When it comes to a COVID 19 vaccine, fairness in health care is not in sight

We believe that a COVID-19 vaccine will not be distributed fairly in our world. Why? We know about the systemic inequality of the world organized according to race, gender, and class that determines who are the have and the have-nots, the ones who may live and the ones who must die.

The race to get the vaccine has started. A recently released OXFAM report confirms that health inequality is well established in a market-driven environment, concluding that wealthy nations, representing 13% of the world population, have already struck a deal with the five big pharmaceutical companies to receive 51% of the promised doses of the vaccine. The distribution of health care vs. excessive wealth is still following the same pattern as before the pandemic struck, despite all the promises of change. Of course, this is no surprise. The profit market system has generated inequalities in every aspect of modern society while justifying it with illusionary access to modern technology and comfort.

The coronavirus pandemic’s story has generated an interlocking system throwing into deeper poverty many women, children, and men. It has revealed the dirty secret that the neoliberal system only serves the wealthy to make them wealthier. Déjà vu! Yes, but what is striking is the nature of the discourses about solidarity in this world pandemic, making populations believe that the market had gotten the message of its inability to serve us. Although the discussion of the Coronavirus 19 has been technical, it has rarely linked this new type of virus behavior to deforestation and the industrial production of meat.

Similarly, the absurdity of the global neoliberal monopoly approach to global health is kept invisible and not discussed as the pandemic’s leading cause and its consequences. In the 1980s, we saw the devastating effects of the Structural Adjustment Programs on global health. Restricting access to healthy living was part of that program. By the same token, we have seen the impact of this approach on AIDS, the Executive Director of the UNAIDS reminded the public that “the corporations use monopolies to artificially restrict supplies of life-saving medicine and inflate their prices.”

Big pharma industry’s ethics-devoid lobbying is supported by a number of world leaders and quietly pulls the political process’s strings, warping the solidarity attempt to have a patent-free accessible worldwide vaccine. The Oxfam report underlines the absurdity of not sharing and cooperating: “The estimated cost of providing a vaccine for everyone on Earth is less than 1 percent of the projected cost of COVID-19 to the global economy.”

Meanwhile, COVAX is an entity whose goal is to accelerate the development and manufacture of COVID-19 vaccines and “guaranteeing” fair and equitable access for every country in the world. COVAX is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and WHO. It aims to accelerate the development and manufacture of COVID-19 vaccines and guarantee fair and equitable access for every country in the world. GAVI, the Vaccine Alliance, pledges to ensure that no one is left behind in having access to health care, including the vaccine. It regroups The World Health Organization, UNICEF, the World Bank, and the Bill & Melinda Gates Foundation. It is presented as playing a critical role in strengthening primary health care (PHC). These entities have minimal means and might also be influenced by massive lobbying.  

All these mechanisms and the pledges of some countries to support COVAX might be vain in this neoliberal environment as freedom for the few is synonymous with freedom to purchase. The absurdity of not considering the global interest of solidarity in facing a pandemic mirrors the folly of continuing politics of gender discrimination, impoverishing environmental equilibrium (encouraging fossil fuel use, deforestation, the industrialization of food production, etc.).  In all cases, women and girls lose out, and they will be the ones on whom the burden of protecting life will fall. 

(Image Credit: Cristian Newman) (Photo Credit: Avel Chuklanov)

Covid Operations: We must address the cruelty

Collins Khosa

In the past day or so, the news has suffered a crescendo of iterations of brutality: police brutality; the brutality of racist, White supremacist violence; and the brutality of designating certain populations as disposable, not important to consider when `opening up’ states, cities, countries. This is a snapshot of today’s three faces of brutality: Collins Khosa; Ahmaud Arbery; and the Arlandria/Chirilagua neighborhood of Alexandria, Virginia.

