Can global health equity gaps be bridged during a pandemic?
Joseph Adu, MPhil, MSc., Ph.D. (c)
Western University, London-Ontario, Canada
Erynn Monette, MSc., Ph.D. (c)
Queens University, Kingston-Ontario, Canada
“Overcoming poverty is not a task of charity, it is an act of justice.
...Nelson Mandela
Equity gaps in health care access have existed between the Global North and the Global South for centuries due to poverty, infrastructural barriers, and disparities in human capital for health care delivery (Baciu et al., 2017). We could trace the existing gaps to the impacts of colonialism and neo-colonialism. Despite pre-pandemic commitments by both Global North and Global South nations to work toward mitigating these equity gaps, prevailing disparities continue to widen since the outbreak of COVID-19. For example, many countries in the Global North are at the moment receiving their booster doses compared to nations in the Global South who are yet to get their first shot of the COVID-19 vaccine. These disparities raise the question: Is global prioritization of health equity conditional on a state of non-emergency? Are we close to achieving global health equity, or will the inequality gaps continue to grow as COVID-19 monopolize global concern?
Pandemic-exacerbated health inequities
In most cases, low-income countries in the Global South feel the effects of the pandemic-exacerbated inequities more than wealthy countries in the Global North. For instance, the already limited infrastructural development in health sectors of various Global South countries has slowed during the pandemic, if not halted, due to a lack of funds to finance projects that could save the citizenry from likely outbreaks of diseases—including COVID-19 mutations (United Nations, 2021). Many Global South nations continue to lose revenue from their ports of entry as borders remain closed to prevent foreign nationals from entering in a bid to contain the novel coronavirus. The lack of vaccine availability and people’s reluctance to get a vaccination have also prevented many people in these developing nations from receiving a full course of vaccination. Due to the fragile nature of existing and underfunded health systems, these low and middle-income countries (LMICs) suffer from other infectious diseases that can cause morbidity and mortality.
The negative impacts of the pandemic on economies and health systems are not limited to the Global South. As nations in the Global North see their vaccination rates rise, they begin to consider plans for “reopening,” a term that has come to represent the hope of returning to semi-normal life for Global North citizens. How normal will this “new normal” be, though, if citizens cannot travel freely around the world as they once did for work and leisure in pre-pandemic times? How will international relations thrive if travel for diplomatic or trade purposes is no longer possible? It takes the migration of only one infected individual to shut down this fragile sense of normalcy and launch the Global North back into lockdown.
A second option exists: reprioritize equity as a critical component of the pandemic response so that the world can return to business as usual, with international travel and trade proceeding with some semblance of normalcy. While this hopeful reality is undoubtedly the better option, in our opinion, work is required to see it come to fruition. To improve in this area, we must acknowledge areas where the world struggles to prioritize equity in the current pandemic climate.
In what ways are we struggling to uphold commitments to equity?
Public Health Ontario postulates that “health equity is created when individuals have the fair opportunity to reach their fullest health potential. Achieving health equity requires reducing unnecessary and avoidable differences that are unfair and unjust” (Public Health Ontario, 2021). It is clear from the aforementioned problems experienced by the Global South that the world has not yet achieved global health equity. What is missing from our global pandemic response that would put the metaphorical equity train back on track? We propose four steps that must occur for equity to be prioritized during the pandemic:
(1) A paradigm shift to acknowledge our current world as a “global village.
The discipline of global health centers on health issues with global impact that can be successfully tackled through a global lens (Chen et al., 2020). This definition implies that an all-hands-on-deck approach to problem-solving is required in which every nation assists and is assisted in ethically sound, innovative ways. The outbreak of diseases within a nation can travel across the globe in hours; hence, if one nation suffers, the world suffers. The Omicron variant that first spread across the African continent is now sweeping across Ontario-Canada and other parts of the world, already demonstrating the ripple effect that foreign-originating variants inevitably have on the advanced world. Many Global North countries have revised their public health protocols, including imposing travel restrictions that invariably affect Global North economies. These restrictions are a wake-up call for leaders in the Global North that, until the Global South receives high vaccination rates close to those of the Global North, COVID-19 would continue to derail the pre-pandemic progress made toward health equity. The genesis of the novel coronavirus and its rapid spread throughout the world should remind global leaders that we now live in a global village.
(2) A surrender of power on the part of the Global North
Global health experts have written about the adverse effects of power dynamics on global development efforts (Shiffman, 2014). The pandemic has revealed new ways in which the Global North holds power and wields it, perhaps but certainly not always unwittingly, over the Global South. For instance, many countries in the Global South cannot produce their own vaccines due to the absence of intellectual property rights and inadequate expertise to commence local production capacity (Cusmano & Raes, 2020). Not only did this dismissal deny Global South countries from the revenue they would have made from the sale of vaccines, but now Global South nations face the task of acquiring Global North-approved vaccines at high costs to ensure that their citizens can travel for sightseeing and medical checkups (Cusmano & Raes, 2020). The import of approved vaccines diverts funds from infrastructure projects that could further improve local health and well-being, exacerbating observed health disparities.
How can equity be achieved when so much power lies in the hands of the Global North that breeds unfair and unjust conditions experienced by the Global South? The Global North must recognize its role in perpetuating these inequities and make efforts to share the power it has historically held over opportunities for economic success and socio-political recognition of innovation and leadership in the Global South.
