Social & Economic Inequalities

Photo by: Clay Banks (Unsplash)

 

Global herd immunity remains out of reach because of inequitable vaccine distribution – 99% of people in poor countries are unvaccinated

 

In the race between infection and injection, injection has lost.

Public health experts estimate that approximately 70% of the world’s 7.9 billion people must be fully vaccinated to end the COVID-19 pandemic. As of June 21, 2021, 10.04% of the global population had been fully vaccinated, nearly all of them in rich countries.

Only 0.9% of people in low-income countries have received at least one dose.

I am a scholar of global health who specializes in health care inequities. Using a data set on vaccine distribution compiled by the Global Health Innovation Center’s Launch and Scale Speedometer at Duke University in the United States, I analyzed what the global vaccine access gap means for the world.

A global health crisis

Supply is not the main reason some countries are able to vaccinate their populations while others experience severe disease outbreaks – distribution is.

Many rich countries pursued a strategy of overbuying COVID-19 vaccine doses in advance. My analyses demonstrate that the U.S., for example, has procured 1.2 billion COVID-19 vaccine doses, or 3.7 doses per person. Canada has ordered 381 million doses; every Canadian could be vaccinated five times over with the two doses needed.

Overall, countries representing just one-seventh of the world’s population had reserved more than half of all vaccines available by June 2021. That has made it very difficult for the remaining countries to procure doses, either directly or through COVAX, the global initiative created to enable low- to middle-income countries equitable access to COVID-19 vaccines.

Benin, for example, has obtained about 203,000 doses of China’s Sinovac vaccine – enough to fully vaccinate 1% of its population. Honduras, relying mainly on AstraZeneca, has procured approximately 1.4 million doses. That will fully vaccinate 7% of its population. In these “vaccine deserts,” even front-line health workers aren’t yet inoculated.

Haiti has received about 461,500 COVID-19 vaccine doses by donations and is grappling with a serious outbreak.

Even COVAX’s goal – for lower-income countries to “receive enough doses to vaccinate up to 20% of their population” – would not get COVID-19 transmission under control in those places.

The cost of not cooperating

Last year, researchers at Northeastern University modeled two vaccine rollout strategies. Their numerical simulations found that 61% of deaths worldwide would have been averted if countries cooperated to implement an equitable global vaccine distribution plan, compared with only 33% if high-income countries got the vaccines first.

Put briefly, when countries cooperate, COVID-19 deaths drop by approximately in half.

Vaccine access is inequitable within countries, too – especially in countries where severe inequality already exists.

In Latin America, for example, a disproportionate number of the tiny minority of people who’ve been vaccinated are elites: political leaders, business tycoons and those with the means to travel abroad to get vaccinated. This entrenches wider health and social inequities.

The result, for now, is two separate and unequal societies in which only the wealthy are protected from a devastating disease that continues to ravage those who are not able to access the vaccine.

A repeat of AIDS missteps?

This is a familiar story from the HIV era.

In the 1990s, the development of effective antiretroviral drugs for HIV/AIDS saved millions of lives in high-income countries. However, about 90% of the global poor who were living with HIV had no access to these lifesaving drugs.

Concerned about undercutting their markets in high-income countries, the pharmaceutical companies that produced antiretrovirals, such as Burroughs Wellcome, adopted internationally consistent prices. Azidothymidine, the first drug to fight HIV, cost about US$8,000 a year – over $19,000 in today’s dollars.

That effectively placed effective HIV/AIDS drugs out of reach for people in poor nations – including countries in sub-Saharan Africa, the epidemic’s epicenter. By the year 2000, 22 million people in sub-Saharan Africa were living with HIV, and AIDS was the region’s leading cause of death.

The crisis over inequitable access to AIDS treatment began dominating international news headlines, and the rich world’s obligation to respond became too great to ignore.

“History will surely judge us harshly if we do not respond with all the energy and resources that we can bring to bear in the fight against HIV/AIDS,” said South African President Nelson Mandela in 2004.

