, there are other vulnerable groups who will be suffering from increased difficulty in accessing healthcare during the pandemic. An example of this are the homeless who will not have the opportunity to social distance in the same way those with a home do, and who will often not be able to access quality healthcare as easily. Another example of a vulnerable group who might experience more difficulty are prisoners. Prisons are often not adept at containing major infectious disease epidemics. Thirdly, immigrants and refugees who are currently living in dire conditions in camps and settlements, particularly as these people will likely live in crowded places with poor sanitation and more difficulty to access healthcare. Beyond the elderly and those with underlying conditions, there are so many other people who might be particularly at risk in this time. Many of whom have been neglected by society, but all of whom are particularly at risk of having their human rights abused.

This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are.

Health is a human right as recognised in the Universal Declaration of Human Rights. The decade of systematic cuts to our health systems and the secondary effects of austerity of thousands of people working in precarity and dealing with failing living standards have caused us to be woefully unprepared for a catastrophic event like this. This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are. In a world where the rich are able to self-isolate in mansions or second homes, and get access to tests even when others can’t, it seems difficult not to imagine there might be an aspect of class strife involved. It seems clear that we won’t be able to return to normal after the pandemic is over. The shaky foundations our systems are built on are not likely to survive in tact after this. It is then up to us to decide what’s next and to prepare for the next pandemic – which will come – in more comprehensive ways such as defending the right to healthcare, increasing its access, funding our health systems, implementing fairer labour policies, and redistributing wealth. We must applaud our essential workers, but we must also not forget them when this pandemic is over and they ask for more than just verbal appreciation. We, after all, are only as strong as the weakest link and at the moment the tower is crumbling.

On the (possible) return of community

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The world has been under the spell of the novel coronavirus (COVID-19) first discovered in Wuhan in 2019, which has quickly transformed from a semi-local epidemic to an unprecedented global pandemic. The disease’s epicentre has rapidly shifted from China to Europe, with Italy being the first domino to fall on the continent and many countries following swiftly. At this point Spain and France are (almost) in complete lockdown, and other European countries are contemplating the best course of action.

Public health officials have advised a measure called ‘social distancing‘ – perhaps better called physical distancing – where we are encouraged (or mandated) to avoid large gatherings, work from home, stay home as much as possible, and in many cases are closing schools and businesses altogether. Social distancing has as its main goal the reduction of the spread of disease, and ‘flattening the curve’. ‘Flattening the curve’ is, not unlike ‘social distancing’, a term that has got more attention in the media and popular culture (the graph has gone viral…pun not intended) lately. It refers to how the social distancing measures we take – in particular staying at home – can effectively spread out and slow down the number of infected cases so our health systems can still operate at capacity rather than overburdening the already fragile systems.

These unusual and drastic measures have in many cases, for example in Wuhan, Italy and Spain, brought out the best in people, with neighbours singing and chanting in unison, and neighbourhoods applauding their brave healthcare workers. At the same time, this pandemic has also brought out the internalised hyper-individualisation many Western societies have been experiencing for a long time. Many countries are experiencing empty shelves in supermarkets as people are hoarding products, and people across Europe and the United States are still not quite taking the pandemic seriously and are still going to bars, cafés and other events with a large number of people around.

Indeed, it seems like we are at a juncture where we can either increase our sense of community and solidarity and turn a new leaf, or we can get more entrenched in our internalising of the neoliberal lie that it is every man for himself. In a pandemic situation where community solidarity is essential to our mutual survival, it seems to me clear what the best course of action is. This means, perhaps ironically, to limit physical contact with other people as much as possible. This means checking in on our loved ones and the most vulnerable in our communities (that is: the elderly and those with underlying conditions). The current circumstances can, and in some cases already do, bring us together. In a world of constant distraction, it is perhaps an uncomfortable but nonetheless perfect time to return to the heart of what matters to us as human beings: love and community.

For many Christians around the world, the pandemic coincides with the Lenten season where we deny the flesh, contemplate our fleeting mortality, and try to give alms and care for those in our communities. Contemplation is an essential facet of the Lenten fast. However, beyond the religious, many people have a longing for something more; people long for the knowledge that there is more to life than can be found amidst the hectic and distracting nature of our societies and constant competition within our hyper capitalist contexts. In that moment, a pandemic that asks of us to isolate ourselves and return to our core out of community solidarity, might cruelly be the thing that can bring us back to ourselves and our communities. This is the best possible time to do some shopping for your infirm or elderly neighbours, to spend more time reading, with family, or alone in silence. Now is the time for self-reflection and for deciding how it is we can bring back our connection to our local communities and our central humanity.

Even though it might seem easier, or more pleasant, to be amongst each other in bars, pubs, shops, clubs and cafés instead of at home at a physical distance from our friends, there is little to despair. The act of isolating as much as possible at this time is an act of profound love and care for the least of these, for our neighbours, for those who are working in healthcare and are trying their best to save as many people’s lives as possible.

