A Project for HIST 1000 in 2020-2022
Who Gets What? How Money and Status Dictate the Flow of Resources During Pandemics

Who Gets What? How Money and Status Dictate the Flow of Resources During Pandemics

March, 2020. COVID-19 has officially shut our country down, rendering the foreseeable future terribly bleak. By December, attitudes were on the up and up: frontline workers and others at most risk were eligible for a vaccine in record time. By September of 2021, additional booster shots were made available for those same populations. COVID has ended, hope has been restored! People are able to live their lives happily and healthily once again, as safety guidelines and restrictions are continually eased.

…Well, at least if you live in a developed nation, that is. For a majority of the world, and especially outside of the United States, the situation isn’t as rosy. While the U.S. was administering nearly three million vaccines a day by May of 2021, many other countries didn’t even have the capacity for their doctors and nurses (Teicher). Zooming in, the continent of Africa had only vaccinated six percent of its people by November of last year, compared to a whopping sixty percent here in America (Donovan). Further than that, 56 countries belonging to the World Health Organization weren’t able to vaccinate even 10% of their populations by September of 2021. In that same time frame, we as a country ended up letting fifteen million doses go to waste. While a small number in the grand scheme of things, those fifteen million shots could have proved invaluable anywhere else in the world. 

Unfortunately, this huge disparity of protection from and prevention against disease between rich and poor countries is nothing new. Throughout recent history, there have been multiple examples of developing nations being shorted out of vaccines, treatment, and care, with the most notable occurrences being the AIDS and Ebola pandemics: both centralized in Africa, and both marked by the infected being forced to suffer in silence, as their governments were unable to pay steepening prices for medicines, and as the world turned a blind eye to their struggle. 

Money Talks

“…the pharmaceutical companies want to be sure that there’s an actual market… that there’s money to be made through the research and development of all these scientific methods… We have the ability to prevent Ebola from resurfacing, but does humanity truly have the will to make this happen?”

Veronique Tadjo (109), from her book In the Company of Men

Shortly after the AIDS crisis exploded in the U.S. in the 1980’s, experts were hard at work to develop a cure. The treatments that were created were effective, but more than that they were expensive, in the mid-nineties going for “$10,000 to $15,000 a year and needed to be taken for life,” (McMillen 113). Most Americans would be unable to foot that bill year over year, let alone a grand majority of the African population, where HIV/AIDS proves more prevalent. Eventually, the costs of drugs and treatments would be brought down to appropriate levels, and generic alternatives would arise, but not without widespread protest and activism. Even still, these generic brands would continue to be too expensive for poorer nations: 

Following the increasing production of generic ARVs [antiretroviral drugs] by companies in India, Thailand and Brazil and a high-profile campaign to lower the cost of these medicines, prices have fallen by an average of 90% in the developing world. However, for the least developed countries in Africa with a per capita income of $300, many of which are hardest hit, this price is still too high… UNAIDS estimates that only 4% of those requiring retroviral drugs in Africa currently have access to them.

Johanna Hanefeld (84) in an article for Feminist Review

Not only are the drugs alone expensive, but it’s recommended to take two or three in combination with one another for true effectiveness. This initial inability to understand the state of need people are in and provide for a people who have been plagued with a disease for the longest time and collectively see the worst outcomes constitutes gross negligence on the part of those tasked with providing care. 

A hospital isolation ward in Gulu, Uganda, during the October 2000 Ebola outbreak