Pharmaceutical companies began donating antiretrovirals to countries in need and allowing local businesses to manufacture generic versions, providing bulk, low-cost access for highly affected poor countries. New global institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria were created to finance health programs in poor countries.

Pressured by grassroots activism, the United States and other high-income countries also spent billions of dollars to research, develop and distribute affordable HIV treatments worldwide.

A dose of global cooperation

It took over a decade after the development of antiretrovirals, and millions of unnecessary deaths, for rich countries to make those lifesaving medicines universally available.

Fifteen months into the current pandemic, wealthy, highly vaccinated countries are starting to assume some responsibility for boosting global vaccination rates.

Leaders of the United States, Canada, United Kingdom, European Union and Japan recently pledged to donate a total of 1 billion COVID-19 vaccine doses to poorer countries.

It is not yet clear how their plan to “vaccinate the world” by the end of 2022 will be implemented and whether recipient countries will receive enough doses to fully vaccinate enough people to control viral spread. And the late 2022 goal will not save people in the developing world who are dying of COVID-19 in record numbers now, from Brazil to India.

The HIV/AIDS epidemic shows that ending the coronavirus pandemic will require, first, prioritizing access to COVID-19 vaccines on the global political agenda. Then wealthy nations will need to work with other countries to build their vaccine manufacturing infrastructure, scaling up production worldwide.

Finally, poorer countries need more money to fund their public health systems and purchase vaccines. Wealthy countries and groups like the G-7 can provide that funding.

These actions benefit rich countries, too. As long as the world has unvaccinated populations, COVID-19 will continue to spread and mutate. Additional variants will emerge.

As a May 2021 UNICEF statement put it: “In our interdependent world no one is safe until everyone is safe.”

 

 

By               :          Maria De Jesus (Associate Professor and Research Fellow at the Center on Health,                                                                      Risk, and Society, American University School of International Service)

Date            :         June 22, 2021

Source        :          The Conversation

https://theconversation.com/global-herd-immunity-remains-out-of-reach-because-of-inequitable-vaccine-distribution-99-of-people-in-poor-countries-are-unvaccinated-162040

 

Inequalities Are Shaping How We’re Fighting the Pandemic — And How We’ll Remember It

 

Covid-19 infections in most countries have been hugely underestimated — not least because rich countries bought almost all the tests.

The first wave of the 1918-19 influenza pandemic did not have much impact in India; it was the second wave that was the most devastating.

It is now thought that 12 million people died in India during the flu pandemic, the equivalent of 4 percent of the population at that time. Most of these deaths were concentrated in a few short months from September to December 1918. This quote is from Punjab’s sanitary commissioner at the time:

“The hospitals were choked so it was impossible to remove the dead quickly enough to make room for the dying….; the burning ghats (cremation site) were literally swamped with corpses; the depleted medical service, was incapable of dealing with more than a minute fraction of the sickness requiring attention.”

Yet amazingly this incredible event was barely recorded. While photographic images are widely available for the 1918-19 flu pandemic in Europe, the United States, and the UK, there are virtually no such images for India.

A century later, another deadly pandemic is sweeping India, and watching our screens it feels like the only thing that has changed from a century ago is that the impact of coronavirus in India is not hidden; it is on 24-hour news across the world. The Covid-19 pandemic is many terrible things, but unlike the 1918 flu, it at least seems to be being clearly recorded and understood across the world.

Yet in fact I think this is far from the case. Instead, brutal historical and existing inequalities are not just shaping how we fight this pandemic but how we are recording it and how we will remember it too.

Twenty years before influenza hit India, there was an outbreak of bubonic plague. While it did not take nearly as many lives, it was still very serious. Unlike the influenza epidemic, there is a relatively strong photographic and written record of this outbreak. So why no pictures of the influenza pandemic?

One of the obvious differences was that, unlike the flu, other countries were not impacted by India’s bubonic plague. I think part of the reason events in India today are getting so much coverage in the Western press is probably because widespread vaccination in rich nations has meant Covid deaths at home have collapsed to very low levels.

