VACCINE EQUITY?

Editorials and Twitter threads have arrived weekly on the issue of global vaccine equity. They’re easy to find. Every major news source has run a piece, or many, about how some nations are getting vaccine doses, or several, while others have gone without. These offerings from academics, doctors, journalists, and justice workers tell us things like, "three billion people have yet to receive their first dose, most of them are in low-income countries." They call this “vaccine apartheid” and warn that "until we address vaccine inequity the pandemic will not end for any of us."

But the intuitions and beliefs expressed demonstrate clearer than anything how hard folks work to ensure the views they publish don’t track with reality. What makes equity claims like those being shared across social media so bizarre is that they demand the world is sterile and homogeneous. In their pleadings and castigations authors and commentators insist that France and New Zealand are Liberia and Sudan; that not only are the demographics identical but that folks in these places have identical religious, political, health, and justice framing, motivations, and aims. The world, they demand, is flat.

However, it’s all a little worse than that. As expected, they commonly leave out the bit where Canada has offered $575 million to buy and distribute vaccines to others. They miss the part where Canada (a tiny nation of just 38 million) promised to donate 50 million doses from its own vaccine contracts and not less than 150 million more through the global vaccine sharing alliance – a number that is likely to rise. Worse still, these publications and posts insist that places such as Canada, who prioritised vulnerable populations in their vaccine roll-out at home, cannot even contend with the concept of vaccine equity. (It’s all Olympic qualifying-level mental gymnastics and by the very people most likely to proclaim they're the ones being gaslit.) Here in Canada, though Indigenous and health-compromised folks were also prioritised, the primary focus, even within these other cohorts, was on age: 80-year-olds before 60-year-olds before 40-year-olds. And why was that? Well, very early on in the pandemic we learned that this particular virus strongly discriminates based on age. The world watched on as Italy’s seniors were disproportionately attacked. After months of this, with dramatic repeats in many countries, it became obvious that an elder hit with the virus had real reasons to be worried they might not make it while even serious illness presenting in a teen remains a shock even today.

Does anyone reject this basic fact about the pandemic or, then, the ethics of targeting older populations with vaccine? I’ve been unable to find any such arguments. So are the authors of these rants pitching that all regions of the world have the same, or even similar, age make-up? Not directly. If you ask these commentators “Who are most vulnerable to this virus?” and “Who has been worst affected by it to date?” they will typically tell you that it has been those who are least vulnerable and least affected. Their articles and essays are even titled reflecting such backwardness. They’ll generally point to low-income countries or specifically highlight the entire continent of Africa. Yes, they’ll get themselves printed in publications of record with articles on the correlation between low GDP or low household income and low vaccination rates. They’re effectively claiming that the virus doesn’t discriminate by age but that SARS-CoV-2 is somehow colluding with the International Monetary Fund or the tax department or people’s banks to check on their income before infecting them… or some such incoherent nonsense I can’t wrap my head around.

Most depressingly, they get no push-back at all – despite their adamant rejection of one of the best known facts in global health. Go look. Pick some high income nations and pull up their per capita GDP and then pair that with life expectancy figures. Find any sources you like. Then do the same for low income nations or just those with half the GDP of the richest places. You may just have a shock if you’ve never looked at the numbers and only relied upon your own or others’ intuition. You may discover that Peru and Costa Rica, for example, with just a fraction of the GDP of the United States, have higher life expectancy; South Africans and Nigerians, among the wealthiest in Africa, have shorter life expectancy than Rwandans and Sudanese, who are among the poorest; that, despite being worlds apart in GDP, Saudi Arabia and the United Arab Emirates are not much different on life expectancy from Tajikistan and Uzbekistan. In this way, what is claimed (without argument) to be the strongest and most obvious correlation couldn’t be farther from the truth. That’s a real problem. And if someone has such a worldview, one that has just so distorted their picture of the world, they may wish to regroup and check back in with reality – particularly if we’re going to talk about COVID-19 and vaccines.

