Global vaccine equity demands reparative justice — not charity

By late April, more than 80% of the world's COVID-19 vaccines had gone to people in wealthy countries, with just 0.3% to people in low-income countries.1 This reprehensible imbalance is no accident. High-income countries have used neocolonial negotiating power, global policy leverage and capital to procure enough doses to cover 245% of their citizens while leaving few doses for poorer countries.2 As a result, lower-income countries may not be able to vaccinate their populations until 2023.3 Such inequity is yet another example of how the interests of racial capitalism run roughshod over the golden rule of global solidarity-attend to the highest risk first.4 Currently, older and medically vulnerable individuals are dying from COVID-19 disproportionately in poor countries, while young, healthy individuals are getting vaccinated in wealthy ones.5 Vaccine apartheid is a not novel phenomenon. The notion that only certain corners of the world get to benefit from life-saving treatments is an everyday reality of a global health system driven by a capitalist, philanthropic model.6 7 But in times of crises-and as new variants threaten the vaccination plans of wealthy countries-these inequities and their solutions come to the forefront of global debate.8 Policy-makers in rich nations are aware of these issues. But the solutions they have proposed so far do nothing to address the underlying structural problems. They offer charitable donations and partial, temporary fixes that are designed to deflect the substantive demands for reform that global South countries are fighting for, including challenges to unethical intellectual property (IP) regimes.9 This approach will not work, because it is not designed to 'work.' If we want to end vaccine apartheid, we need to target the root causes of global health inequities. We need reparative justice.