A similar situation would arise with the more recent Ebola pandemic. This time, with a disease almost solely indigenous to African nations, relief would be even harder to come by. As opposed to dishing out exorbitant prices, “…the pharmaceutical companies want to be sure that there’s an actual market… that there’s money to be made through the research and development of all these scientific methods… We have the ability to prevent Ebola from resurfacing, but does humanity truly have the will to make this happen?” (Tadjo 109). If action was taken in a timely manner, there is a good chance that a remedy could have been created much faster, and possibly alleviating the outbreak which we saw in 2014, or even avoiding it altogether. Unlike HIV/AIDS, it is possible to vaccinate against the virus, but the story of its creation is still an unfortunate one. “It took several years to convince funding agencies of the value of spending the National Microbiology Laboratory’s limited resources on Ebola vaccine research over other pressing public health issues in Canada… There was little interest in the vaccine from the pharmaceutical industry,” (Plummer and Jones). Research for this vaccine officially began in 2001. Not only did it take four years for any serious action to begin, but the first vaccine for Ebola would not come out until 2019. Comparing this process to COVID-19 is, admittedly, a bit unfair, since there is no doubt that COVID was much more widespread and warranted as quick a response that it received, but we had to wait less than a year for a vaccine and even that felt unending. Our proficiency in modern medicine suggests a twenty-year-long fight for a cure should only occur if the virus is actually that elusive, but all signs point to at least some sense of unwillingness. Not to mention, African people have been suffering with this deadly disease for nearly fifty years, and we are practically just now able to vaccinate against it. All things considered, this response time should be considered as nothing short of abhorrent. 

On the note of COVID-19, information on the financials for treatment against it is probably the most easily attainable, and therefore the most heartbreaking. The companies Pfizer and Moderna are able to produce vaccines at a rate of anywhere from $1.18 to $2.85 per dose, and yet were charging, on average, anywhere from $16.25 for Pfizer to up to $24 for Moderna (Marriott and Maitland). Not only are we talking about charging eight times the production cost or more, but scaling that up to literal billions of shots to be bought; poorer countries cannot feasibly be asked to pay that amount for vaccines regularly.

Without these conditions the COVID-19 vaccines funded largely by the public have been privatized and monopolized leaving pharmaceutical corporations the power to set prices as they like. Some are charging wildly varying prices to different buyers that suggests there is no discernible relationship to the actual cost of production. And some rich country governments appear to have willingly paid higher prices than necessary to push their way to the front of the vaccine queue, thus contributing directly to vaccine scarcity in low- and middle-income countries.

Anna Marriott and Alex Maitland, “The Great Vaccine Robbery”

Operation Warp Speed, the United States’ flagship COVID vaccine response, allocated eighteen billion dollars, with some amount coming from the citizens, in order to put this pandemic behind us (Kim). Using our dollars to try and profit off of a global health crisis on the part of pharmaceutical companies, and intentionally engaging in bidding wars and throwing more money than can possibly be spent by poorer countries on the part of rich governments, are actions, by both parties, that can only be described as scummy at best, and outright xenophobic at worst. 

Out of Sight, Out of Mind

“One area of striking neglect was Africa, which was both the origin point and epicenter of the pandemic.”

Christian W. McMillen (108), from his book Pandemics: A Very Short Introduction

In order to send aid and resources, those with the capacity to help must be aware of your plight. Sadly, this first hurdle is a difficult one to surmount for citizens of the African continent. Beginning with AIDS, there was little attention paid to the people who were diagnosed, outside of ridicule for contracting it. Even within the grand United States of America, the leader of the Free World, President Ronald Reagan did not so much as recognize the disease existing in his own country, so it’s not hard to imagine that common people wouldn’t begin to consider it ravaging the oft-ignored continent of Africa. Could you imagine if our officials refused to recognize COVID existing in our country, let alone the devastation it has wreaked, until two years from now? Residents would be enduring the pandemic’s effects for nearly half a decade, without any response from the people in power. Overseas, “the consequences for Africa were great. The dismissal of heterosexual transmission as unimportant in the United States meant that the burgeoning heterosexual pandemic erupting in Africa- was initially ignored,” (McMillen 109). This ignorance of the situation would then lead to unfettered spread of the virus across the continent, due in large part to first-world exceptionalism. 