Collins Khosa, 40 years old, lived in the Alexandra township, in Johannesburg, South Africa. April 10 was the fifteenth day of the national lockdown, a lockdown enforced by both local police forces and the South African National Defence Force, SANDF. On April 10, members of SANDF saw Collins Khosa and a friend in his yard. The SANDF members saw a cup half full of liquid, which they assumed was alcohol. They asked Collins Khosa whether that was the case, and Collins Khosa correctly answered that drinking alcohol on one’s own premises was not a violation of the lockdown rules. The SANDF members then demanded that Collins Khosa step into the street, so that he might be taught a lesson. Then the SANDF members taught. They beat Collins Khosa to death. Now the Khosa family is in court, demanding an investigation. As they explain, their “case is not about the justification for the lockdown or its extent. It is about combating lockdown brutality”. Lockdown brutality. Leading South African constitutional lawyer Pierre De Vos asks, “Why has there been less public outrage (and less debate) about Khosa’s death and about other lockdown brutality by law enforcement officials, than there has been about the ban on the sale of cigarettes, on the one hand, and about those complaining about the ban, on the other? Is it because soldiers largely patrol working class and poor areas and not the leafy suburbs where most white people live? Is it because victims of brutality have been predominantly black? Or is it because the perpetrators of the abuse have been largely black?”

The past two days have seen numerous reports of lockdown brutality across South Africa, and South Africa is not alone. For example, it was reported yesterday that in Brooklyn, in New York City, of the 40 people arrested for violation of social distancing, 35 are Black, 4 are Latinx, 1 is White: “The arrests of black and Hispanic residents, several of them filmed and posted online, occurred on the same balmy days that other photographs circulated showing police officers handing out masks to mostly white visitors at parks in Lower Manhattan, Williamsburg and Long Island City. Video captured crowds of sunbathers, many without masks, sitting close together at a park on a Manhattan pier, uninterrupted by the police.” Why has there been less public outrage and less debate?

Ahmaud Arbery

At the same time, videos circulated showing the cold-blooded murder of Ahmaud Arbery. Ahmaud Arbery was a 25-year-old Black man, a former high school football player, an active athlete, an all-around good guy. Ahmaud Arbery went jogging through a neighborhood in Brunswick, Glynn County, Georgia. Two White men decided that Ahmaud Arbery was dangerous `resembled’ someone suspected of burglary. There were no burglaries, there was no suspect, there was no reason, other than that of Being Black. Being Black was evidence enough of criminality. The two men followed, hunted, Ahmaud Arbery and shot him, killing him. The two men were not charged with any offense. That all happened February 23, in the early afternoon. Only this week a video emerged showing what actually happened. Only this week were the two White men finally taken into custody. Had it not been for the video, they would be free as any other White man with a gun in the United States. Needless to say but it must be said, Ahmaud Arbery was unarmed. The line from police brutality to `citizen brutality’ in the prosecution of some imaginary crime is a short, direct line.

The Commonwealth of Virginia released Coronavirus data this week, the same week that the Governor, a medical doctor, announced that it was time to start `re-opening the state. The data was broken down by postal zip codes. In the small northern Virginia city of Alexandria, itself hotspot, one zip code stood out, 22305, the largely working-class, Latinx immigrant and first-generation neighborhood of Arlandria/Chirilagua. In Arlandria, a community of around 16,000 residents, 608 residents were tested, and 330 tested positive for Covid-19. That’s an extraordinary 55% of the test population testing positive. Why have so few been tested? Because so many are deemed `ineligible’ because of status or income. That leads to a situation in which people only get tested if they can pass various stringent hurdles. In a press conference today, the Tenants and Workers United, a chapter of New Virginia Majority, demanded “expanded access to testing, ensuring tests and treatment are free, and providing housing so that residents can safely isolate.” Repeatedly, they invited Governor Ralph Northam to leave the Governor’s Mansion and come to Alexandria to see what’s actually happening. Earlier in the week, the Legal Aid Justice Center responded to Northam’s plan to `re-open’ Virginia by labelling the proposal “reckless and cruel”. As Legal Aid Justice noted, “Due to systemic racial inequities, infection and death rates are highest in Black and brown communities. In our state capital of Richmond, 15 of the 16 deaths from COVID-19 were Black residents. In Fairfax County, while only 17% of the population is Hispanic, 56% of all confirmed cases are Hispanic.”

It’s all cruelty actually, rather than brutality. Brutality suggests that those committing the acts of violence are somehow “brutes” or “animals”. Cruelty, on the other hand, suggests that those committing the violence range between indifferent to the pain of others to actually taking pleasure in inflicting pain on others. As with the Khosa family pursuit, this concerns more than this particular police officer or that particular White racist, although they must be addressed. It addresses the whole system of disposable populations, a Black man sitting in his front yard, a Black man jogging down the street, an entire Brown neighborhood, all of them trying to make it through another day. Why has there been less public outrage and less debate? We must address the cruelty that structures our lives.

