Niranjan Shrestha/AP

In May 2021, the World Health Organization (WHO) director announced that the world had reached a situation of ‘vaccine apartheid’ – where vaccines are hoarded by wealthy countries, while those in developing countries suffer from a limited supply. According to the WHO, more than 75% of all vaccines have been administered in only 10 (wealthy) countries. As a result, while around 57% of people in high-income countries have received at least one vaccine dose, only around 2% have in low-income countries. The discussion and resistance against vaccine apartheid becomes increasingly important as wealthy countries consider third booster shots for its population, while millions in developing countries remain completely unprotected.

Many wealthy countries have been accused of hoarding vaccines and thereby limiting supply to poorer countries. Canada has secured enough vaccines for almost four times its population. Similarly, the UK has ordered vaccines for 295% of its population, and Australia for 269%. New analysis also shows that wealthy countries – the United States, the European Union, Canada, Japan and the United Kingdom, could have more than one billion vaccines in surplus by the end of 2021 that are not allocated for donations.

Along with the supply effects of vaccine stockpiling, intellectual property rights for Covid-19 vaccines mean that they cannot be mass-produced in developing countries and distributed to the public in an affordable and timely manner. Instead, developing countries are forced to purchase the limited stocks offered to them by vaccine companies who mainly sell to wealthy nations. For example, Pfizer and BioNTech have delivered nine times more vaccine doses to Sweden than to all low-income countries. Even worse, bilateral deals between wealthier nations and vaccine manufacturers mean that low-income countries are often charged a higher price on limited stocks. For example, AstraZeneca sold its vaccine to South Africa for nearly 2.5 times the price it charged European countries. The explanation given for this by the company was that higher-income countries have invested more in research and development and therefore deserve a discount on the price. It seems that AstraZeneca conveniently forgot that around 2,000 South Africans participated in clinical trials for the Oxford-AstraZeneca vaccine in 2020, which was critical to the approval of the vaccine. The behavior of these pharmaceutical giants has caused Amnesty International to accuse them of fuelling a human rights crisis.

In response to this, India and South Africa brought forward a proposal to temporarily waive patent rights on Covid-19 vaccines. However, for the proposal to be passed, all 164 members of the World Trade Organization (WTO) must agree to its terms. Achieving this is doubtful, as many countries, especially those in the European Union, are pushing back hard against this proposal. These countries argue that vaccine companies will be disincentivized to invest in future vaccine research and development without intellectual property rights to protect their profits. This argument remains weak as (1) most of the funds used to produce the vaccine were sourced from the public, (2) these companies have already made billions in profit from the vaccines and could continue to make a sizeable profit even with the removal of patents since they have specialized technology and know-how, and (3) the proposal calls for a temporary waiver of the patent until the pandemic and death rates slow down, after which point the patent can be reinforced and companies can continue making profits from their inventions.

Many have also noted the hypocrisy in vaccine hoarding. It is the countries whose reckless behavior and disbelief in the seriousness of the pandemic that facilitated the spread of the virus that are now benefitting from an early end to the pandemic due to vaccine hoarding. Meanwhile, developing countries like Vietnam and Rwanda that immediately initiated lockdowns and other protocols to protect their populations for most of 2020 are now experiencing massive surges and remain unprotected due to the lack of vaccines. This also means that while many wealthier countries are opening up, developing countries have to continue to decide between sacrificing their economy or the lives of their citizens.

However, vaccine apartheid has deeper roots than simply the selfish behavior of wealthy countries. It exposes the deeply unequal world we live in and the neocolonial institutions that maintain this.

A recent article by Vice exposed this very problem in Africa. When many African states first achieved independence, they started investing heavily in public health and successfully improved healthcare for its citizens. However, by the 1980s, the International Monetary Fund and the World Bank handed out loans to over 40 African countries, conditional on the receiving governments cutting spending, including on healthcare, and encouraging foreign investment. Even now, countries in Sub-Saharan Africa spend less than 5% of their GDP on healthcare – granted, partly due to inefficient handling of the national budget. At the same time, foreign funding and aid is rarely directed towards local research and development programs. For example, Dr. Christian Happi, an acclaimed geneticist, developed a Covid vaccine, ACEGID which showed a 90% success rate, even against multiple virus variants. However, he has been unable to receive funding despite submitting multiple proposals. The development of this vaccine could have led to a much faster vaccination drive in Africa and a much lower death rate. Instead, they remain in a system where they are dependent on organizations from wealthy Western countries to direct medical research initiatives and the manufacturing and distribution of vaccines – Africa currently imports 99% of its vaccines. Exposure to the unequal power structures surrounding the global health system has led to calls for greater investment in local research and development in developing countries.

Given this context, it is arguably the responsibility of the wealthy countries that have deprived developing nations of the resources and potential to create their own vaccines, and historically benefitted from exploiting their natural resources, to now share their vaccines in an equitable manner.

While devasting to developing countries, the global impact of vaccine apartheid is not to be underestimated. In the short term, vaccine hoarding can backfire on wealthy nations. As we saw in India, countries who are suffering from a rapid spreading of the virus due to low shortage of vaccines will be the perfect breeding grounds for new variants. Mutations of the virus could develop that are resistant to the existing vaccines, bringing the entire world back into the depths of the pandemic. This could lead to a cycle of lockdowns, rising deaths, and even deadlier mutations unless all countries achieve herd immunity levels through equitable vaccine distribution.

However, even if we are able to escape this pandemic once and for all, a new global order might emerge. While wealthy Western nations were stock-piling vaccines, China and Russia have been practicing vaccine diplomacy, with China having delivered 755 million doses globally. While this is of course not out of altruism, the contrast between their policies and that of the West’s will cause developing countries to become increasingly dependent on and welcoming of China and Russia over Western countries. This would give China and Russia a greater claim over the world, and allow them to rise as global leaders, unless Western countries cut back on their nationalistic policies and embrace a more globally cooperative policy.

Overall, the Covid-19 pandemic brought with it rising nationalism, creating the perfect environment for vaccine apartheid. However, there needs to be international cooperation, with greater sharing of vaccines and technology to end the global pandemic. In the long run, there needs to be a reexamination and breakdown of unequal global power structures, including those surrounding health systems.