During the height of Ebola’s reign over Africa, you would be hard-pressed to find much coverage of it on our soil, which translates to a lack of aid being sent from us, as well, until “the apprehension reached a fever pitch when the Americans found out that the second [American] nurse, after treating the patient, had taken a plane… International aid was doubled, then tripled. Quadrupled,” (Tadjo 83-85). This is the point where the subject was inescapable in the media, after two of our citizens unfortunately succumbed to the virus. As sad as that is, it doesn’t even light a candle to the thousands who would perish just across the Atlantic, and it’s possible that many could’ve been saved had the rest of the world paid attention. This continues the expected trend of well-off nations who pay little mind to the state of disease in poorer countries; no matter how prevalent the disease is, or how deadly, or how long it has been around, they will not care until it directly affects them. The bad news is, a virus could not care any less about the cute, fictitious “borders” which we humans have drawn up, nor about the socioeconomic status of those who live there; human beings in the United States are just as ripe for a biological takeover as human beings in Africa, and so people worldwide must learn to band together to stop a common enemy, instead of turning a blind eye to the impoverished time and time again. Nobody is saying that it is a bad thing for rich countries to contribute their resources to the eradication of a disease either, it’s just a matter of when. It’s no secret that a proactive response will curtail an issue more quickly and effectively than a reactive one, so there is no reason for any entity with the knowledge of an issue and the ability to help, to wait until it happens to them.

Now, with COVID, we are seeing similar tones of neglect for the poorer nations of the world. By the time the U.S. cleared all populations for vaccination, we had bought 1.2 billion doses to use (Teicher). In a country of nearly 330 million, that number is high enough to fully vaccinate every single citizen, with half a billion left over. Meanwhile, some countries might not see a sufficient supply until 2023. Globally, “High-income countries and wealthier middle-income countries have confirmed purchases of 5.4 billion doses, whereas LMICs [low-income and middle-income countries]…have 1.2 billion doses,” (Kim). The pandemic cannot end if only the U.S. and other developed countries are the only nations which are engaging in this “vaccine nationalism”. The virus will find in these poorer countries a safe haven, where it can spread and reproduce and thrive with zero resistance, ultimately leading to new mutations which can be more deadly, transmissible, or vaccine-resistant, all of which pushes back the entire globe’s progress. This has already been seen with many variants of COVID-19, specifically the Beta and Omicron mutations, the latter of which was actually discovered well after vaccines had begun rolling out, which were discovered in (although not confirmed to have originated from) South Africa (Katella). South Africa does seem to be making good progress with immunizing its citizens, but it also features a significant wealth gap akin to our own, making it a prime candidate to potentially birth future mutations in addition to the two previous occurrences, and also giving credibility to the need for us to stop hoarding vaccines. 

Hope for the Future?

If there’s anything that can be gathered from humanity’s recent battles with disease, it is that relief will come slowly and steadily to every corner of the globe. But, there is reason to believe that we are turning a corner on treating multiple diseases, as long as we hold our leaders and medicine-makers accountable, and don’t let them retreat into their greedy, “what’s in it for me?” attitudes and continue to treat pharmaceuticals as a for-profit industry. AIDS in Africa is becoming much less prevalent and has taken much fewer lives this decade: “starting from less than 1 percent covered in 2000, now almost half (46 percent) of Africans who need ART [antiretroviral therapy] are receiving it,” along with a reduction in one million yearly deaths due to AIDS from 2008 to 2015 (Mojola 170).

The Ebola virus has also begun to be curbed, due to the recent release of multiple vaccines. Although a small sample size, within the Democratic Republic of the Congo “over 290,000 have been vaccinated under compassionate use protocols,” (WHO) as of February 2020, so the number can only have grown since then. With this information, I hope that it is not just wishful thinking to say that COVID aid will become more widespread, poorer countries will receive the help they deserve, and we will eventually put this virus behind us all. The Ebola virus has also begun to be curbed, due to the recent release of multiple vaccines. Although a small sample size, within the Democratic Republic of the Congo “over 290,000 have been vaccinated under compassionate use protocols,” (WHO) as of February 2020, so the number can only have grown since then. With this information, I hope that it is not just wishful thinking to say that COVID aid will become more widespread, poorer countries will receive the help they deserve, and we will eventually put this virus behind us all.

Works Cited

Donovan, Doug. “As Africa Goes Unvaccinated, U.S. Remains Awash in Shots.” The Hub, 2 Nov. 2021, https://hub.jhu.edu/2021/11/02/covid-vaccine-inequality-africa/.

