Global COVID Vaccine distribution is a central concern for global bioethics, and feminist bioethics’ attention to patterns of power and injustice

In June of 2020, when US President Trump formally expressed his intention to withdraw from the WHO just as the scope of the COVID-19 pandemic had become clear, this also meant withdrawing from COVAX, the international program intended to change distribution patterns of vaccines to globally more fair/ethical. US President Joseph Biden has expressed his intention to not withdraw from WHO and thus to support COVAX. However, the fact of the matter is that wealthier nations with stronger connections to the established patterns of imperialism and settler colonialism have already bought up the largest shares of vaccines already available (Canada, the US, the UK, etc. AKA the “usual suspects”). So have other powers with global reach and/or national wealth such as China, Israel, and the United Arab Emirates.

This image shows a map of the world. Darker nations have had more vaccines per 100 people, lighter ones fewer. Most of Africa is entirely white or has no data. So is much of Eastern Europe and central Asia. The US, Canada, and Europe are darkest. Russia and China are a little paler, as are Mexico, Brazil, and a few other South American nations. Most of Central America, the Caribbean, and much of western and northern South America are not colored at all.

Of course, those shares procured by the US and Canada were of the vaccines that are the most expensive per dose, and the hardest to store, with the Pfizer and Modern vaccines both requiring ultra-cold or cold storage that could not be maintained in nations with unpredictable electrical grids and standard refrigeration capacity–this is also true of rural and tribal areas of the US and Canada. Perhaps they were never good candidates for global distribution. We’ll have to keep our eye on what happens to the more affordable vaccines now coming available, including the Oxford Astrazeneca vaccine and those out of China such as Sinovac that don’t use mRNA methods but rather use more traditional vaccination methods with parts of killed virus. These are not only less expensive, but also are more easily stored and transported and may work better with global vaccine distribution infrastructure.

These concerns about the transnational/international operation of power and privilege, gendered or otherwise, are paramount for global feminist bioethics. And of course, any analytical lens concerned with the welfare of women will be concerned for these same systems since women are members of every non-gendered social group against whom–or for whom–power works. Even within nations that have vaccines, pregnant women are not always listed as a vaccinatable population due to their exclusion from vaccine trials (the US CDC and WHO differ on this); the impact of research exclusions of pregnant women has been an IJFAB concern since our second issue in 2008.

In addition, the classic global bioethics issue of who is used for new drug testing vs. who receives access to those new drugs is highlighted by South Africa’s role as a test site despite its reliance on COVAX for access to vaccines to begin, at best, in the 2nd quarter of 2021. Several African nations were test sites for multiple COVID vaccines, but will expect to see delivery long after the nations in which the companies who developed the vaccines are based. This is reminiscent of the bioethics issues seen with HIV medication trials that exhibited similar patterns in the late 20th century.

For more on these issues see the links embedded above plus:

GRAPHICS: Global Covid Vaccine Distribution and Inoculations (Al Jazeera; 3 January 2021)

Brazil begins distributing AstraZeneca CoronaVirus Vaccine (Axios; 23 January 2021)

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Rich Countries Are Hoarding COVID Vaccines: 80 million vaccine doses have gone out–but only 55 in a low-income country (Vox; 29 January 2021)

Pregnant Women Get Conflicting Advice On COVID-19 Vaccines (New York Times; 28 January 2021)

How Rich Countries Affect COVID Vaccination For The Rest of The World (National Public Radio; 13 January 2021)

As Israel Leads in COVID-19 Vaccines Per Capita, Palestinians Still Await Shots (National Public Radio; 31 December 2021)

Serbia Turns to China for Vaccine Relief (DeutscheWelle; 25 January 2021)

Coronavirus Vaccinations Data Visualizations (Our World In Data; updated daily)