BY SACHINI PERERA
Covid-19 has laid bare the worst of neoliberal capitalism and the depth of inequalities and injustices in the world we live in. The links between the pandemic and our sexual and reproductive rights are not hard to fathom and are being documented and discussed in various ways. However, other aspects of Covid-19, especially the current global conversation on the vaccine, are bringing up opportunities for intersectional cross-movement solidarity that acknowledge and address the fact that health and sexual rights are intertwined with economic rights. It is also showing uncomfortable gaps in our own accountability in Sexual and Reproductive Health and Rights (SRHR) movements.
Vaccines, a cornerstone of public health, are also very much an industry, and come with a number of challenges around accessibility, affordability, acceptability, inequity, etc. that are symptomatic of capitalist industrialization. Those of us working in and advocating for SRHR are familiar with these challenges and the absurd realities they produce. For example, the global distribution of the HPV vaccine is so inequitable that the World Health Organization “has recommended that wealthy countries temporarily stop expanding their vaccinating campaigns to cover boys, so other nations can focus at least on covering young girls.”
While there were early signs that the urgent, critical and global nature of Covid-19 would preempt and prevent such inequalities in the distribution and administration of the vaccine, it has instead turned into what the Director General of the World Health Organisation (WHO), Dr Tedros Adhanom Ghebreyesus, has called “the brink of a catastrophic moral failure.” In a recent speech he remarked that “More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.” As this article goes into publication, the bid by South Africa and India to the WTO to waive patents for Covid vaccines is being blocked by rich and powerful countries including the US, Canada, UK, and the European Union. Add to this misinformation about inoculation (often based on neoliberal ideas of the self and freedom and arguably further driven by the attention economy of social media), and it is a perfect storm we are contending against.
How does SRHR fit in with Covid-19 and vaccines?
In broad strokes, Covid-19, as with SARS, Zika and others in the past, has implications on sexual and reproductive health and rights and our call for SRHR for all is, and must be, a call for Universal Health Coverage for all.
Many feminist and SRHR advocates, including RESURJ members, have been collecting and documenting evidence to this end and advocating for Covid-19 responses that take into account sexual and reproductive rights. However, when applying a justice framework that considers the economic dimensions related to the violations and realizations of SRHR, it is clear that these linkages run deeper.
While the privatization and cost of healthcare and medicine remain a key concern for SRHR and other health rights advocates, vaccines occupy a liminal space in this landscape because while essential, they are not profitable given that a person needs only one or two doses in their lifetime. Therefore, the incentives and funding/subsidies for discovering and producing vaccines are led by governments so that pharmaceutical companies can maintain a satisfactory profit margin, including by securing copyrights and patents. This means vaccines are usually produced through public private partnerships (PPP’s) that are most often designed to advantage profit over rights. Resulting in the kind of inequitable distribution and access mentioned earlier, whether it is the HPV vaccine or Covid-19. Or the kinds of disputes and rhetoric of “vaccine nationalism” that are emerging between the European Union and AstraZeneca that not just show power struggles between states and corporations but also could put the global south and developing countries in a precarious position depending on the outcome of such disputes. As noted by Dr. Tedros, “Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue. This is wrong.”
All of this shows that it is urgent and essential that SRHR and other health rights movements build a strong analysis on macroeconomics and trade in our advocacy and build cross-movement solidarity and learning with those embedded in economic justice movements. Especially those calling to resist neoliberal capitalism through their work on intellectual property rights, corporate accountability, technology and technology transfer, tax justice, and financing for development. It is heartening that there are groups who have been building these relationships and analyses over the years. We must be particularly cognizant of the negative precedents that the Covid-19 vaccine will set for health as a right and its impact on the progress made so far on Universal Health Coverage.
In other words, if there has ever been a moment for SRHR movements to become staunchly anti-capitalist and justice-oriented then this is it.
This brings me to the “uncomfortable gaps in our own accountability in SRHR movements” that I referred to earlier. If the achievement of SRHR is intrinsically intertwined with economic rights as well as the resistance of neoliberal capitalism then we need to stop allowing capitalist interests to shape and dictate our work, priorities and resources. A very topical example is the intervention by the Bill and Melinda Gates Foundation that resulted in the University of Oxford changing its initial position to donate the rights to its coronavirus vaccine to any drugmakers who want to make it. This initial position could have introduced a paradigm shift in how the pharmaceutical industry approaches vaccines and other essential medicine and in how intellectual property regimes often block access to free and affordable medicine. However the intervention by the Gates Foundation resulted in the university signing “an exclusive vaccine deal with AstraZeneca that gave the pharmaceutical giant sole rights and no guarantee of low prices—with the less-publicized potential for Oxford to eventually make millions from the deal and win plenty of prestige.”
Analysis of this intervention by the Gates Foundation shows that it sits very much at the intersection of the influence and vested interests Bill Gates has over vaccines and the pharmaceutical industry and his “ideological belief that the intellectual property system is a wonderful mechanism that is necessary for innovation and prosperity.” The capitalist underpinnings and objectives of his philanthropy (as with many other philanthropists and donor organizations) and his undue influence on policy making have been investigated and documented in the past too. These latest interventions are resulting in what some activists are calling a ‘vaccine apartheid’.
So how does our accountability as SRHR advocates feature in this? I don’t need to explain to SRHR advocates the influence the Gates Foundation has over our movements and a cursory look at the foundation’s list of grantees confirms this. The foundation allocates a considerable amount of resources into SRHR, especially contraception and family planning, and this financial influence is very much connected to an ideological influence that is rooted in capitalist values. If our advocacy for SRHR is to take into account the economic realities and challenges of our lives, we need to critique and challenge Bill Gates and other capitalists who work on SRHR, and provide genuine solidarity to economic justice movements. Efforts like COVAX (a model that may not even be as equitable as it claims or aims to be) by the WHO are attempting to ensure equitable distribution of the Covid-19 vaccine, especially to countries in the global south. Still, it is important that we consider the current developments and decisions around the Covid-19 vaccine within the larger context of how health and economic rights converge. It is our responsibility to ensure that SRHR is not resourced at the expense of maintaining the capitalist status quo.
Shedding corporate and capitalist shackles on SRHR is easier said than done. Ever increasing hostility and restrictions against human rights activism, shrinking funds as well as backtracking by so many governments on their SRHR obligations all create an environment in which we have little choice in how we resource our work. The tragi-comedy of nonprofit work is that most often the same structures and institutions that we rally against are also connected to how we get funded to do such rallying. However, Covid-19 and the vaccine could be a moment of reckoning to consider and push forward economic justice in our work and movements.