Health for all? Addressing disparities and wellness deficits
April 4, 2023
By Eric Otenyo, PhD
In his editorial for World Health Day, Elsevier author Eric Otenyo calls on policy leaders to eradicate health inequality and vaccine nationalism
Governments around the world grapple with meeting the healthcare needs of citizens. Policy debates continue to focus on the reality of hefty price tags attached to lifesaving pharmaceutical products. The voices challenging the perpetuation of systems that make medical care a scarce resource out of reach for billions of people have grown louder with the onset of this century’s first pandemic; COVID-19 exacerbated existing inequalities in global healthcare.
The World Health Organization, which has designated April 7 as World Health Day(opens in new tab/window), remains committed to the elimination of global inequalities in healthcare.
In word and deed, the WHO signaled the potential for the COVID-19 moment to be the trigger mechanism for world governments to sharpen their knives and combat inequalities. With the world’s initial dismal response to the pandemic causing unhealthy suspicions and blame games among nations, the WHO received the wrath of US President Donald Trump. In 2020, he cut off US support for the organization, accusing it serving China’s interest. WHO Director General Dr Tedros Ghebreysus(opens in new tab/window) responded to the indictment by calling upon all nations to unite and fight the common enemy — COVID-19 — a public health emergency.
With the threat of COVID-19 diminishing, the unity calls by the leader of the WHO remain critical as nations reflect on the journey toward health for all.
During the pandemic, many powerful political leaders opined, “We are in this together” — but walked away from implementing policies that would lead to equitable outcomes. French philosopher Bernard-Henry Lévy(opens in new tab/window) remarked that selfishness was evident in the America First agenda Trump embraced to undermine the WHO’s capacity to do its work.
Health inequality among indigenous peoples
In our book The Inequality of COVID-19: Immediate Health Communication, Governance and Response in Four Indigenous Regions(opens in new tab/window) (Elsevier, 2022), we reflected on “health for all indigenous people” by highlighting the relative lack of appreciation of indigenous pockets of effectiveness in mitigating against the first waves of the pandemic.
Witness the example of the Sioux Tribes in South Dakota, who instituted shelter-in-place policies but were frustrated by a state government ideologically opposed to “lockdowns.” The Sioux policy was in line with public health recommendations. However, the state government ignored the wisdom in the tribe’s decision and instead charged the tribe for interfering with traffic on State Highways! Those and other communities gallantly fought back amidst barriers imposed by nation states unwilling to wholeheartedly reverse colonially induced inequalities in healthcare apparatus.
During the peak of the pandemic, fatality rates from COVID-19 were highest among many marginalized groups, including the Navajo. Initially, the federal government in the US did not send the right signals about the disease. Trump said it was like flu! However, indigenous Aborigines of Australia were in a different political system that recognized the need for time-tested communication skills and modeled well for its First Nations.
If we are to learn anything from the pandemic, it is that exposed inequalities in provision of health services were laid bare. And governments failed to seize the moment and signal that the need for combatting disparities in healthcare must now be a priority. It makes sense to provide basic health infrastructure to Siddis in India and Maasai in rural Africa. As explained in The Inequality of COVID-19, at the basic level, indigenous communities were often denied testing facilities. Building their capacity to access quality healthcare is an insurance from unequal healthcare and, especially, the serous neglect of the solidarity that Dr Ghebreysus reminded us of during his numerous briefings on COVID-19.
To reminisce about the 75 years of WHO’s achievements and to reflect on the meaning of the clarion call of “health for all” means we turn to basic healthcare policies. A reasonable approach to health policy for governments is to rekindle strategies for achieving clear objectives, especially for those exposed to COVID-19. We know from The Inequality of COVID-19 that pandemics result in unequal impacts. Arguably, that is largely because hospitals and healthcare centers in marginalized communities are overwhelmed most of the time. Centuries of exploitation deny indigenous people access to benefits from telemedicine, broadband internet, health literacy and rebuttal of misinformation and disinformation, and adequate nutrition — all of which are ingredients of successful pandemic mitigation plans. Those basic components of integrated health policy deserve our immediate attention.
As we think about World Health Day, nations ought to rationalize public health to be synchronized to overall development policies. Health policies work only if government action leads to spending funds on adjacent issues like adequate housing, supply of clean water, and ethical commitment to adequate medical care for marginalized communities, the elderly, refugees, and folks with disabilities. In addition, the health ecosystem is not independent of the ecological disasters that contribute to the spread of illnesses. That, too, is an issue for consideration in the prevention of disease and provision of health for all.
