On racism, inequalities and the emergence of vaccine apartheid: notes of a vaccine trial volunteer

7/5/2021

At the time of writing this piece, I was confronted with two strikingly different scenarios. One, involved friends in the UK posting images of their vaccine cards on social media (and I am proud of them for taking the first step in making themselves and the world a safer place). The other, involved friends and relatives in India calling out for emergency oxygen cylinders and empty ones, telling stories of lifesaving medication sold on the underground market at 200% markup and lengthy queues outside the hospitals. Some friends in India have also been paying respects to and memorialising people they know who have died. Social media feeds are filled with pictures of bodies lying in queue to be cremated, and makeshift funeral pyres built in parks and parking lots as city crematoriums have run out of space. The official statistics, which are already scary, understate the rise in cases and deaths, and these images often show the true scale of suffering.

In addition to the two different pandemic related scenarios mentioned at the beginning, I also live in two different realities and have two very different experiences simultaneously. I am from India. I live in the UK and have citizenship of the country. I am an academic who works on racism and migration. Last year, I was a vaccine trial volunteer and have now been vaccinated, while my mother and brother live in the outskirts of Mumbai and both contracted COVID-19 in early April. They are recovering, but both continue to cough and feel weak. Their oxygen levels are in the healthy mid-upper 90% range, so neither need oxygen or hospitalisation. Both need a lung CT scan, but they are avoiding hospital visits as it is overflowing with patients who need urgent intervention, and they also fear getting re-infected. A few other relatives are hospitalised or using oxygen at home. As you can imagine, the past few weeks have been filled with worry, dread and sadness. Living 4500 miles away and not able to physically be there and help also continues to cause me a great deal of frustration and guilt. I am facing another layer of diaspora blues, from Ijeoma’s book of poetries.

Back in 2020, when the UK, as well as India and half the world, were in a lockdown, I experienced a similar feeling of frustration, and it is for this reason that I decided to enrol for the vaccine trial. I met the criteria and was invited for a detailed health screening, and eventually inoculated. Since then, I’ve visited the trial research centre on multiple occasions for routine blood tests and health check-ups. The doctors and nurses involved with the trial were incredibly supportive, friendly and empathetic, and that made the entire process pleasant. In the initial stages, I asked a series of questions, largely around safety, consent and ethics, and what would happen if things go wrong medically, insurance cover, complaint mechanisms and so on. While I am not a medical ethicist, I am aware of the literature that discusses the erosion of medical consent and treatment of racial minorities in clinical research settings.

More broadly speaking, racialised minority groups may be sceptical of the health systems and trials not only due to historical precedents and traumas, but also the everyday and institutional racism we face. Even with that, there is a disproportionate political and media focus on such scepticism as if we are the ones who pose a problem or threat. Such representations were also accompanied in the media with the denial of institutional racism that underpinned it. The denialism, particularly at a time when racial minority groups are disproportionately affected by COVID-19, reached its pinnacle with the recent misleading Commission on Race and Ethnic Disparities report that denies the existence of institutional racism. The report shocked and enraged me, and it was also criticised by the Runnymede Trust and head of the NHS Race and Health Observatory. As such, I was initially hesitant of the trial, but thought it was important. Thus, after carefully assessing the information, consent and ethics, I decided to go ahead with it.

For me, this was a way of helping and addressing my feelings, but there are numerous ways in which people across the world continue to help in these tough times. For instance, in the UK there have been those who set up social media pages and mutual aid projects to help those in isolation, fetch groceries or pick up prescriptions for those unable, or simply have an online chat with individuals feeling lonely or frightened. The examples of selfless acts are numerous and participation in the trial is a small drop in the vast ocean. While I cannot speak for all the other trial volunteers, the handful of testimonies in media have indicated that people were driven by the urge to help and make the world safer (note: the keyword here is ‘world’).

As a migrant from India to post-colonial Britain, the Tory party and hostile environment shrinks that world to small island nationalism and treats others, and people like me, like we do not matter. Therefore, the actions of the Tory government continue to anger me. The racist hostile environment agenda was introduced by Theresa May in 2012, and it continues to harm migrants and expose them to unsafe conditions. The policy is now aggressively pursued by the Home Secretary Priti Patel, who has demonstrated a sheer (criminal) recklessness and disregard for human life by authorising the use of Napier army barracks and/or house people seeking asylum in unsafe conditions. The barracks were run down and unfit for human habitation and the cramped communal conditions led to a major COVID-19 outbreak, with nearly 200 people testing positive. The squalor and hopelessness of the situation also resulted in many suicide and self-harm attempts.

In the middle of a pandemic, Patel also pledged an overhaul of the asylum system based on a series of unfounded claims. I was one of the many academic experts who signed a letter outlining the ways in which these plans circumvent international law and are based purely on ridiculous assertions as opposed to concrete research evidence. Furthermore, the reports continue to show that years of austerity, health inequalities and high poverty rates have resulted in a spiral of health deterioration and multi-morbidities in deprived areas, and this has also increased the vulnerability to COVID-19 infections and deaths. The most deprived areas also have a lower vaccine coverage, and the government vaccine programme has not rapidly or adequately responded to health inequalities or prioritised vaccine according to deprivation.

Research published in the British Medical Journal highlights that the risk of death from COVID-19 for racial minority groups is higher when compared to the rest of population, and after considering potential confounding factors such as age, sex, income, education, housing tenure and area deprivation. Both socio-economic factors and racism play a key role in understanding the impacts of the pandemic. What angers me is to know that while I, a racial minority, migrant, vaccine trial volunteer, hoped to make the country a safer place – the government on the other hand has pursued a dangerous divisive agenda. The government continues to deploy the politics of race and immigration to divide the working class (and working poor) and have consistently attempted to block any real solidarity from emerging – something we need now more than ever.