“Four Countries in the African Region License Vaccine in Milestone for Ebola Prevention.” World Health Organization, World Health Organization, 14 Feb. 2020, https://www.who.int/news/item/14-02-2020-four-countries-in-the-african-region-license-vaccine-in-milestone-for-ebola-prevention.

Hanefeld, Johanna. “ Patent Rights vs Patient Rights: Intellectual Property, Pharmaceutical Companies and Access to Treatment for People Living with HIV/AIDS in Sub-Saharan Africa.” Feminist Review, 2002, https://www-jstor-org.unh-proxy01.newhaven.edu/stable/pdf/1395886.pdf?refreqid=excelsior%3A3a315c7e6a4d14ec4a6be2408a222a04&ab_segments=0%2FSYC-6294%2Ftest_segment_2&origin=.

Katella, Kathy. “Omicron, Delta, Alpha, and More: What to Know about the Coronavirus Variants.” Yale Medicine, Yale Medicine, 20 Apr. 2022, https://www.yalemedicine.org/news/covid-19-variants-of-concern-omicron.

Kim, Jerome H. “Operation Warp Speed: Implications for Global Vaccine Security.” The Lancet. Global Health, The Author(s). Published by Elsevier Ltd., 26 Mar. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997645/.

Marriott, Anna, and Alex Maitland. “The Great Vaccine Robbery.” The People’s Vaccine, 29 July 2021, https://webassets.oxfamamerica.org/media/documents/The_Great_Vaccine_Robbery_Policy_Brief.pdf?_gl=1*1g58wlt*_ga*MTM2MjMyNTIzMi4xNjI5OTczMjgz*_ga_R58YETD6XK*MTYzNTUwNTEwNC45LjAuMTYzNTUwNTEwNi41OA..

McMillen, Christian W. Pandemics: A Very Short Introduction. Oxford University Press, 2016.

Mojola, Sanyu A. “AIDS in Africa: Progress and Obstacles .” Current History, May 2017, https://www-jstor-org.unh-proxy01.newhaven.edu/stable/pdf/48614258.pdf?refreqid=fastly-default%3A2098aa836ddcad9b569d55e8777d906e&ab_segments=0%2FSYC-6294%2Ftest_segment_2&origin=search-results.

Plummer, Francis A., and Steven M. Jones. “The Story of Canada’s Ebola Vaccine.” CMAJ, CMAJ, 30 Oct. 2017, https://www.cmaj.ca/content/189/43/E1326.

Tadjo, Véronique. In the Company of Men: The Ebola Tales. HopeRoad Publishing, 2021. Teicher, Carrie. “Op-Ed: The US Is Hoarding the COVID-19 Vaccine. the Rest of the World Is Suffering for It.” Doctors Without Borders – USA, 2 May 2021, https://www.doctorswithoutborders.org/latest/op-ed-us-hoarding-covid-19-vaccine-rest-world-suffering-it.

Images Cited

Alexander, Mary. “Life Expectancy in South Africa from 1960-2015.” South Africa Gateway, 16 Aug. 2021, https://southafrica-info.com/infographics/infographic-life-expectancy-south-africa-1960-2015/. Accessed 2 May 2022.

Bausch, Daniel. “A Hospital Isolation Ward in Gulu, Uganda, during the October 2000 Outbreak.” CDC, 1 Oct. 2000, https://www.cdc.gov/globalidplan/7-priority_1.htm. Accessed 2 May 2022.

Porter, Doune. “Supporting Africa Vaccination Week in Sierra Leone.” Flickr, 24 May 2011, https://www.flickr.com/photos/dfid/5815618256/. Accessed 2 May 2022.

Schludi, Daniel. “COVID-19 Vaccine Bottle Mockup.” Unsplash, 13 Nov. 2020, https://unsplash.com/photos/mAGZNECMcUg. Accessed 2 May 2022.

One comment

  1. Dana Gellis

    The conclusion of this article offers hope and encouragement, and it is probably accurate. Sadly though, the help that will make its way to poorer countries and populations will come after those with money and power “get theirs.” As pointed out in the article, this has been the trend with diseases and epidemics/pandemics prior to Covid, and yes, money most definitely does talk.

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