DEBATE: Covid-19, Comedy and Crimes against humanity

Trump is gone, but his political buzz word, ‘America first’, seems to have infected the minds of political leaders in the global north, because these countries’ hoarding of billions of doses of COVID-19 to secure full coverage for their own populations represents a radical u-turn from their position expressed in the UN General Assembly Covid-19 resolution of September 11, 2020.

Vaccination in San Francisco, United States

WILD CAPITALISM: The name of this taboo should be pronounced, it is neoliberalism, it is wild capitalism, where business, companies, and self-interests govern the world instead of respect for human dignity and human rights, the researchers Shereen Cox , Jan Helge Solbakk, Rosemarie Bernabe and Susana Maria Vidal Suarez state in this article. The photo shows  vaccination against Covid-19 in South of Market Health Center in San Francisco, California.  (Photo: Maggie Hallahan/MHPV/Flickr)

For more than a year the world has been under an unprecedented siege caused by the Covid-19 pandemic. On April 20, 2021 it was reported that 3,047,872 inhabitants of the world, i.e. more than half of Norway’s population, have died from complications following the SARS-CoV-2 infection.[1]

The word pandemic comes from two ancient Greek words (pan ‘all’ + dēmos ‘people’), so literally speaking ‘pandemic’ means all the people, the whole world. But in spite of the fact that all inhabitants of the global city are affected, albeit in different ways, by this virus, there are few signs among those in power to really join forces to fight the pandemic. A notable exception is COVAX, the WHO-led initiative to ensure access to COVID-19 vaccines for all countries, but a timely realization of this initiative is greatly hampered by the rise of vaccine nationalism in some of the most affluent regions of the world: in North America, in the UK and in the European Union, as well as in Iceland, Lichtenstein, Switzerland and Norway. As stated by Harry Kretchmer: “…’vaccine nationalism’, where countries prioritize their own vaccine needs, is forecast to handicap not just global health recovery but the economic one too…”.[2] A study commissioned by the International Chamber of Commerce confirms this statement predicting “that the global economy stands to lose as much as 9.2 trillion USD if governments fail to ensure developing economies access to COVID-19 vaccines, as much as half of which would fall on advanced economies”.[3]

 

Trump is gone, but his political buzz word, ‘America first’, seems to have infected the minds of political leaders in the global north, because these countries’ hoarding of billions of doses of COVID-19 to secure full coverage for their own populations represents a radical u-turn from their position expressed in the UN General Assembly Covid-19 resolution of September 11, 2020. [4] 169 Member States voted in favor of this resolution, only Israel and the United States voted against. In the resolution the special challenges and needs of the most vulnerable countries are recognized and commitment to global solidarity are reaffirmed. And paragraph 12 of the resolution:

 

Urges Member States to enable all countries to have unhindered, timely access to quality, safe, efficacious and affordable diagnosis, therapeutics, medicines and vaccines, and essential health technologies, and their components, as well as equipment, for the COVID-19 response”.

 

By November 2020, when the world had several vaccines yielding favorable results in clinical trials, the International Federation of Pharmaceutical Manufacturers & Associations and the International Generic and Biosimilars medicines association issued a joint statement that while the pharmaceutical industry is committed to ensuring equitable access of COVID vaccines and medicines, this was not entirely up to them and “others will have to play their part”. They highlighted several areas of concern, placing emphasis on the need for “international solidarity, cooperation, coordination and support.” One concern most relevant to this discussion is “for multilateral organizations and country leaders to align on allocation principles to ensure fair and equitable access to COVID-19 treatments and vaccines”.[5]  Despite this plead for global justice and solidarity even from the industry, some of the approved vaccine manufacturers such as Pfizer and Moderna have only just recently reached an agreement with COVAX, and notably after they made deals with the richer countries that puts these countries at the front in the vaccination race. [6],[7] 

 

One possible argument on their part for not focusing on LMICs could be the concern that mRNA vaccines have very stringent storage requirements (-70 degree Celsius) and may not be sustainable in certain environments. There is also the cost factor as well as the possible need for further phase 3 clinical data for some countries. Pfizer and Moderna are yet to complete arrangements with India, the largest manufacturer and supplier of vaccines to developing economies.[8] But these arguments are far from convincing, at least with regard to Pfizer, since the vaccine manufacturer included thousands of individuals from Argentina, Brazil and South Africa in its efficacy trial (in total 8792 individuals or 23,4% of the trial population). This raises the moral question about Pfizer’s post-trial obligations vis-á-vis these populations.[9]