So, back to COVID, not even once do the authors of these rants appear to have compared, oh I don’t know, COVID cases, hospitalisations, or death rates between poorer nations and wealthier ones. And they don’t compare vaccine doses with case counts either. Is that not bizarre? Wealth is the factor they’re interested in and are claiming is the critical element determining outcomes. And, just as odd, they never place regions, nations, or continents side-by-side with infection and vaccination rates. So odd, that; it’s almost like they don’t want to know and don’t care.

And if you do the work for them, as you must, pulling up their own categories, what you find is that reality couldn’t differ more starkly from the rhetoric. When per capita COVID cases and deaths are called up for any of the wealthiest nations (and the countries with among the highest median ages – ZOINKS!) the numbers are huge and the worst in the world. By comparison, the poorest nations on Earth (and those with the lowest median age – DOH!) seem to have yet to even experience the pandemic. Per capita, many of the wealthiest nations (Netherlands [with median age 42], Germany [48], Spain [44]) have seen several orders of magnitude more cases, hospitalizations, or deaths than the poorest nations (Papua New Guinea [24], Sierra Leone [19], Uganda [16]). This should surprise no one. Still, the argument from commentators appears to be that in a fight with COVID you’d be better off as a senior citizen in Canada or Austria than a child in Nicaragua or Kiribati. That’s as mad as arguing that the virus doesn’t exist or that Ivermectin is horse medicine. And yet, here we are.

And when you attempt to question these writers of op-eds or anyone keen to defend them, they will, most amazingly, pull out all their best racist and classist stereotypes rather than offering any numbers. Our moral exemplars and self-proclaimed anti-racists will pitch to you their observations that Africans are all perfectly incompetent and ignorant, lacking in the most basic infrastructure and information. Without having looked at which nations are reporting case and fatality data, they will insist that entire continents have no reliable figures (ignoring too, of course, that the numbers are extremely weak in the West.) Best of all, after telling you there are no functional resources on the ground and that regional authorities are too corrupt and useless even to estimate numbers of dead, they will only push harder their insistence that we need to immediately send a billion unstable vaccines. It’s all pretty brilliant.

Of course, none of the above gets into the safety, efficacy, or ethics of these vaccines themselves or anyone’s perceptions or feelings about any of this. That’s right, the people who reject numbers also oppose personal experience and beliefs. I love it. Of course, if you read these blurbs, and even the news more broadly, you’ll be told that opinion is essentially unanimous and that those less keen to get a shot are only outrageous, anti-social deviants. And, naturally, anyone who hasn’t been offered a shot or who hasn’t sought one out is a tragic victim. It’s simply not possible that, as our leading bioethicists tell us, this whole discussion of vaccines (and everything associated) has been dominated by self-styled intellectual and moral elites who are all fully immersed in medical culture. It can’t be that any persons or entire societies have been discriminated against or abused by the “health-care” system and may not want your damn shot, even to save their life, and that this may be perfectly rational. It’s not that anyone could have a legitimate concern or hesitation or ideological consideration they’re unable, or simply not yet willing, to throw aside. It isn’t that beliefs translate into behaviour (and that billions of your neighbours have unwavering faith in the protective and healing powers of God or garlic, perfume or peridot.) It cannot be that even now experts don’t have answers to people’s simplest questions; and it certainly cannot be that answers are persistently conflicting with the medical consensus, those of our neighbouring districts or friendly nations, or just what these authorities said in front of a team of reporters last week. Nope.

And it doesn’t need saying but, of course, these authors haven’t even begun contending with the alternate reality of their utopic vision – the one in which AstraZeneca shots were not first sent to Europe but to the Caribbean or Central America, West Africa or Melanesia. As such, they leave out how in their ideal world it wouldn’t have been the Norwegians, Danes, or the Dutch crying foul and ceasing the use of this vaccine (and the world largely ignoring the issue); but that we would be reading their dissertations on the attempted genocide by neocolonialist-backed operatives of Big Pharma.

Every part of this is a real problem. What would a little introspection do?