A Vision of Tomorrow: Vaccine Equity
An art piece by Andrew Sun and Erica Prager
This submission is part of a series by McGill students who were in the Fall 2024 course, Fundamentals of Global Health.
The Trickle-Down Model
The “trickle-down” model of vaccine and treatment access is the central idea represented in this piece, illustrated by the limitless amount of money and vaccines “trickling down” from rich, predominantly white, Global North countries to Global South countries. The model is further represented by the coins in the bottom half of the page, representing the Global South being denied access to affordable treatments. This funnel of access along a North-South gradient is one of the greatest injustices of global health today. The restriction of access to life-saving medicines, such as antiretrovirals for HIV, and the evergreening of medical patents, are just a few examples of rich, Global North nations valuing money over human life (Frontline Aids, 2019). More importantly, many of these actors continue to put unthinkable amounts of money into already unthinkably rich hands over providing medicine and resources to disproportionately Black, brown and LGBTQ2+ communities.
“It had taken nearly forty years for the United States government to put apartheid South Africa on a sanctions watch list. But it took less than three years to put democratic South Africa, trying to make medicines affordable to its people, onto a sanctions watch list – at the behest of drug companies” (Mohan Gray & Achmat, 2012)
-Zackie Achmat, represented in our piece
Leaders in Treatment Equity
The concepts of “leaders in global health” and “leaders in treatment equity” are represented by the head (seen in profile)––a young global health student––whose mind is filled with ideas of the future of health equity. The student, supported by the knowledge of their forebears in treatment equity, envisions a better, more equitable future. This future builds on the past, including movements like the Treatment Action Campaign (TAC), which, in the ‘90s, used an anti-apartheid and gay rights activism approach to demand better access to life-saving HIV/AIDS medicines. Founded by Zackie Achmat, the group successfully pushed the South African government to make antiretrovirals accessible to South Africans (Treatment Action Campaign, 2024). This movement is an example of collaboration and leadership in global health being in the hands of those most affected, and those with the necessary life experiences. A second figure highlighted in our piece is Marsha P. Johnson, who was a gay liberation leader, Stonewall veteran and AIDS activist with ACT UP who was tragically killed in 1992 (Rothberg, 2022). Marsha was a prominent figure in the queer community, and an example of queer and marginalized people taking leadership roles in the face of global health crises. The student depicted in the art piece is a leader as well and has both the support and wisdom of their predecessors as well as their own ideas, hopes, and goals for the future of global health.
“History isn’t something you look back at and say it was inevitable. It happens because people make decisions that are sometimes very impulsive and of the moment, but those moments are cumulative realities” (Burgos, 2020)
-Marsha P. Johnson, represented in our piece
African, Queer, and Global South Leadership
Another core theme of our piece is the shift of power, leadership, and platform to Global South actors, specifically Black and queer leaders in Global Health. The piece features a globe centred on Africa to showcase the wealth of knowledge from the Global South, and more particularly, African voices.
Often, Global South knowledge and leadership is sidelined on the global stage, subjected to bias, and deprived of platform and resources (Abimbola et al., 2021). The future of global health paints a different picture. Health equity cannot be achieved worldwide without the invaluable knowledge, lived experiences, and leadership of African and Global South actors as a whole. The people holding hands around the globe, clad in rainbow colours, illustrates a future that prioritizes queer and gender-diverse collaboration and representation in global health, like Zackie, Marsha, and all those before them. This is the future of vaccine equity and global health that we envision. The next step is the decolonization of global health and for Global North actors, such as ourselves, to work in solidarity with Global South actors and become accomplices and co-conspirators.