Azucena, member of Tenants and Workers United

(Photo Credit 1: Daily Maverick) (Photo Credit 2: New York Times) (Photo Credit 3: Tenants and Workers United / Facebook)

As Black folks are dying from Coronavirus at disproportionate rates

As Black folks are dying from Coronavirus at disproportionate rates, we cannot just talk about co-morbidities. We must seriously discuss medical racism and how once you are diagnosed with Coronavirus, you are isolated. And there is no one with your best interest at heart to advocate for you. Black folks, all of us, have at least one horror story about how if we hadn’t intervened or if someone had not intervened on our behalf with a doctor or team of doctors, the outcome might have been fatal. 

I know I have my share of stories even going so far as to pull a Ralph Ellison “Invisible Man” and open a sealed envelope that a pediatrician gave me to hand off to the emergency room attendant because I questioned the pediatrician’s treatment of my son in her office. Lucky for me that I opened the letter because that racist pediatrician, who happened to be Pakistani, had recommended that social services intervene (you know, even foreigners see Black women as inept mothers. And how dare I question her treatment protocol). When the pediatrician came to visit my son in the hospital after attending a cocktail party, I not only ran her the riot act and obtained a new pediatrician, but I reported her for being intoxicated on the job. If you are on call, you are not supposed to be consuming alcohol. 

So, let’s make sure that we have a margin of error for the fact that some of these deaths can be attributed to race-based biases that often do not promulgate positive outcomes for our health.

(Photo Credit: Praxis Center)

When the neoliberal and globalization creed meets the virus

Did we see it coming? In the United States there was a presidential campaign taking place along with social unrest, immigration unrest and wall building. In Europe, countries were passing laws either to exclude people in exile, or people in vulnerable position, with no alternative! Then the novel coronavirus came to life creating Covid 19. We call it now a corona virus crisis. A new crisis in the series of crises that capitalism has been feeding itself from. At the beginning it was a Chinese made virus. But China is the iconic representation of globalization and all a sudden everything was in shambles. 

One should make the connection between globalization and the development of neoliberal economic dogma. However, this dogma initiated after WWII as the colonies were engaged in a struggle for independence from the imperial war mongering West, did not always exist. The response to the independence of former colonies was the creation of this new dogma of globalization, based also on the Western yearning for universalism. Toni Morrison reminds us that globalism “understands itself as historically progressive, enhancing, destined, unifying, utopian”. That is how it forms its delusional promise to allow itself to create a dehumanized system of deregulation, globalization and total competition. 

In the mid 1980s, Structural Adjustment Programs, SAPs, were imposed on poor countries, sometimes former colonies of the rich countries, often rich in natural resources needed in the rich countries. These SAPs were designed according to the logic of the Washington Consensus (growth at all cost and at the expense of public social services) to justify globalization. The IMF and the World Bank provided loans to poor countries under the aegis of development, but these loans came with conditionalities that required repaying these high interest loans in priority rather than developing social and health services. This complete overhaul of social structures with the development of competition for markets undermined women’s economy and women’s position.  

The Ebola virus outbreak in the 2010s shed light on the cruelty of these programs. By the same token, the austerity measures following the same neoliberal economic orthodoxy similarly stoked the elimination of public services in richer countries. The current pandemic, with the risk of infection as a common denominator, has reunited every social class and gender, with some variation according to age; therefore, it has become an international source of anxiety especially that the rich countries have become the epicenter of the epidemics. 

The national responses are different, as, for example, when the contamination of the virus is progressing rapidly in the US due social factors such as lack of a public-run health care system, lack of protection for workers under US labor laws, lack of social services, lack of access to medications. Only now is the US government considering paid sick leave for a number of people who are quarantined and whose jobs are on hold. The US hospital system has the fewest number of beds per 100 among the developed world.  The US pharmaceutical industry depends on its products and ingredients from companies in India and China. Tests for coronavirus are not widely available to identify people affected by this highly contagious disease. In the US only 11 000 tests were administered in the past few days whereas South Korea uses 20 000 tests every day.

If one wants to measure inequality concerning access to health care, one should look at the prison and immigration detention systems. “From a public health perspective, prisons [are] so dangerous because they’re overcrowded and their systems of care provision, such as they are, have intentionally gone from bad to worse”

This coronavirus pandemic reveals how a government’s callous disregard for human life and the environment relies on its “capacity to decide who may live and who must die.” Only this time the powerful are caught in their own game.

