Colonial epidemiology: From Columbus to COVID
I don’t mean to cause alarm when I say that modern medicine and colonialism are interwoven institutions. If I do, I quickly redirect you to Fanon’s short essay ‘Medicine and Colonialism’ because this is the sturdy platform on which I’ll base my concerns. In Europe, empire building has historically weaponised diseases and healthcare infrastructures in the conquest of foreign lands. I first think of the classroom favourite: Columbus and the ‘New World’. What they don’t teach 10-year-olds is how the introduction of endemic European diseases, such as smallpox and the plague, exponentially dwindled indigenous populations and facilitated their subjugation. I then think of Africa’s AIDS crisis. Is it a wonder that a philanthropic industrial complex erupted after the inequitable distribution of antiretroviral drugs across the continent? At their intersection, we see a Newton’s cradle of medical racism that oscillates between unabashed neglect and the depiction of Black and Brown people as indestructible specimens for probing, then dispensing once proven impenetrable. In postcolonial African countries, hospitals became the playgrounds for ‘voluntourists’ or, rather, unqualified white teens who believe they are more equipped to ‘make a difference’ in their gap year than the local doctors of their host countries. Instead, these doctors are invited to babysit said white teens who take turns on the operating table, delivering picture-perfect and malnourished African babies. I use unsettling language, but all of this is necessary to acknowledge before I point out how Western COVID responses mimic these imperialist patterns.
Maybe you’ve already arrived at the same conclusions as I have. Ill-titled articles like the BBC’s retracted headline ‘Coronavirus in Africa: Could poverty explain mystery low death rate?’ struggle to conceal how British media continues to perceive the entire continent as one giant ‘urban slum’ that lacks epidemiologists working to understand their own trends. The repeated reference to a homogenous ‘Africa’ also ignores how from the East to the West, and from the North to the South of the continent, different countries can have vastly different approaches to containing the virus. More dire than the BBC poking holes in the global South’s approach to the pandemic is the veneer of a unified international front against the pandemic that obscures something truly sinister. ‘Vaccine nationalism’, the latest pandemic buzzword, is arguably the largest barrier that we’ve run up against in our so-called united battle against the virus. Perhaps the only unifying thing here is the sordid outcome: vaccine nationalism is steadily endangering both its ‘poverty-stricken’ victims and the powers who perpetuate it. The WTO’s Ngozi Okonjo-Iweala calls vaccine nationalism ‘a phenomenon where rich countries are vaccinating their populations, and poor countries have to wait’. Aljazeera describes it as a process where ‘governments sign agreements with pharmaceutical manufacturers to supply their own populations with vaccines ahead of them becoming available for other countries’. I’ll call it by the mouthful that it is: *inhale* a time-sensitive entanglement of foreign policy and public health, all underscored by colonial institutions that undermine the world’s most impoverished countries *exhale*. Despite multiple studies warning against it, vaccine nationalism is rapidly setting itself up to reverse global efforts achieved so far, and yet, it informed the UK and the USA’s race for the procurement of jabs. Initially, it was a justified action towards protecting their most vulnerable people. After all, isn’t it ‘a good thing that a technically advanced country benefits’ from the knowledge of its scientists? (Fanon, 121) What is beyond me is the selfish hoarding and newly erected front for geopolitical tensions that has emerged within global health. Vaccine nationalism also obscures the history of vaccine hesitancy in developing countries (do we Africans even want vaccines?!)—specifically, the collective memory of exploitative vaccination campaigns and weakened trust in Western medicine.
The white man’s hospital
Many people still believe that Africa endlessly benefits from the torrent of aid and knowledge that it graciously recieves from the global North. ‘How ungrateful of you!’ is what I’d imagine a middle-aged European woman on Facebook commenting under an article like this. Certain East African countries have infamously appeared on the news for their distinctive approaches to the pandemic. Their governments have been criticised for disregarding the pandemic and encouraging their citizens to live a life closer to the ones they had before the virus. Reliance on herbal remedies and other ineffective traditional pseudoscience is viewed with scepticism from the West but also ridiculed in a manner that continues to displace Africa from the core of what everyone’s enduring: a deadly pandemic, where we are all at risk of losing loved ones.
But within these criticisms, there is a crucial piece of context that is always missing. They entirely omit the historical motivations behind vaccine hesitancy and the reliance on traditional medicine, ‘sorcerers and healers’ over modern medicine’s universality. A paper published just before the beginning of the pandemic does a more thorough job at explaining this. It studies the 20th-century vaccination campaigns against tropical diseases like sleeping sickness and malaria by France in its colonies. Between 1921-56, villagers in the DRC, Gabon, Chad, and other former French colonies were ‘forcibly examined and injected’ with medicine that caused severe side effects and death. Often, unsanitary medical instruments were used for the procedures, proliferating even more diseases as a result. Unsurprisingly, the areas where more of these campaigns occurred correlate with a severe distrust in recent vaccination campaigns, like local resistance to 1990 tetanus campaigns in Cameroon.
Vaccines are the only way out of this pandemic. This doesn’t mean that I can’t be empathetic towards my grandmother’s unwillingness to inoculate herself against the virus. I understand that part of her concern is rooted in Western medicine’s track record on the continent and the other part in the fear that she’ll only likely receive a left-over jab after every rich country’s last citizen is vaccinated first. It does get old, always being the last one at the table to be served (especially when you’re projected to be served a couple of years after everyone else).
Nobody eats unless everyone eats?
I’ll return to vaccine nationalism and its implications. The WHO’s global vaccination campaign, COVAX, risks failure. It turns out that leftovers from the UK aren’t enough to vaccinate the most vulnerable of low-income countries. While ‘39 million vaccine doses had been given in 49 richer states’, the WHO’s Dr Tedros relays how ‘one poor nation had only 25 doses’. He reiterates that we are on the ‘brink of a catastrophic moral failure’ because of these institutional lapses. What’s worse? Hoarding by wealthier countries will eventually reveal itself to be self-defeating: with the virus rampant in other countries, it threatens more ‘escape mutations’ that could render previous vaccination efforts useless. Without ‘full commitment’ to the scheme, we all remain vulnerable. As Western countries gear themselves up for returning to normal, other countries are simultaneously dealing with the worst waves of the virus yet. Global citizenship only works when the immediate benefactors aren’t the poor, and vaccine nationalism is on track to cost absolutely everyone, not least developing countries, where needless deaths will happen before we can even begin to think of the light at the end of the tunnel.