At the June 2020 General Assembly, United Nations (UN) Secretary General Antonio Guterres declared that the impacts of the COVID-19 pandemic are falling “disproportionately on the most vulnerable: people living in poverty, the working poor, women and children, persons with disabilities, and other marginalized groups.” His statement accurately depicts the asymmetric effect that this pandemic is having on low- and middle-income countries (LMICs), a situation that parallels epidemics and pandemics of the past. Such circumstances were seen in the numerous cholera pandemics since the early 1800s as well as in the 2009 H1N1 pandemic, amongst others. Greater scrutiny of these case studies shows how truly unequal the access to proper healthcare is between countries, illustrating how nations’ health infrastructure, availability of medical staff, and the ability to acquire supplies is severely limited in many regions worldwide.
The UN’s Universal Declaration of Human Rights considers health a fundamental human right and states that all must be done to ensure that even those furthest behind socially and economically can obtain the resources needed to have an equal chance at survival health-wise, a principle that has been established in the 2030 Agenda for Sustainable Development and Universal Health Coverage. However, as observed in epidemics and pandemics past, developing nations are often hit much harder and longer than Western countries, due to both a lack of resource availability as well as the developed world’s inactivity in aiding the developing world, even once they have access to treatments. This demonstrates a failure in global governance efforts to uphold human rights for all populations without discrimination.
Past pandemics and their impacts
In 1817, the first mass outbreak of cholera occurred in Bengal, India — a pandemic that would affect the world for decades to come. The creation of the first vaccine in 1885 marked the beginning of the growing gap between developed and developing nations in regards to the pandemic’s impact on their communities. As of the last few decades, the most effective cholera vaccine produced — Dukoral — has been made easily accessible in First World nations. However, this particular medication cannot be taken in many developing nations, as access to clean water is required to have it administered, a luxury these regions do not always have. While there are other treatments available, their success rates are much lower, and the costs for providing these treatments remain prohibitive for many LMICs. India, for example, still experiences tens of thousands of cholera-related deaths each year — all because of the lack of a proper healthcare system.
This visible inequity in global health was also observed during the 2009 H1N1 influenza pandemic. While the outbreak was poorly handled even at the international level, individual developing nations struggled excessively. This particular pandemic emphasizes how much easier it is for industrialized nations to access medical resources, in comparison to LMICs. The H1N1 vaccine was quickly produced, and at that time, developed nations placed mass advanced orders for it, leaving many to wonder how the developing world would manage to access it. The earlier availability of the vaccine for wealthier nations was attributed to pre-production contracts that allowed them to purchase a certain amount of treatment doses well before many other countries.
The case of COVID-19
Since the outbreak of COVID-19 in early 2020, healthcare workers have been raising concerns about the devastating effect the virus would have on developing nations once it began spreading within their populations. As in the case of the cholera and H1N1 influenza pandemics, poorer regions are more vulnerable to viral outbreaks in the first place, and are often the ones who continue suffering through them even when solutions have been found and distributed in wealthier parts of the world. While the COVID-19 pandemic — which is currently afflicting almost the entire world without exception — has yet to undergo this route, obvious healthcare divides between the developed and developing world will surely result in the same scenario.
In February 2020, China began purchasing protective equipment from African nations such as Kenya and Tanzania due to a shortage of supplies in their own factories. As a result, prices in these areas multiplied exponentially, and with demand rising as well following the virus’s continued spread, these countries were left with little to no medical resources for themselves when COVID-19 eventually reached them. This left citizens in an increasingly precarious position regarding their health and safety, especially considering that their healthcare sectors were already underdeveloped and underfunded to begin with.
While a vaccine has yet to be approved and mass-produced for COVID-19, there is a high chance that supplies will be very limited when it does, hence the competition already present among states trying to guarantee stocks through pre-purchase agreements. Certain states and organizations, such as France and Doctors Without Borders respectively, have denounced such actions as unacceptable, and have stated that “global solidarity should be paramount,” but other governments have made different decisions. The Trump administration has already made deals with several vaccine companies to increase the chance that doses will be made available to Americans first as soon as they are approved, which officials have agreed might not be fair, but “is what is likely to happen in the end.” This once again emphasizes the global health asymmetries still present between developed and developing nations, as priority is given to nations like the United States due solely to their superior wealth. While this allows industrialized nations to get their lives back to ‘normal,’ it fails to take into account that no country is safe from COVID-19 and we cannot go back to ‘normal’ until all countries are able to distribute vaccines. Today’s nations are so economically interdependent that access to others is essential for numerous industries, such as tourism, to keep functioning, making it clear that vaccines must be equitably distributed.
The consequences of pandemics on LMICs spread across their social, economic, and political rights. The most pressing issue that has arisen from this and that needs to be addressed, however, is the blatant health inequities seen between developed and developing nations, and the lack of actions that have been taken to solve such a crisis. Decisions regarding COVID-19 vaccines must be made in the interest of developing nations as well, so as to avoid a repetition of past outbreaks.
Edited by Yesmine Abdelkefi and Arimbi Wahono.