(Photo, image credit: Robert Metz and Matteo Paganelli)

Covid Operations: What happened to a half century of mass incarceration? Covid-19

In the past week, news agencies and advocacy organizations have discussed the role of prisons and jails in spreading the novel coronavirus. Some are longstanding advocates for just solutions to the incarceration crisis; others, especially news agencies, are just now `discovering’ that prisons, jails and immigration detention centers form an archipelago of infectious morbidity and mortality. Headlines from the past three days include: To Arrest the Spread of Coronavirus, Arrest Fewer People.  Visits halted in federal prisons, immigration centers over virusHow Coronavirus Could Affect U.S. Jails and PrisonsPrisons And Jails Worry About Becoming Coronavirus ‘Incubators’Our Courts and Jails Are Putting Lives at RiskTo contain coronavirus, release people in prison. In Virginia, the Legal Aid Justice Center noted, “Adults and youth held in Virginia’s prisons, jails, and detention centers are particularly vulnerable to the spread of disease and deserve to be protected with adequate sanitation and medical care or, if possible, be released.” England and Wales developed “emergency plans to avoid disruption” in their prisons. Also in England, immigrant advocates called on the government to release hundreds of immigration detention center detainees, noting, “There is a very real risk of an uncontrolled outbreak of Covid-19 in immigration detention”. In France, prisoners, supporters, staff, and advocates are concerned and see no way out of coronavirus running rampant through the prison system.

While this attention is welcome, the question that lingers, and haunts, the current carceral controversy is, “Why now?” Public health researchers have long documented prisons’ role in the spread of infectious disease. From a public health perspective, prisons so dangerous because they’re overcrowded and their systems of care provision, such as they are, have intentionally gone from bad to worse. A half century of mass incarceration married to a global programme of austerity has left us with prisons waiting to pump out HIV and AIDS, TB, Ebola, SARS, opioid addiction, and now Covid-19. 

Earlier this year, a special issue of The Lancet began as follows, “About 11 million people are currently being held in custody across the globe and more than 30 million individuals pass through prisons each year, often for short but disruptive periods of time .… The health profile of the detained population is complex, often with co-occurring physical and mental health disorders, and a backdrop of social disadvantage. Detention can also expose people to new and increased health risks, yet the profiles of the population behind bars and their health needs have often been neglected.”

Last year, The Lancet editorial board noted, “The sheer scale of imprisonment in the USA and its unequal burden on people from minority and poor backgrounds raises concerns about its impact on the health and wellbeing of the national population …. Being in prison worsens several health outcomes and might even drive the spread of disease.” Elsewhere, medical researchers noted, “There is a growing epidemic of inadequate health care in U.S. prisons. Shrinking prison budgets, a prison population that is the highest in the world, and for-profit health care contracts all contribute to this epidemic.”

Inadequate health care in prisons across the globe is the growing pandemic that preceded the current pandemic. Where are the women in this pandemic scenario? Women are the fastest growing prison population. What does that “growth” look like? “As adults, women who are incarcerated have enduring reproductive health issues such as unintended pregnancies, adverse birth outcomes, cervical dysplasia and malignancy, and sexually transmitted infections. Women who are pregnant or parenting a newborn during their incarceration are at high risk for poor outcomes, and just like individuals in the community they need prenatal care, supports with labor, postpartum bonding, and breast-feeding support. Women who have returned to the community or are under community supervision face similar health issues as women who are incarcerated and may lack access to care.”

Repeatedly, public health researchers have described the situation in prisons and jails as a crisis. For women – and especially women of color and poor women – that crisis stretches across their lifespan in two ways. First, the health consequences of even short stays in detention endure a lifetime. Second, detention itself lasts a lifetime: “Over 1.2 million women in the United States were on probation, parole, or incarcerated in jail or prison facilities at the end of 2015, the most recent year for which data are available.”

The decades of mass incarceration, in which women have consistently been the fastest growing prison population, are built on systemic neglect. While the current pandemic is in no sense an opportunity, it is a moment in which we can turn that neglect on itself and pay attention, not only to this particular instant but to the decades that prepared the ground, toxically, for it. Immigrant detentionjailprison are always bad for health. The only route to a healthy world is decarceration.

(Image Credit: Prison Policy Initiative)