Besides creating division within their own country, the Tory government (along with a few other developed countries) have also created global division through the idea of ‘West vs. the rest’. It is worth noting that over half of the UK population has now received the vaccine first dose, but for India the figure drops to 9% (and 2.1% fully vaccinated). The vaccine figures are even lower for other countries: Venezuela 0.9%, South Africa 0.6%, Mozambique 0.2% and Papua New Guinea 0.01%. There is an unequal distribution of the vaccine, and certain developed nations are stockpiling/hoarding millions of doses and placing vast orders. The previous estimates have suggested that ten rich countries have received 75% of the global vaccines. At the current rate, poor countries will take a further two to three years or more to achieve inoculation of the entire population.

The (criminal) irresponsibility and moral bankruptcy of certain developed countries does not stop here. Human Rights Watch have stated that while Israel is a ‘global leader' in terms of vaccine speed, it has removed nearly five million Palestinians in the occupied West Bank and Gaza Strip from its vaccination drive. Nevertheless, the UK (and Western) media and politicians continue to celebrate Israel’s vaccine success and COVID-19 recovery story. The nationalism and racism are exacerbating inequalities and injustices during the pandemic, both nationally and globally.

To make vaccines accessible and affordable, it must not only be the wealthiest countries that have new medicines and technologies to control the pandemic. India and South Africa submitted a joint proposal to the World Trade Organisation (WTO) in October 2020, requesting a temporary patent waiver, and it was backed by over 100 developing countries. They urged the manufacturers to share their knowledge, so more countries can produce vaccines for their own population and for other developing nations. Unsurprisingly, a handful of wealthy countries and pharmaceutical industry blocked the proposal and continue to do so – with the UK being one of the loudest voices at WTO.

The past few months have shown a serious lack of integrity on the part of the British prime minister and Tory ministers, who have let the corporations and pharma giants dominate the policy on vaccine and overall response to the pandemic. The Tory government (and their capitalist friends) have cashed in on the crisis through secretive deals and have consistently demonstrated that profits come before human life. The US and other developed countries are equally culpable. There is a system of vaccine apartheid emerging, and it is set to cause greater suffering and deaths in the non-Western world. As a vaccine trial volunteer, it angers me to see that certain groups of people and developing countries being subjected to a slow death. Furthermore, the majority of the pharma involved in vaccine manufacturing have already made billions in profit through government contracts (which is taxpayer money). It is mindless and deeply immoral to withhold intellectual property during a pandemic.

Along with higher deaths, the difference between the vaccinated developed world and the non-vaccinated Global South is going to create debilitating economic conditions, and poverty in the latter. COVID-19 will continue to deepen the existing inequalities and create a hunger crisis, pushing millions into starvation and cause deaths – while the rich become richer. A recent report by Oxfam noted that 1000 billionaires, mainly white men, recovered all their wealth lost due to the initial shock of the pandemic. The ten richest men saw their combined wealth increase by half a trillion dollars.

Originating from one country and living in the other also adds to my anger and frustration. As mentioned earlier, the UK has vaccinated over 50% of the population, while India has vaccinated around 9%, and there are even lower rates for other countries. However, the UK partly relies on India for vaccine doses (yes, you have read that correctly). In March 2021, the Serum Institute of India, who is licensed to manufacture one of the COVID-19 vaccines, were asked to place a hold on the UK-bound export of 5 million doses while the Indian government figures out how to slow the virus surge. There were speculations in the UK that shortage will lead to delays in the easing of lockdown measures (and the prime minister later assured the public during the press conference that ‘progress along the road to freedom continues unchecked’). The secretive deals have also allowed the UK to export 10 million doses manufactured in-country to Australia, while importing 10 million doses produced in India.

India had planned to deliver 1.2 billion doses of vaccine this year to 92 low and middle income countries in Africa, Asia and Latin America. However, India is at present fighting the worst viral surges, and there are various virus variants in circulation, including double and even triple mutant variants. The Modi government’s bureaucratic incompetence, lack of preparation for a potential second wave, arrogance and hideous hyper-nationalist stance has caused trauma, misery and chaos. The ‘pharmacy of the world’ is very sick, and its citizens are dying in large numbers. Therefore, there is an extremely high degree of uncertainty and unpredictability whether other countries will receive the planned doses. The UK (and other rich developed countries) have accessed vaccines manufactured in India, which should have gone to developing and poor countries of the world.

There is a world beyond us. A world with which we are closely connected, and one that we need to play an active part in improving. When I took part in the vaccine trial, I thought about people in the UK, people in India, people in Pakistan, those in Kashmir and Palestine (both subjected to repression by Indian and Israeli governments, respectively), Latin America, Yemen and beyond. I thought about the migrant workers, lower caste, working class, elderly, disabled and more. None of us is safe until all of us are safe.

I want to end this piece by drawing on the famous words of Arundhati Roy: a pandemic is a portal, a gateway between this world and the next. We can choose to walk through it, 'dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it'.

Let’s imagine another world, a better world, a safer world. We need to fight for it now. We need to fight against racism, inequality, nationalism, imperialism, capitalism. We need to stop the emergence of vaccine apartheid. Let’s hold the governments and corporations to account. Waiving the patent and giving other countries technical know-how of vaccine manufacturing is not only pragmatic, necessary and urgent – but the only way the world can be saved from more and greater loss.

Image credit: Photo by Swarnavo Chakrabarti on Unsplash

Blog post by Monish Bhatia, Birkbeck, University of London, School of Law, UK

Read more Identities COVID-19 Blog Commentaries:

India, untouchability and quarantine: a historical perspective

Can COVID-19 malign the idea of India?