“Solidarity is an uneasy, reserved and unsettled matter that neither reconciles present grievances nor foreclosed future conflicts” (Tuck & Yang, 2012)
Vaccine Inequity
Health inequity is not limited to HIV/AIDS. It is a persistent injustice seen for many other diseases around the globe. The COVID-19 pandemic has brought one kind of health inequity to the fore––vaccine inequity. Just as HIV and tuberculosis have become endemic in the Global South, COVID-19 has joined the list of endemic diseases for poorer countries, even as high-income nations move on. Thus, fewer resources are being used to tackle coronavirus around the globe, leaving behind countries of the Global South that are still fighting the pandemic. Even today, while the COVID-19 vaccination rate is about 80% in higher-income countries, it is only about 13% in low-income nations (Pai et al., 2022). SARS-CoV-2 is not the only disease the Global South is still fighting. Many infectious diseases that are endemic in lower-income and middle-income countries continue to kill millions every year, even as they have been largely controlled or eliminated in the Global North. With the rise of monkeypox, vaccine inequity will likely continue to lead to unnecessary suffering and death. As in the case of COVID-19, rich countries such as Canada have been hoarding vaccines for monkeypox, while the disease has not even reached our shores (Ireland, 2024).
“The idea that some lives matter less is the root of all that is wrong with the world”
-Dr. Paul Farmer
In conclusion, we hope our art piece has underscored the urgent need to dismantle, decolonize, and rebuild global health systems to prioritize health for all over profit. With these demands for action, it is clear that the only way to work towards vaccine equity going forward and to end the trickle-down model is to platform Global South, African, and queer voices and for Global North actors to fight in solidarity alongside them.
References
Abimbola, S., Asthana, S., Montenegro, C., Guinto, R. R., Jumbam, D. T., Louskieter, L., Kabubei, K. M., Munshi, S., Muraya, K., Okumu, F., Saha, S., Saluja, D., & Pai, M. (2021).
Addressing power asymmetries in Global Health: Imperatives in the wake of the covid-19 pandemic. PLOS Medicine, 18(4). https://doi.org/10.1371/journal.pmed.1003604
How Patents Affect Access to HIV treatment. (2019, October 2nd). Frontline Aids. https://frontlineaids.org/how-patents-affect-access-to-hiv-treatment/
Burgos, A. (2020). Marsha P. Johnson & Sylvia Rivera (U.S. National Park Service). National Parks Service.
https://www.nps.gov/articles/000/marsha-p-johnson-sylvia-rivera.htm
Ireland, N. (2024, August 14). Canada must respond to mpox crisis in Africa to prevent spread here, experts say. Toronto Star.
https://www.thestar.com/news/canada/canada-must-respond-to-mpox-crisis-in-africa-t o-prevent-spread-here-experts-say/article_98cc1333-598d-5d08-a155-333d84291beb. html?utm_medium=social&utm_source=copy-link&utm_campaign=user-share
Mohan Gray, D., & Achmat, Z. (2012, January 27). Fire in the blood. Stanford CIS. https://cyberlaw.stanford.edu/blog/2012/01/fire-blood/
Pai, M. (2022). Countering failures of imagination: lessons we learnt from Paul Farmer. Forbes.
Retrieved 2024, from https://www.forbes.com/sites/madhukarpai/2022/10/21/countering-failures-of-imagin ation-lessons-we-learnt-from-paul-farmer/.
Rothberg, E. (2022). Marsha P. Johnson. National Women’s History Museum. https://www.womenshistory.org/education-resources/biographies/marsha-p-johnson
Treatment Action Campaign. (2024, October 14). About Treatment Action Campaign. TAC. https://www.tac.org.za/about/
Tuck , E., & Yang, K. W. (2012). Decolonization is not a metaphor. Decolonization: Indigeneity, Education & Society, 1(1), 3. https://doi.org/https://jps.library.utoronto.ca/index.php/des/article/view/18630
Sam-Agudu, N. A., Titanji, B. K., Okumu, F., & Pai, M. (2022, March 4). The Pandemic is Following a Very Predictable and Depressing Pattern. The Atlantic. https://www.theatlantic.com/health/archive/2022/03/pandemic-global-south-disease-h ealth-crisis/624179/
Erica Prager and Andrew Sun are Canadian students at McGill University in Tiohtià:ke, Québec, Canada studying Anatomy & Cell Biology, and Computer Science & Biology, respectively. Both are Global North actors in Global Health and carry the lived experiences of being healthcare workers and children of immigrants. Erica and Andrew are settlers in Tiohtià:ke, traditional unceded lands of the Anishinabeg and Haudenosaunee Nations.