Modern colonization drastically differs from what it was historically. Today’s control does not require economically rich countries to invade, set up physical colonies, or exert military control in less powerful countries. Instead, the neo-colonial power dynamics and approaches of today are more complex. A key difference is the emergence of global health in the 1990s and early 2000s which has become a method to influence country-led decisions in favor of countries that are providing aid – exerting soft power political control.
The intent and impact of these relationships based on dependence, subjugation, and Shylock-like indebtedness is problematic. Yet, they continue through public and global health, providing humanitarian aid, INGOs, and global health governance, a colonial paradigm through which to operate.
Take the COVID-19 pandemic.
Global health experts agree that resolving the pandemic requires equitable access to vaccination. Yet, roughly 35% of the world hasn’t received at least one dose, and about 42% of the world’s population isn’t fully vaccinated. In high and upper-middle-income countries, 79% of the population has received at least one dose as compared to 14% in low-income countries. Africa Centers for Disease Control and Prevention Director John Nkengasong has been outspoken about the inequitable distribution of vaccines to the global South, as rich countries buy vaccines in excess; for example, Canada purchased enough doses to vaccinate their country five times over, while poorer countries were left with only enough doses to vaccinate one out of every ten people.
Furthermore, approximately two years after the start of a pandemic that has claimed nearly 6 million lives, crucial proposals that would expedite access to vaccines have been stalled.
Researchers in the U.S. developed the Corbevax vaccine which is 90% effective against the original COVID-19 strain, and 80% effective against the Delta variant. At around $1.50 a dose, it’s also economical. Yet, the option was ignored in Washington, in favor of giving tax dollars to pharmaceutical companies. Even as tax-payer dollars have been used to fund vaccine development for the greater good, Pfizer and Moderna refuse to license their mRNA technology in developing countries, inaccurately citing the countries’ inability to produce high-quality vaccines. Disappointingly, some of the most prominent global health foundations working to end inequity have failed to support the production of mRNA vaccines in low and middle-income countries (LMICs) as well, perpetuating the very inequities they’re supposedly working against.
Meanwhile, the European Union continues to block attempts by some sixty World Trade Organization (WTO) members to waive Trade-Related aspects of Intellectual Property Rights (TRIPS) for technologies needed to prevent, contain, or treat COVID-19. Even as over 100 low-income countries support this proposal, many high-income countries (HICs) continue to oppose it, delaying progress in the WTO’s TRIPS Council. The refusal to remove barriers places undue pressure on health systems around the globe that are already on the verge of collapse.
The path HICs have taken is solely narrow self-interest and apathy. Instead of developing a rights-based approach, they’ve taken to charity – which is just an extension of the colonial mindset to exert control and power.
Then those same HIC governments leverage their “charity” – boasting they’ve provided for ‘poor countries.’ The reality is that LICs have rejected over 100 million vaccine doses because they were close to expiry, or because they didn’t have the infrastructure required to store and deliver vaccines. Meanwhile, Western countries have perpetuated a global imbalance in healthcare staffing by ramping up their recruitment of healthcare workers from LICs. In terms of population, HICs have on average 10 times more nurses than LICs. Thus, the cycle of inequity continues.
HICs don’t seem to realize the colonization of global health has consequences for everyone – as we’ve seen with the Delta and Omicron variants. Currently, the high level of omicron transmission is leading to supply chain issues and staffing shortages across the U.S; we can’t ignore the pandemic and then wonder why grocery store shelves are empty, prices go up, schools go to remote learning, or our surgeries get rescheduled because hospitals are overwhelmed.
To make meaningful changes toward decolonizing global health and health equity, we must recognize that decolonization is in the global best interest.
We will only see a real end to the pandemic when the scales are balanced and HICs move towards empowerment. This requires public health leaders and those in decision-making to continue raising their voices; work tirelessly to strengthen systems by sharing technology and expanding manufacturing and delivery mechanisms in LICs; and relinquish power in favor of solidarity to balance the scales.
Countries that are leaders in colonizing are self-imposing the decolonization responsibility on themselves. Most discussions around decolonization are happening in HIC institutions and the outreach to institutions in the south is limited. Audre Lord famously said, “The master’s tools will never dismantle the master’s house.” The first step is to let those on the receiving end lead the charge to decolonize.
Ultimately, decolonizing global health and the pandemic response will save lives and help the global economy. It will restore hope and build unity. If global health governance wasn’t entrenched in power dynamics and motivated by money, the solutions to global health issues would instead be rooted in equity and justice. This decolonized world that we and other health equity advocates envision cannot be built overnight. But we sure think it can be built!
About the Authors:
Dr. Vineeta Gupta, an award-winning global health advocate and keynote speaker, is maternal and child health physician, human rights lawyer and trailblazer for health equity. Dr. Gupta, currently, Director of the ACTION Secretariat, provides expertise at the nexus of the most critical issues in the fields of health equity, RMNCAH, women’s rights, and global health. Vineeta has been invited to speak in over 60 universities in the U.S and Europe. She is widely covered in print and online media globally, including in the Washington Post, The Economic Times, Devex, Times of India, China Daily, NPR, US News and World Report, FOX news, and CNN.
Mervyn Christian is a Senior Program Officer with the Bill and Melinda Gates Institute for Population Family and Reproductive Health at the Bloomberg School of Public Health. He is global health multi-faceted issue expert with 15+ years of experience in policy advocacy, program management, strategy planning, and research. Mervyn works to strengthen health systems programming and reduce inequities worldwide by applying expertise in technical areas including sexual and reproductive health and rights, gender-based issues, and maternal, newborn, child, and adolescent health.
Competing interests: None
Handling Editor: Neha Faruqui