The world is ill-prepared to respond to threatening public health emergencies. What is most disturbing is how our global leaders continue to lack health equity’s moral and scientific premises. At the beginning of 2020, the novel coronavirus rampaged across the globe, with many officials referring to it as the great equalizer. However, referring to the virus as the great equalizer ignored the history that diseases have always made a preferential option for populations that are marginalized. COVID-19 unveiled social, political, and economic inequities within and between nations. With disparities in testing and vaccine rollout, the COVID-19 pandemic also exposed the monopoly of technology and science.
At the time of this writing, about 187.6 million people are fully vaccinated in the U.S. However, reaching herd immunity will most likely require more time. When observing the trends of vaccinations among racial and ethnic groups, Black and Latinx people received smaller shares of vaccinations compared to their white counterparts despite a greater supply of vaccines in the country. In Washington, D.C., Black people received 42% of vaccinations despite making up 71% of coronavirus-related deaths and 46% of the total population. There are multiple factors contributing to the disparities in vaccine distribution. In California, non-white Hispanics account for 40% of the total population, 48% of coronavirus-related deaths, yet only 28% are fully vaccinated against COVID-19. Although there have been efforts to close the racial gap in COVID-19 vaccinations, these trends are concerning, especially with the emergence of the virus variants.
A study found that cases caused by the Alpha variant fell from 70% to 42%, with the rise of the Delta variant driving much of the change. The Delta variant has been reported to be on the rise in the U.S. During a Senate health committee hearing, CDC Director, Dr. Rochelle Walensky, cautioned that the Delta variant now makes up 83% of sequenced samples in the nation. What is more concerning is that more than 97% of the people who are hospitalized from COVID-19 are unvaccinated. As Dr. Anthony Fauci warns about Delta’s hyper-transmissibility, it’s important to note that vulnerable populations continue to be at greater risk of infection. Predominantly South U.S. states are reported to be under-vaccinated. Past studies on health trends in the Mississippi Delta have shown that those communities tend to have high rates of chronic conditions, such as heart disease, diabetes, and obesity. Moreover, as we discuss the under-vaccination in certain states and communities, we must also remember the role of vaccine hesitance and the lack of access to vaccines and other life-saving technology.
The health care system has not been very compassionate towards the well-being of marginalized communities, especially communities of color and those living in poverty. A longstanding history of abuse has contributed to a mistrust of the medical community. Although vaccine hesitancy does play a role, as public health researchers of sociomedical sciences, we encourage a deeper examination of how oppressive laws and policies — redlining, war on drugs, gerrymandering — reproduce inequities that ultimately impact the health of the population. These issues are not reserved locally, just as they’re also not reserved for wealthy nations.
If there are unvaccinated people in the world, SARS-CoV-2 will continue to spread and mutate. According to a New York Times article, India is reported to have more than 300,000 new coronavirus infections a day, setting a world record. Despite having one of the largest vaccine manufacturers, India struggled to produce and distribute vaccines. Moreover, their main challenge has been ensuring that their health care settings were furnished with PPE, oxygen tanks, hospital beds, and ventilators. The demand for these supplies is exponentially high given the daily infections the country is facing. When examining India’s challenges, we begin to recognize the similarities between countries that are deemed to be wealthy and those that otherwise are not. Frailties within the health care system, air pollution, overcrowded cities, and a large population of people living in poverty are realities that existed before the pandemic in India. These public health concerns that were largely ignored by government officials have made the country a lot more vulnerable to coronavirus infections.
Then, there are countries where coronavirus is the least of their problems. Yemen is currently facing the world’s worst humanitarian crisis with epidemics of cholera, diphtheria, famine, and COVID-19. About 80% of the population requires humanitarian assistance. Since 2015, when the Iranian-backed Houthi rebels took over the capital Sana’a against the Saudi-backed government of Yemeni President Hadi, 80% of the population has been internally displaced. The U.N. reports that the country has a severe case of underreporting of coronavirus cases and deaths due to the civil war. Moreover, Yemen’s hospitals refuse to take in COVID-19 patients due to a lack of resources. Understanding public health emergencies requires a critical examination of social systems locally and globally.
Clinical deserts and poor public health infrastructures exist in the U.S. or other parts of the world. Exploitative structure and settler colonialism, which are reproduced and upheld by capitalist ideologies and practices, are the driving forces of negligent health care and public health systems. Although public health officials have claimed that health is a human right, we continue to be faced with leaders who are immobile to transform the social conditions that lay at the root of the problem.
To create a healthier, more just, and more equitable world, we must confront the truth; and that requires an act of collective courage. Perhaps there needs to be a whole new consciousness that abandons ideas of reforms and instead labors a social transformation toward liberation. There cannot be effective solutions that expand globally in the public health sphere if there isn’t an effort to shift the way we think about the kind of power that is needed to create a world worth living in.
Ira Memaj is a public health educator. Robert Fullilove is a professor of sociomedical sciences.
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