COVID-19 and the geopolitics of health

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It’s not about individual countries. It’s not about individual regions. It’s not even about blocks. This doesn’t work unless we vaccinate everybody. But is geopolitics getting in the way of good public health policy as we strive to overcome COVID-19?

In this podcast, Rachael Jolley, former editor-in-chief of Index on Censorship and research fellow at the Centre for Freedom of the Media at the University of Sheffield considers how geopolitics is affecting government decisions around vaccines and distribution, with guests from the US, UK and the Philippines.

Mark Toshner: It’s not about individual countries. It’s not about individual regions. It’s not even about blocks. This doesn’t work unless we vaccinate everybody.

John Nery: The survey shows that something like 68% of Filipino adults have doubts about whether they should take the COVID-19 vaccine or not. Then that’s just really worrying.

Jeffrey Wasserstrom: So we can think of it as soft power sort of related to having a space program, to have this idea that Beijing is one of the world capitals that’s at the forefront of various technologies.

Michael Jennings: And if you look at many African countries, they’ve responded extremely effectively. They’ve made use of technology. Rwanda has been making use of drones to get messaging to very remote communities.

Rachael Jolley: Hello, my name is Rachael Jolley and welcome to this episode of a series of podcasts I’ve hosted for Pod Academy on the global politics of the pandemic. In this episode, I talk to academics in the UK, USA and the Philippines about how national agendas are affecting decision-making, how the virus has to be tackled internationally and how history can sometimes get in the way.

We also talk about misinformation around the disease and why, if we don’t think globally, then in the end, the virus wins. Geopolitics is increasingly a major factor in the discussions around COVID whether about access to PPE or access to the vaccine. Delivery of stocks or stopping vaccine supply arriving over a border often gets tied up with the politics and economics between countries.

As some nations trumpet how well they’ve done, they rank themselves against others. There’s something of a global competition to see which national leader can take the most glory. In the midst of this, there are countries trying to win friends and influence people by delivering stocks of vaccine to those that don’t have any. Economic alliances are being built or improved while others are being undermined.

With us on the podcast are Mark Toshner, a lecturer at the University of Cambridge and a pulmonary vascular physician who spends a lot of time on Twitter answering the public’s queries about vaccines when he’s not looking at the impact of long COVID. We also hear from John Nery, who’s based in Manila in the Philippines and teaches media and politics, and is the chair of the journalism centre at the Ateneo de Manila University. Also joining the conversation are Jeffrey Wasserstrom, a professor in the history of China at the University of California at Irvine, and Michael Jennings, Michael is a reader in international development in the department of development studies at SOAS, University of London, and researches global health and development.

I started by talking to Mark Toshner. Mark, are you worried about geopolitics getting in the way of people’s acceptance of vaccines?

Mark Toshner: [00:03:09] The short answer to that is yes. I usually deal on social media with individual concerns about vaccines. And so I spend a lot of my time just addressing people and what their concerns are and, and I think they’re complex and they vary from region to region.

They vary from place to place, but the one thing that I think hasn’t really been addressed very well in looking at how we improve uptake is that we’ve got a whole world to vaccinate here. So it’s not about individual countries. It’s not about individual regions. It’s not even about blocks.

This doesn’t work unless we vaccinate everybody. And what you can clearly see is forget about hesitant people, forget about individual reasons for not doing it, there are now really big structural problems with politics as usual getting in the way of what needs to be a kind of international approach to vaccinating everybody.

Rachael Jolley: So, what are these obstacles?

Mark Toshner: They’re quite complex and they might be insoluble, which would be a really depressing thought, given that we have a way out of this now and that’s, you know, it’s relatively simple. It’s just get as many of these pretty safe and pretty effective vaccines in people as quickly as we can. But you can see, for example, in Europe, the kind of tribal politics of nation versus nation blocks acting in self-interest and Britain has been as culpable in that as anybody else.

