On Privilege and the COVID-19 Vaccine
By: Alyssa Arbuckle
Tags: Vaccines, Privilege, Canada, Covid 19

Over the past few days provinces across Canada have received their first shipment of the Pfizer COVID-19 vaccine. Healthcare workers and seniors are first in line, and, although rollout plans differ from province to province, it is anticipated that these communities will (rightly) be prioritized from now until the springtime. If things go to plan — as if anything has gone to plan in 2020, but still — the general population beyond these critical groups will be able to be vaccinated starting in late spring / early summer 2021… if they so choose.

Canada is a democratic country, and among other mores and laws this means that the government does not force the citizenry to do things like get vaccinated against the COVID-19 virus. We are a country of strong recommendations and we welcome you to participates. Vaccination is optional.

Informed, autonomous decision-making is a critical tenant of the way this country governs itself, and the way its citizens live their daily lives. The opportunity for autonomous decision-making around the COVID-19 vaccine also means that many will opt to not get vaccinated. Curiously to me, I have even heard this resistance expressed by members of my own community who are (full disclosure) generally pro-science, pro-vaccination, pro-equity, and overall progressive individuals.

I recognize that this is, partially, a fear-based response. Since the vaccine is so new, we necessarily cannot know for certain what its long-term effects are. We don’t know whether the vaccine causes infertility, or breast cancer, or some other future health challenge. Similarly, since COVID-19 is also a “young” virus, we don’t really know what its long-term effects are, either. But we do know the short-term effects, and that these effects can be immensely difficult (see: long periods of isolation, months-long brainfog, persistent respiratory illness) if not outright deadly. As I write, it has claimed nearly 1.7 million recorded lives already.

As a researcher who pays very close attention to the Open Access and Open Science movements, I can say with certainty that we are witnessing an absolutely unprecedented international collaboration to address COVID-19. Top researchers across disciplines and around the world are studying every aspect of the virus, its consequences, and elements of its solution. Scientists, pharmaceutical companies, and policymakers, among many others, have been exchanging information openly and persistently in what I can only hope is the model for the future.

So no: we don’t know what the vaccine’s long-term effects are for sure. But if the very best immunologists, pharmacologists, and epidemiologists in the world have been working on getting this right, and sharing their data and findings at unprecedented rates, I trust them. I trust them, because I trust in the scientific endeavour, and I understand that it necessarily involves a degree of unknowability. That is the nature of the research beast.

To move past this personal thumbs up for science, I want to focus on the equity issues that are intertwined with the rollout of and access to COVID-19 vaccines. There are personal and local equity issues: it is easy for people to grasp, I think, that a refusal to get vaccinated means they are potentially endangering a dear friend or family member who is immunocompromised and unable to take the vaccine. Where I live in Vancouver BC there has also been significant recognition of how COVID-19 has disproportionately affected marginalized groups from the very beginning of the pandemic. The cracks in our communities are getting wider as we’ve watched COVID-19 sweep through the Downtown Eastside over the past few months — colloquially known as “Canada’s poorest postal code” — or we compare data on who exactly are frontline workers, broadly considered (and thus most at risk for infection). Spoiler alert: they’re women, and people of colour, and those who embody the intersection between these identity groups. The pandemic has been especially crushing to our substance-using population who have been experiencing overdoses and death by overdose at an absolutely damning rate over the last year. Less vaccination = more COVID, until we get anywhere close to so-called “community immunity.” And more COVID = more inequity.

Broadening out from my own local context, however, COVID-19 vaccination is a significant concern from a global equity perspective. Canada has secured a mass amount of vaccine; according to a recent Global News article by Hannah Jackson, “the country has more than 400 million doses of coronavirus vaccines on order from a number of different trials, some of which are still ongoing.” With 2 doses per person required, this means that Canada has ordered over 5x what is needed for our population. (There are reasons behind this strategy, and that’s the subject for another post.) But Canada is absolutely the exception, not the rule. There are relatively few countries who have successfully secured vaccinations for their entire population; and Canada joins the ranks of Russia, the United Kingdom, and the United States in being able to vaccinate so quickly, and at such scale. Not bad for a country of only 37 million inhabitants.