Within the Latin Church there is an antiphon that is chanted during Holy Thursday which proclaims: ubi caritas et amor, Deus ibi est – where charity and love are, there God is. Even though it might seem easier, or more pleasant, to be amongst each other in bars, pubs, shops, clubs and cafés instead of at home at a physical distance from our friends, there is little to despair. The act of isolating as much as possible at this time is an act of profound love and care for the least of these, for our neighbours, for those who are working in healthcare and are trying their best to save as many people’s lives as possible. Even if you are alone, remembering that where charity and love are, there God is, should bring a sense of profound peace, whatever ‘God’ means to you. So, please, stay at home whenever possible – binge your favourite Netflix shows, read, sit in silence, spend quality time with your loved ones if they live with you. But also check in on your elderly relatives and neighbours, help your chronically ill family, friends and neighbours out with groceries. Help and care for each other. Fight against the voice in your head that says it’s every man for himself. Stand in solidarity…from a sensible distance and without shaking hands!

Healthcare as a human right

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Any discussion of universal healthcare is seemingly conducted as if it is a solely partisan issue. The left wants universal healthcare, the right doesn’t — so goes the argument. However, the fact of the matter is that the United Nations’ Universal Declaration of Human rights, article 25, states that:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The countries that have signed up to this declaration have implicitly or explicitly accepted healthcare as a human right. Most countries provide free or affordable healthcare to its citizens, but how it manifests for non-citizens seems to differ between countries. We can do better.

War and natural disasters seem common and omnipresent, and will likely increase with climate change. Unsurprisingly, these calamitous events will also leave the most vulnerable exposed to health risks — particularly women, children, the elderly, and the chronically ill. Particularly in war and conflict areas, getting healthcare to the most vulnerable populations can be an arduous task, made more difficult by various state actors and disparate political motivations. Attacks on humanitarian aid workers make it difficult for vital medical care to arrive to the people who need it most. The World Health Organisation’s (WHO) 2017 report estimates that 14.8 million people in Yemen have no access to healthcare, and the International Medical Corps has said that delivering healthcare to affected populations in the country is difficult with major infrastructure destroyed, and the lack of a government that could support them. In addition, Amnesty International reports that the Saudi-led coalition has restricted the access to essential goods such as medical supplies from entering Yemen. The situation in Syria is equally dire, with the WHO reporting calamitous conditions in Syrian refugee camps, and additionally refugee camps housing former members of ISIS and their children have also not received adequate medical assistance. Chatham House experts recently wrote that many people with chronic illnesses end up being under-treated in war and conflict as the nature of chronic illnesses and the nature of war make it logistically very difficult to help them. In many instances, these local makeshift hospitals end up being in rebel-held territories with Western aid organisations fearing a loss of funds if they were to support these hospitals. From a security and counterterrorism point of view this might make sense, but the fact of the matter is that vulnerable people will see their right to medical assistance denied. It is clear that healthcare as a right is often a casualty of war, with deliberate attacks on hospitals, as well as restrictions on humanitarian aid depending on whose side the territory is held by, creating more issues for the local population and constituting continuous violations of international humanitarian law and human rights.

Closer to home, it is often the case that refugees and immigrants do not get to enjoy free healthcare in the same way citizens of a country can. A report by the Equality and Human Rights Commission published in 2018, showed that asylum seekers in Britain are often afraid of seeking medical care for fear of high costs, or being tracked by the Home Office. Ambiguities and an increasingly hostile environment for migrants, refugees, and asylum seekers, create inaccessibility to healthcare for an already vulnerable group of people. Guaranteeing that everybody, regardless of background and citizenship status, gets access to healthcare that respects human rights, requires political will and leadership. Moreover, people with mental health issues are still often subject to violations of human rights in mental health care where they are often stripped of agency and dignity — this has been the observation of the UK’s parliamentary and health service ombudsman as well. In the United States, many black women are dying in childbirth because they are not listened to in health settings and their human rights are systematically violated. Worldwide, people with dementia are still fighting for their human rights to be respected. There is still a lot to be done.

So, how do we make sure that human rights are respected and guaranteed, even in disaster and conflict zones, even when someone is an asylum seeker or a refugee, and even when the patient is disabled, mentally ill or cognitively impaired? There is no simple answer, but political leadership that sees beyond manoeuvring and posturing to behold the human cost of war, conflicts, health disparities locally and globally, and the victims it makes, would go a long way. In an international setting the countries with vetos in the UN security council have a particular responsibility to look beyond political expediency and geopolitics when the stakes are so high and there are no winners. The WHO has a prime position as an intergovernmental organisation to coordinate medical response and epidemiological research, and assist local governments after a disaster or in conflict zones. Human rights organisations monitoring, researching, and advocating for human rights to be respected, in conflict and in peacetime, play a vital part in holding the powers that be to account. Academic research in how to best coordinate humanitarian aid, particularly medical aid, in disaster and conflict zones is imperative. Non-governmental aid organisations and their local partners on the ground need continued support to take care of affected citizens regardless of their affiliations in war. Disability and mental health advocates need to be listened to. And finally, as citizens we have a duty to be aware and cognisant of our human rights, the inalienability of it, and that by respecting them we are doing not only the other, but our selves, a great service. By being informed and educated on the role human rights play in our day to day lives, we can lobby and advocate our local governments, and in turn politicians of good will can effect change. Eleanor Roosevelt, the mother of the UN Declaration of Human Rights, said it best:

Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighbourhood he lives in; the school or college he attends; the factory, farm, or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.