So it’s not about throwing brickbats at other nations, but you can see that politics with a small ‘p’ is getting in the way of doing the right thing.

Rachael Jolley: Michael Jennings, why are countries not thinking more internationally about what is an international disease?

Michael Jennings: In some ways, I think we seem to actually have retreated from more global responses.

If you look back to the SARS epidemic, for example, in the early two thousands, I think actually the world was responding much more collaboratively and cooperatively, particularly those countries that were most effective. And I think that was a high point of global health. And I think perhaps what we’ve seen since then, and especially during COVID is a retreat from globalised global health to a much more nationalised version. People have retreated behind their borders. They’ve competed with each other. So, you know, at the moment we’re focusing on competition over vaccines, but if you take us back to a year ago you think about the competition for PPE and the competition for other things.

Mark Toshner: Right now, I’m enormously pessimistic because local politicians have their own audience to play to. And it’s a difficult sell to come to your populace and see effectively for the moment it would be: “We’re going to divert vaccines somewhere else because we think they’re needed somewhere else.” And in the UK, we may be able to demonstrate a bit of largesse right now, because we have 50% of our adults vaccinated.

But, but even then, you know, we’ve still not given any of our vaccines away. So I think the first thing is we really desperately need a supranational organisation, that everybody puts their time, faith and weight behind. And I just cannot see that being anything other than the WHO. They’ve actually been very good on vaccines throughout. They have a very clear, very whole world vision on it, but obviously there’s a lot of factional politics and the WHO haven’t always been perfect in this pandemic. I think there aren’t very many organisations that have, but I think it’s just really difficult to imagine approaching this as a whole world with the current national structures that we have, but we really need to an organisation above everybody. And that is beyond kind of political reproach. The first thing we need to do is we need to have a clear idea of where vaccines are needed in the world. And actually in the last three or four months, vaccines were needed in the UK. You know, if you were going on a need basis, the UK or the US were probably right up at the top of there, but as we go forward, that’s not going to be the case.

And yet we’re going to see a disproportionate amount of vaccines sequestered in places like the States and the UK, and not finding their way to places that might need them. We also need to think about how that infrastructure works around the world. Both for manufacturing vaccines, which at the moment is incredibly spotty and then equitably distributed them with good distribution networks.

So I don’t think any work has really gone into this yet. Each country has kind of left to fend for itself with whatever vaccines it can get it’s hands-on. And money talks at the moment. You know, the Western power nations are the ones that have of sequestered all the vaccines stocks, but we’re still talking about individual nations right now. We’re all still focusing on our little patch of the world and that’s not how we need to be approaching this. So if we were really serious about this, we would all be focusing on Brazil. Because Brazil is an absolute and utter disaster. It’s a car crash happening in slow motion.

And we’re going to see new variants come out of there because of the absolutely terrifying prevalence levels. And yet Brazil does not have adequate stocks of vaccine. And we might get past the point where its infrastructure is able to deliver it. So I think there are huge global challenges.

I’m not sure we have either the organisation or the leaders to cope with this right now, but the best we can do is kind of shine the lights on it and, and try to keep people’s attention on it. There’s a real problem here as well. The inevitable conclusion of this is going to be, we’re going to make pariah states of some of the poorest places in the world where effectively we are going to end up with countries where we have not helped them to vaccinate themselves and the disease becomes endemic. And then we all close borders off to them because we don’t want them to export it to us, which will only increase the cycle of poverty and worse than the social, inequality margins between countries.

In politics the greatest distractor is having somebody else to blame, particularly somebody other. That other might be foreign, or it might be something else – there’s lots of different stripes in which that can be patterned – but it’s a really powerful lever to pull, and a really easy one, and it works.

Rachael Jolley: John Nery, are you worried at all about the way that geopolitics is getting wrapped up into the acceptance of vaccines in the Philippines?