But not only have relatively few countries successfully secured vaccinations for their entire population; many are nowhere near this capacity. Croatia recently announced that they have been able to secure 5.6 million vaccine doses, which will provide inoculation for just over 65% of their population of 4.1 million people. According to a recent article by the CBC, Sudan will receive vaccinations for 20% of their population; a report by Bloomberg on December 4 indicates that South Africa has claims to vaccinations for just 10% of their country. Access to the Sudanese and South African vaccine doses are being made possible through the COVAX program.[1] For the first half of 2021, Ukraine hopes to secure 8 million units of COVID-19 vaccine, according to a Reuters post. Since each person requires 2 doses, this means Ukraine can inoculate 4 million people. Ukraine has a population of 42 million people; to do some quick math for you, this means that, at the time of writing, Ukraine will be able to vaccinate less than 10% of their population.

Although it has been roundly claimed that vaccines will go to frontline workers and vulnerable communities first, the proof will be in the pudding. History shows us that limited lifesaving resources tend to go to those who can bid the highest. (And I hope, desperately, that my cynicism here is misplaced.)

To clarify, the percentages I quoted above are starting numbers: ideally, as production ramps up there will be much more vaccine available. It is also promising to see that companies like Moderna have committed to not enforcing vaccine patents against other companies. Such a commitment means that other production facilities around the world can undertake their own manufacture rather than purchasing units from the leading pharmaceutical companies, which may well be at a price point beyond what is tenable for them. (For the absolute urgency of pharmaceutical companies not pursuing patents on the COVID-19 vaccine, I’d recommend reading up on the disputes between the South African government and Big Pharma companies that held HIV medicine patents in the 1990s.)

So why should this matter to you, dear privileged Canadian reader who will have access to vaccine within 6 months, if not sooner? It should matter to you because COVID-19 has reminded us yet again that we are part of a global community and a global economy. The decisions we make matter, and they affect people in various parts of the world. Countries that are unable to vaccinate a majority of their population will continue to see steep declines in lives and livelihoods. There will be major economic ramifications if those who are unvaccinated are unable to travel for work, for instance. Think of how damaging this will be to a South African researcher who needs to attend a conference in New Zealand, or a Ukrainian trader whose key business is in Brussels. There will be major social ramifications, too, as the unvaccinated will not be able to reunite with friends and family. The rest of the world will move on, but these people won’t.

And all of those unvaccinated North Americans? You can bet they are not canceling their Mediterranean cruises in Croatia, regardless of the fact that they could bring undetected COVID-19 virus to an under-vaccinated country. You can bet they’re not skipping that sojourn to Italy, even when they might be passing through Heathrow at the same time as a group of Sudanese delegates. You can also bet that they will not be traveling to countries with exceptionally low immunization rates, and that their tourist dollars will flow elsewhere. There is no way for us to safely reopen only half of the world and continue the international travel that so many have become accustomed to or rely on for their own livelihoods. The (voluntarily) unvaccinated will infect the (never-had-the-option) unvaccinated, again and again. Undoubtedly, as global travel picks up again, countries without substantial vaccination programs will see outbreaks that throw them back into restrictions and lockdowns.

Bear in mind, as you consider whether or not to get vaccinated this year: the world will look on at the immense privilege it is to be a Canadian who is saying no to a lifesaving vaccine, even when it is more than just one’s own life that needs to be saved. If you consider yourself a progressive person who is committed to global equity: I ask that you look at your role in this larger system, and reflect on how you can be an agent for the collective good. Even if it potentially comes at some personal risk.

[1] For a nuanced consideration of COVAX and particularly the affect it may have on African countries, see Laura Lopez Gonzalez’s recent Al Jazeera article: https://www.aljazeera.com/features/2020/11/17/coronavirus-vaccine-how-will-poorer-countries-get-a-fair