(3) Empowerment of the Global South
The natural next step following recognition of ongoing biases in the provision of equal opportunities to countries of the Global South for leading in its strengthening is for substantial moves by power holders to step aside and open up space for fuller participation by Global South actors in transforming existing inequities. Standards of measuring health systems, medicines and vaccines, equipment, human resources, and other machinery developed in the Global North are often relied on to evaluate systems in the Global South. This reliance makes it difficult for Global South nations to thrive without depending on the developed world for support and direction, which could make the citizenry distrust their innovations. Although innovations exist in the Global South, their legitimacy and recognition appear to be limited. This lack of legitimacy seems to be a long-standing problem that reproduces Global North’s dominance expertise, authority, and superiority. For a power rebalance to occur, the world must recognize the Global South for the expertise its citizens can offer, including the Global South itself. By this approach, the Global North and Global South can collaborate and fight against COVID-19 through technology transfer from the Global North and local expertise and labour from the Global South. As a global village, we thrive on collaborative ideas that benefit all. These ideas can come from anywhere in the world, and through a broader buy-in, we would succeed in reducing the existing equity gaps in global health.
(4) Sharing of resources between the Global North and South
Similarly, the Global North must share its material resources and innovations, especially vaccines, with the Global South. As citizens of the Global North line up to receive their third dose of a travel-approved vaccine, many in the Global South await the opportunity for a life-saving first. Given the extrapolation that COVID-19 vaccines would reach the Global South by 2023 (Padma, 2021), the Global North should consider the plight of those living in Global South nations. We fear the worst is yet to be seen among developing countries concerning rates of morbidity and mortality due to COVID-19. These rates would not remain isolated in LMICs. The hoarding of vaccines and personal protective equipment (Towey, 2021)—often past the point of reasonable use or expiry (Cohen, 2021; Mlaba, 2021)—observed in the Global North must stop for the world to achieve a universally protected population.
A challenge to remain steadfast in our pursuit of equity
While it is easy to view the COVID-19 pandemic as a barrier to equity, we instead see an opportunity for supremacy. While the lack of precedent on how to proceed makes the future uncertain, humanity has come a long way since its last pandemic over 100 years ago. We now know that human rights and social justice matter, and if nothing else, international buy-in to the United Nation’s Sustainable Development Goals provides evidence that many of the world’s nations want to see global health equity achieved, even when putting this work into practice seems an impractical task. The next step for a world vocalizing desire for change is this: Put your money where your mouth is, “unprecedented times” justify unprecedented responses, and a global pandemic requires a global solution. By reframing our thinking to view the world as a global village, encouraging a surrender of power from the Global North, empowering the Global South to respond to local health challenges, and pooling Global North and Global South resources, ideas, efforts, and expertise, not only will we bridge gaps left in the wake of the pandemic, but will set a new precedent for how we approach global health problems in non-pandemic conditions. If we can prioritize equity in a crisis, then we can undoubtedly prioritize it in a time of prosperity.
So, the question remains: Can global health equity gaps be bridged during a global pandemic? Our answer to this question is a vehement yes if nations in the Global North and the Global South are prepared to collaborate as equals, acknowledging one another as partners in achieving global equity goals and prioritizing these even—and we argue, especially—in times of emergency.
References
Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The root causes of health inequity. In Communities in action: Pathways to health equity. National Academies Press (US).
Chen, X., Li, H., Lucero-Prisno, D.E. et al. (2020). What is global health? Key concepts and clarification of misperceptions. Global Health Research Policy 5 (14). https://doi.org/10.1186/s41256-020-00142-7
Cohen, R. (2021, February 09). COVID vaccines: rich countries have bought more than they need – here’s how they could be redistributed. https://theconversation.com/covid-vaccines-rich-countries-have-bought-more-than-they-need-heres-how-they-could-be-redistributed-153732
Cusmano, L., & Raes, S. (2020). OECD Policy Responses to Coronavirus (COVID-19); Coronavirus (COVID-19): SME policy responses. Retrieved from OECD Better Policies for Better Lives: http://www. oecd. org/coronavirus/policy-responses/coronavirus-covid-19-sme-policy-responses-04440101/# section-d1e160.
Mlaba, K. (2021, December 17). Why Are African Countries Throwing Away COVID-19 Vaccines? https://www.globalcitizen.org/en/content/african-countries-throwing-away-covid-19-vaccines/
Padma, T.V. (2021, July 05). COVID vaccines to reach poorest countries in 2023 — despite recent pledges. https://www.nature.com/articles/d41586-021-01762-w
Public Health Ontario. (2021). Health Equity. Public Health Ontario. https://www.publichealthontario.ca/en/health-topics/health-equity.
Rajasekaran, V. (2021, February 12). A lack of vaccines in the global south worsens inequality. https://policyoptions.irpp.org/magazines/february-2021/a-lack-of-vaccines-in-the-global-south-wors-ens-inequality/
Shiffman, J. (2014). Knowledge, moral claims and the exercise of power in global health. International journal of health policy and management, 3(6), 297–299. https://doi.org/10.15171/ijhpm.2014.120
Towey, R. (2021, September 07). WHO criticizes wealthy nations for hoarding Covid treatments and vaccines, saying it’s prolonging pandemic. https://www.cnbc.com/2021/09/07/who-says-wealthy-nations-are-prolonging-pandemic-by-hoarding-covid-treatments-and-vaccines.html
United Nations. (2021). Developing Countries Need More Financial Aid, Influence in Multilateral Institutions to Overcome Economic Devastation from COVID-19, Speakers Tell General Assembly. https://www.un.org/press/en/2021/ga12366.doc.htm
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