John Nery: Yes. I am very worried because I can see it happening. The president of the Philippines and his entire administration has been pushing for a Chinese vaccine. As early as I think April [2020] if I’m not mistaken, so about a month or so, about six weeks or so after the pandemic was officially declared Duterte was already talking about you know, the vaccines are coming, but he was already pushing for mainly the Chinese or some sometimes he would also add the Russian vaccines. Yes, there’s a lot of geopolitics involved right now, as far as vaccines are concerned and that just complicates everything. In fact, unfortunately, our president has politicised the vaccine response and that has an impact on vaccine hesitancy.

It’s not the only factor. In 2017 we had this scare, which was stoked by his own administration. And that has also led to an increase in the number of mothers, for instance, who did not want their children to have the measles vaccine. So I think that was the prior factor. And then on top of that, you have the politicisation of a vaccine for COVID-19.

So that explains why, if I’m not mistaken, the latest survey shows that something like 68% of Filipino adults have doubts about whether they should take the COVID 19 vaccine or not. That’s just really worrying. It was only in February that so-called emergency use authorisation was given to the Sinovac vaccine.

And it was, it was a very strange decision by our food and drugs administration, because the clearance given has a limitation. It said, in fact the FDA director announced, that we are giving emergency- use authorisation to the Sinovac vaccine, but we are not encouraging it to be used for our medical frontliners. They thought that it doesn’t say the efficacy rate wasn’t high enough for the medical frontliners to use it.

And that explains why there are many doctors and nurses and interns and other hospital staff who have decided to wait for AstraZeneca or the other Western vaccines.

Rachael Jolley: Let’s look at some of the significant players in the world of global health right now, here’s Michael Jennings.

Michael Jennings: I think India is interesting because one of the things that is doing is to try and emphasize the strength of its pharmaceutical sector and India, for a long time, has been involved in providing vital drugs and medicines across the world to countries in the global South to those that don’t have the capacity, or don’t currently have the capacity anyway, to establish strong, extensive pharmaceutical sectors. So, for example, it’s been long involved in producing generic versions of key treatment for HIV, the anti-retroviral therapy drugs, and, you know, shipping those to countries in the global South. And so it’s become a very important player. So I think part of what India is trying to do is perhaps to emphasise the strength of its pharmaceutical sector and to position itself, not just as a strong pharmaceutical power within the terms of the global South, but a strong pharmaceutical power within global terms, full stop. And it might be quite successful in that.

If you look at China, China has been been seeking to become a global power for its engagement through investment, through international aid and through other forms , including health, for the past two decades. So there’s an extent to which I think it’s using its vaccine as part of that strategy. So it’s not necessarily something new, but it fits into that way of responding.

So it’s clearly about demonstrating China’s global responsibility, it’s global authority, it’s global power, it’s willingness to help other countries. And in doing so, try to gain support for its model, particularly the Chinese model of governance.

We can certainly see this very clearly in the current COVID crisis, where people are clearly using vaccines, both for soft power prestige games. But also aligning it with aspirations for getting an economic toehold. For example, you can see Russia and China quite clearly using their vaccine donations in Latin America in particular – a global region where neither of them have traditionally had a significant amount of influence – using the vaccines to perhaps gain more of a foothold in those areas.

Rachael Jolley: Jeffrey Wasserstrum puts Chinese actions into an historic context and considers if today is any different.

Jeffrey Wasserstrom: The Chinese communist party has been trying to develop relationships with a wide spectrum of countries around the world, often countries that used to be in the category of developing countries or some still are. With some of the countries they are interested in they’ve had relationships going way back to the Mao era. But there are also some that are specifically being connected with through the Belt and Road initiative, this very broad reaching set of economic initiatives which tend to place Beijing in the position of having things to provide to other countries that they might in other cases have looked to Washington for, or to some other part of the world, for.