Perhaps events in India are so terrible that they would have broken through even during the height of the coronavirus pandemic in the United States and Europe. Yet the pandemic has been as bad in Latin America from the beginning as it has been India, but this has barely registered. Queues for oxygen, overwhelmed graveyards, deaths on the street, privatized health systems leaving the poor to die — all have been pretty much a constant in Latin America for the last year.

This also says a lot about our colonial ties and historic connections. That news from Latin America barely registers time and again is partly because of a linguistic and cultural gap that itself is a product of colonialism.

The other main similarity with the influenza pandemic is something that is perhaps the ultimate inequality: lives and deaths that are not even recorded at all. The official numbers of those testing positive for Covid-19 in most countries have been hugely underestimated — not least because rich countries bought almost all the tests. In Kenya, the government is still testing about 3,000 people a day, and tests cost as much as $100. The UK is testing a million people a day.

The Economist magazine estimates that the true death toll from Covid-19 so far is more like 10 million people, not 3 million, and that two thirds of these deaths have not been in rich nations but in poor and middle-income countries. In Egypt, the level of excess deaths (the difference in the total number of deaths in a crisis compared to those expected under normal conditions) is 13 times the number of official deaths from Covid-19. Yet the story of the last year has been dominated by deaths in rich nations, and the history of the first year of this pandemic is likely to be so too.

This inequality in reporting and measuring, leading to the sense that this pandemic was not very serious in the developing world over the last year, has in turn had a major impact on the response. The drive to get vaccines to the developing world has been criminally inadequate and continues to be so.

The scenes in India, in contrast to a rich world now rapidly heading towards full vaccination, are only now finally making the issue of global vaccine apartheid and the suffering in developing countries bigger news.

Part of the reason the dramatic scenes in India are getting more coverage is in turn a result of inequality. It is because they are happening in Delhi, where global media outlets have their correspondents, and the middle classes are being impacted so tragically. The huge suffering of the poorest and of those in the countryside where there is literally no hope of any medical care of any substance is once again being barely recorded — just as it was in 1918. Independent epidemiologists believe India could be seeing not the official 4,000 deaths a day but in fact as many as 32,000.

Without hard facts, the void is filled by anecdotes and personal stories. It seems likely to me, for instance, that coronavirus is also raging across Kenya as we speak and is probably more serious now than at any point in the last year — not because the official numbers show this, but simply by the number of people I know who have lost loved ones or been sick themselves in recent weeks and months.

When my friend Doreen died suddenly and tragically from Covid-19 earlier this year, I found out by WhatsApp. I woke up one morning and sent a message to her husband Stuart to see how she was doing. Only the day before her oxygen levels had been stable and things were looking positive. Stuart’s reply was short and devastating: “Max she is no longer with us.”

I was reminded of this this week when I heard from colleagues and friends in India. They said every morning they dread switching on their phone for fear of seeing messages about friends who have died in the night. It made me reflect on the many thousands of heart-breaking messages being sent each day, each one bringing with it sadness, loss, rage, and disbelief. Beyond the selective headlines, maybe it is this most personal and intimate communication that is in some ways the more accurate record of this terrible moment in our history.

There is no doubt that Covid-19 is a huge global trauma, operating on a personal, family, community, national, and global scale all at once. Its ramifications and implications will be felt for decades to come. In her book on the 1918 influenza pandemic, Pale Rider, the author Laura Spinney asks how we can have forgotten the most lethal episode of the 20th century. I don’t think there is the same danger of humanity forgetting Covid-19.

But I do think that inequalities in the way we measure and record this pandemic have direct implications for how it is understood at the time, how it is responded to, and how it will be remembered.

And it is frightening to think that after all the world has been through in the last year, that unless something dramatic changes, most deaths from Covid-19 are yet to come. A year ago, the main barrier to beating this cruel disease was science. Today it is inequality.

 

Max Lawson is Head of Inequality Policy at Oxfam International.