We claim that investments in health must be seen in terms of opportunity costs. Ignoring investments in pubic health ecosystems means all other economic activities will come to a halt! That is why governments spending lots of money to develop vaccines for COVID-19 was a commendable public good. That said, initiatives like Operation Warp Speed were public-private partnerships that worked well except for the failure of governments to manage problems of information asymmetry.
World Health Day Special Collection
Prof Eric Otenyo is one of the contributors to Elsevier’s World Health Day Collection, which features podcasts, book chapters and journal content, all free of charge.
Vaccine nationalism: when politics undermines healthcare
After the initial dose or regimen of social distancing, testing and isolation, the go-to public health device was vaccines. COVID-19 pushed the scientific community to do what they had never done before: produce effective vaccines on a fast track. Sadly, the production and distribution of the first tranche of vaccines was clouded in political posturing and the rhetoric of nationalism.
Vaccine nationalism is the subject of my latest book, COVID-19 and Vaccine Nationalism: Managing the Politics of Global Pandemics(opens in new tab/window) (Elsevier, 2023). The work focuses on the need for nations to address pandemics through collaborative systems. The aim is to shed light on the international and domestic politics, governance and mechanisms of vaccine production and political management through insightful discussions based on evidence from China, India, the United States, the UK and the EU.
The global community benefits when powerful nations share vaccines in a timely fashion instead of hoarding and practicing vaccine nationalism — a form of victimization of poor countries and communities.
Health for all means that rising nationalism and populism should foster joint approaches to combatting global pandemics. Societies should be unified for their own mutual survival, wellness and progress. The “me first” approach to fighting COVID-19 is a wrong approach to managing a healthcare crisis. Hence, COVID-19 and Vaccine Nationalism could be considered as a successor to the Inequality of COVID-19 in at least two ways:
First, it draws our attention to inequalities in sharing medicines and vital life saving products.
Second, it is about societies grappling with internal contradictions in access to healthcare and vaccine apartheid.
The vaccine rollouts suffered from many problems: misinformation and ideological opposition to vaccines, missing data, and access problems — the later, a function of enduring inequalities. Nationalism was at once a symptom of harmful constructionism of who is deserving to live and an excuse for Big Pharma to make extraordinary profits from a crisis. Vaccine nationalism sends the signal that health is for us.
That said, nations with technological capacity to fight diseases should uphold a new ideology of promoting wellness without leaving behind millions of people in developing countries. Indeed, vaccines should not be destroyed when some countries lacked the ability to store the vital products. Again, Dr Ghebreyesus reminds us that “a handful of nations took the lion’s share of vaccines and denied millions in developing countries from timely access to the vital products.” He considered that action as morally indefensible. On the other hand, African leaders framed the issue in terms of human rights: if the United Nations is about upholding rights to life and health, why not uphold the spirit of the UN Charter by building global capacity to defeat diseases that predominantly or disproportionately affect poor countries and communities?
The politics of vaccine management exposed the dark side of vaccine manufacturing nations: the US, UK, India, Switzerland, Germany, Spain, France] and China. By delaying actions to urgently supply low-income countries with vaccines, a perception of meanness gained currency. Even India, which is the world’s “vaccine factory,” witnessed a wave of COVID-19 deaths as it shipped vaccines it manufactured away to Europe. The contradiction speaks to how the inequalities in global commerce are reinforced even during life-threatening pandemic situations.
A contrary view may be that the rich countries supplied vaccines through vaccine diplomacy, including President Biden’s rhetoric of an “arsenal of vaccines(opens in new tab/window),” President Modi’s “Vaccine Maîtri”(friendship), GAVI, COVAX, and other multilateral arrangements. No question the prepurchase deals between vaccine manufactures and rich countries enabled vaccine nationalism and led to negative outcomes in regions where death rates were already highest. Going forward, it makes sense that we remind ourselves of the need to develop strategies that support WHO goals of health for all. By working through existing collaborative global health networks, we can reduce the deficits in wellness while narrowing inequalities.
COVID-19 vaccine development and distributions were a manifestation of the problem of unequal public healthcare. It should not be so. Technologies for lifesaving medicines should serve all humanity and not be subjected to global power games. Countries competed against each other in rushing to produce vaccines. And at the rollout stage, some leaders discouraged their citizens from receiving jabs made by competitors. The rollout, for the most part, was disjointed and subject to ridiculous episodes of hesitancy and misinformation. The tracking agencies were also at sea as health authorities gave different assessments on levels of protection and efficacy of boosters.
In sum, health for all means we utilize existing institutions and heed to the calls by various world leaders to use this moment to collaborate more in finding solutions of health problems. As members of this global community, let us celebrate April 7, 2023, by making our health systems work for all people.