So the vaccine fits into that. They would partly be looking to, and there’s a pragmatic side to it, is providing a social good public health good. But it’s also part of the soft power way of trying to solidify an idea, a vision of China as a technological and scientific leader in the world. We can think of it as soft power sort of related to having a space program, to have this idea that Beijing is one of the world capitals that’s at the forefront of various technologies. And so in that sense, the vaccine is in part the technology, it’s having been developed quickly, as well as the pragmatic effects of it that are part of the soft power equation.

Rachael Jolley: So China is reaching new partnerships with nations that it wants to have a different relationship with at the same time as growing its overall global power?

Jeffrey Wasserstrom: Yes, that would be true. And this is going on in multiple fronts, you can think about it as their efforts with infrastructure. There are other things. And while clearly there is just a public good side to it, there’s also a hope, I think, in the case of the Chinese communist party, that this would lead to the countries that are getting the vaccine to be more likely to line up with the Chinese communist party at the UN when there were to be less ready to sign on to things, to censure policy. So there’s a pragmatic geopolitical side to it for Beijing as well.

Michael Jennings: I think it’s been quite interesting, for example, to see what China’s been doing in Brazil. Contracts seem to have emerged after pledges of the vaccine were made. You know, where they linked,

Rachael Jolley: What other worries might we have about that sort of relationship and the influence of it?

Jeffrey Wasserstrom: The first thing to worry about is not relationships, but rather the problem is that of information about the safety and efficacy of the Chinese vaccines. There just isn’t enough. We just don’t have enough trust in the media system there to be sure that information about them that’s accurate is getting out.

So this is about not having a free press. And the fact that early in the pandemic there were coverups of some of the medical information. It’s not that there are reasons to think that there are things wrong with the vaccine. It’s simply that we just don’t have the kind of information.

So that’s something to worry about. Or you’d like to have more of a kind of impartial form of vetting and testing of things and have the results that you can trust and believe in.

Rachael Jolley: Is this because we know that doctors who have called out the government have had prison sentences? So is there going to be a scepticism about whether Chinese doctors are being leaned on now to just tow the government line?

Jeffrey Wasserstrom: That’s definitely a concern. And it’s a bigger concern now because if you go back in time to SARS, one of the ways that you had as a check on the information that was coming out of the mainland was that you had a free press in Hong Kong that was monitoring it and testing it.

Now Hong Kong is one of the main places that the mainland is trying to get use of its vaccine. And there have been statements by the Hong Kong government about the safety and efficacy of this, but there’s much less trust at this moment in any statements coming out of Hong Kong with any kind of official stamp, because the Hong Kong government is being forced to line up much more with Beijing on things.

Rachael Jolley: John Nery, can you tell us about whether you’re seeing misinformation or disinformation around COVID in the Philippines?

John Nery: There is an invisible machine already in place, and they have been churning out all sorts of disinformation, mainly political. And now that you have the coronavirus pandemic, you can see that that invisible machine is also being used to push out this information.

A lot of the disinformation, unfortunately, goes back to the Chinese versus Western debates. And that invisible machine pushes disinformation such as that Sinovac has equally high efficacy rates as Pfizer or Moderna and so on. It is aligned with the national government’s own propaganda.

As far as disinformation is concerned, there is already this infrastructure that has been sending out this information and I’ve seen that invisible machine push pro-Chinese content regarding Chinese vaccines. But there’s another layer where people with a little more time on their hands than usual are spreading the latest news about so-called cures.

Rachael Jolley: Is there any evidence that China in, as, as it grows as economic relationship with countries also looks at other kinds of relationships, which can be more worrying than just trade?

Jeffrey Wasserstrom: I don’t think the Chinese communist party is unusual in this. I mean, when the United States develops relationships with other countries based on economic aid, I think there’s a presumption that this is going to go along with a tendency to side with the US on other issues. And certainly this was something that the Soviet Union did. It’s something that happens routinely. But I think it is something to worry about right now, when you have, particularly the case of the human rights abuses in Xinjiang on this very, very worrisome set of appalling policies that there’s a groundswell in some parts of the world toward more censuring of the Chinese communist party on this but there, there are some countries that aren’t taking part in that censoring ,in part because of having developed a degree of economic dependency. So we have a kind of push and pull going on with, with blocks and countries. And it’s not as clear cut as it was during the Cold War.