 

By                   :                      Max Lawson 

Date               :                      June 7, 2021

Source           :                      Inequality.org 

https://inequality.org/research/inequality-pandemic-developing-countries/

 

There a lack of female home ownership in Latin America – here’s how can we change this

 

  • Female home ownership in the developing world is a critical issue, writes the International Finance Corporation VP Georgina Baker.
  • It affects both living conditions and women’s ability to build and grow their own businesses.
  • In Central America, less than 40% of women have access to a bank account, and only 6% have taken out a mortgage.
  • Baker explains why that's a problem and what needs to be done to change it.

For people in the developed world, a mortgage is a step toward owning a home. In developing countries, that dream is often elusive—especially for women.

Female home ownership in the developing world is a critical issue: it not only has ramifications on living conditions, but in women’s ability to build and grow their own businesses. Accessing formal credit relies heavily on collateral, namely large assets—a house or an apartment—that women often lack but which are essential to building their credit history. In many cases, women also use their homes as the base for their business.

Central America presents a clear example of this challenge. Less than 40% of women in this region have access to a bank account, and only 6% have taken out a mortgage . In comparison, 16% of women in Colombia and 13% of women in India used formal loans to purchase housing, according to a recent IFC study, Her Home—Housing Finance for Women.

These gender disparities limit women’s financial capacity and business growth opportunities. Women demonstrate greater educational performance and positive traits (such as lower default rates on their bank loans) as banking clients, but they remain woefully underserved by the financial sector. Women-owned businesses have less access to commercial loans because they tend to be part of the informal sector and therefore lack the proper documentation—for example, proof of income or real estate collateral—required to access financial services. Central America needs to break down this barrier to make its growth more inclusive and to continue reducing inequality.

With this in mind, IFC (the private sector arm of the World Bank Group), recently pioneered a new partnership with Global Bank in Panama to launch the first ever mortgage product targeted specifically toward women . The aim is to create opportunities that will tackle the two interconnected issues of housing finance for women and supporting women-owned businesses. The initiative will address the fact that women-owned businesses in Panama currently have less access to loans because they lack the real estate collateral that financial institutions require.

With one of the largest and most stable financial sectors in the region, this initiative in Panama will show the commercial viability of promoting financial products and services for women to become homeowners and use this as a gateway to receive loans to finance their businesses. This could potentially be a solution that developing economies in Latin America and other regions could replicate to expand access to capital for women entrepreneurs.

The financial sector could also stand to benefit as female homeownership is an untapped business opportunity. Despite the hurdles that women face, there is a large unmet demand for housing finance for women-headed households, particularly in developing countries . IFC’s latest study on women’s access to home ownership—covering Colombia, India, and Kenya— confirms that the women’s housing finance market is more than $70 billion in these three countries alone.

In the one of Panama’s neighboring countries, Colombia, the estimated market size for women’s housing loans is $23 billion, and 49% of women who participated in a survey planned to purchase a home or make home improvements in the next five years. While women make up half of the population, only a small fraction of them are property owners. In fact, only 8% of female-headed households in Colombia applied for a housing loan in the last five years.

Colombia is trying to address this challenge. The country started putting in place initiatives to offer subsidized interest rates for a lower income segment of the population, which includes female-headed households. In another example, India’s “Housing for All,” a Credit Link Subsidy program, provides a subsidy if a woman is on the registered title.

Latin America is also well positioned to start adopting innovative housing finance products and services geared toward women . This way, the banking sector can tap into a large underserved market and add value to their bottom line while contributing to the growth of the housing sector. The positive impacts could be widespread: for the banks, these initiatives help to attract and retain women as retail customers, while also supports women-owned businesses and thus promoting and inclusive economic growth. It’s time for women to own a home and turn their dream into a reality.

 

By                            :                        Georgina Baker (Vicepresidente, IFC para Latinoamérica)

Date                        :                         May 4, 2021

Source                    :                         World Economic Forum 

https://www.weforum.org/agenda/2021/05/women-latin-central-america-housing-houses-poverty-change-gender/