The Cold War was always more complicated than just two big blocks. There were always non-aligned countries, other countries trying to manoeuvre, but now we have a very, variagated geopolitical landscape.

The Chinese government is trying very hard to tip things in its favour on these kinds of things and to some extent has been fairly successful. We’ve seen a set of countries that you might’ve expected to be more concerned about the fate of a largely Muslim ethnic group inside of China that have been loathe to speak out because of strategic or economic forms of dependency.

Rachael Jolley: Several people have highlighted that the Chinese success in creating a vaccine early on and also driving down the numbers of people with COVID in China is being used by the Chinese government to say, “Look at us, we’ve done really well. Look at the rest of the world, they’re really not.”

Jeffrey Wasserstrom: [00:22:41] Yeah. I think there are things that you can conveniently leave out in the story, or you’re emphasizing in the story. There’s no question that there are countries that have handled the pandemic much more effectively than other countries. And I think the problem is when, if you take a more simplistic view, it would be, well, maybe authoritarian structures aren’t so bad because you have a lot of information about your population and you could respond quickly and look at China as an example of that, but the response has been very strong, very effective in Taiwan, which has a vibrant civil society and democracy. And it definitely has quite a good degree of currency within China itself.

And clearly there’s awareness what can be very effective. With media structures is if countries get a little bit of information from outside and a lot of information from inside. So there’s a lot of stories about the positive side of, of the COVID story within China and a limiting of the discussion of the, of the initial cover-up and issues like that.

Michael Jennings: The idea behind global health was to move towards an idea of global cooperation, the idea that health, or a disease, doesn’t know, boundaries, viruses don’t respect borders and the need for collaborative action. But what COVID has shown is that that’s not really the way that it has worked.

And I think one of the key lessons we need to take when we look back at this is what did those countries in the global south do? What did those countries in Sub-Saharan Africa do that meant they were less hard hit than us? Of course, there will be biological reasons relating to the workings of the virus and so on, but there are also responses that were undertaken by governments and medical professionals that we could learn a lot from in the global north in thinking about how we respond, not only to the tail, hopefully the tail end of this current Corona virus crisis, but also for the next health crisis that comes along. And if you look at many African countries, they’ve responded extremely effectively. So countries like Senegal had a track and trace system that was up and running long before that we had our version in the UK. There’s been extensive use of apps, again something that people don’t often think of in relation to Africa, because we’re so embedded in this narrative of poverty, but actually country governments across the region have made use of apps. They’ve made use of technology. Rwanda has been making use of drones to get messaging out to very remote communities. And I think one of the lessons for COVID has to be, how do you truly globalise global health?

How do we ensure that there is much more power and authority at local levels? Not just in production of vaccines and production of drugs, but also in policy and responding, early warning systems.

Rachael Jolley: And for the final word we return to Mark Toshner. Mark, do you think that the argument that if neighbouring countries don’t have the vaccine, and if you’re unwilling to share the vaccine, then the virus comes back to you.

Is this going to finally break through and change the overall approach?

Mark Toshner: I suspect there aren’t a lot of politicians who are immediately focused on that. I think it requires some real vision to be able to see that far down the road. And I just worry right now that I don’t see a lot of people making that pitch at a national level of importance.

In fact, I don’t see or hear anybody making that pitch if you’re going to be really brutal about it. That’s the only argument that, that I think is going to cut through. But actually forget about the altruistic and right thing to do, forget about whether you’re a globalist or localist or whether you’re left or right if we don’t do this, it just comes back. And so we lose, if a few countries lose, we all lose and we’ll be back at square one. And we’ll be going through cycles of this again with potentially more strains or, or even, you know, new pandemic, 2.0.

Photo: Etienne Giradet at Unsplash

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