To this adds affluent countries’ continuous hoarding of the Astra Zeneca vaccine that is cost effective and viable in warmer climates, and which was tested on more than 10002 individuals in Brazil and 2096 individuals in South Africa.[10] The USA alone has an agreement with Pfizer for 600 million doses, with Moderna for 100 million doses, and with Astra Zeneca for 300 million doses for its citizens while Astra Zeneca’s COVAX commitment stands at 170 million vaccines and Pfizer’s and Moderna’s commitment is only 40 million for distribution to 92 countries! In the words of Angela Dewan, a few months after the sweet talk on global solidarity the vaccines have arrived and “solidarity has frayed”. [11]

 

What could be the role of bioethicists witnessing this ugly spectacle? We believe it is time to move beyond the sympathetic and risk-free role of a ‘helpful knower’[12] providing advice to those entitled to make decisions, or the role of a ‘polite bystander’[13] observing - and describing - from distance what is actually going on. What we suggest, instead, is to start speaking truth to power, and notably, in a way that for millennia has been acknowledged as an acceptable and cleansing - cathartic - way of truth-telling: the role of the comic figure. Tragedies, says Aristotle, in his book on the ancient Greek theatre – the Poetics - dramatize irresolvable moral conflicts infected by some sort of failure (hamartia). A comedy, on the other hand, dares to make its anti-hero “say the unsayable”,[14] and violate audience’s taboos by disclosing them.[15] The comic figure thereby provides a form of shock-therapy and eye-opening by pointing to what is disguised and by disclosing what really takes place.   

 

What is then the most unsayable thing or taboo that needs to be violated during the current pandemic? The answer is simple: the affluent nations’ hoarding of the majority of Covid-19 vaccines that will be produced during the next two years does not deserve the label ‘vaccine nationalism’; these are acts pretty close to ‘crimes against humanity’, i.e. acts that are purposely committed as part of a widespread or systematic policy, directed against civilians, in time of war or peace in furtherance of a state policy. But evil acts generating crimes against humanity are not necessarily perpetrated by evil people. Instead, as argued by Hannah Arendt in her study on Adolf Eichmann, such acts can be performed without evil intentions; they can simply be the result of prosaic careerism or bureaucrats dutifully obeying orders. To capture her conception of this kind of evil Arendt coined the phrase ‘the banality of evil’, which she in a letter to Gershom Scholem in December 1964 explained thus: [16]

“You are quite right, I changed my mind and do no longer speak of ‘radical evil.’ … It is indeed my opinion now that evil is never ‘radical,’ that it is only extreme, and that it possesses neither depth nor any demonic dimension. It can overgrow and lay waste the whole world precisely because it spreads like a fungus on the surface. It is ‘thought-defying,’ as I said, because thought tries to reach some depth, to go to the roots, and the moment it concerns itself with evil, it is frustrated because there is nothing. That is its ‘banality.’ Only the good has depth that can be radical”.

Most of the countries implicated in these potential crimes have developed a priority list with regard to which groups should be first vaccinated, i.e., Covid-19 frontline health care-workers, elderly people and individuals with certain co-morbidities. These are priorities based on the epidemiological knowledge gathered so far concerning the impact of the SARS-CoV-2 infection and on justified moral reasoning. But if this is the medical and moral truth within the borders of affluent countries, why is it not converted into a universal policy of benefit sharing, i.e., a health policy addressing the needs of all inhabitants of the global city not solely the privileged ones? We know two crucial things about the prognosis of this pandemic. First, the earlier the same priority groups world-wide get access to Covid-19 vaccines, the lower the global death toll and the faster the pandemic will end. Second, not violating the current taboo disguised as vaccine nationalism will probably increase the number of mutant variants of the SARS-CoV-2 coronavirus with consequences of a possibly detrimental kind for all mankind. The director-general of the WHO, Tedros Adhanom Ghebreyesus, describes vaccine nationalism as “a catastrophic moral failure” and that “we will only truly end the pandemic if we end it everywhere at the same time, which means it’s essential to vaccinate some people in all countries, rather than all people in some countries”. [17]

The name of this taboo should be pronounced, it is neoliberalism, it is wild capitalism, where business, companies, and self-interests govern the world instead of respect for human dignity and human rights. Oxfam’s Briefing Paper, The Inequality Virus discloses the ugly facts of this reality: [18]

“In the first months of the pandemic, a stock market collapse saw billionaires, who are some of the biggest stockholders, experience dramatic reductions in their wealth. Yet this setback was short-lived. Within nine months, the top 1,000 billionaires, mainly White men, had recovered all the wealth they had lost”.

In October 2005, 192 Member States of the United Nations adopted by acclamation the Universal Declaration of Bioethics and Human Rights. Article 15 of this Declaration, on Sharing of benefits states:[19]

Benefits resulting from any scientific research and its applications should be shared with society as a whole and within the international community, and in particular with developing countries.

 

It is due time that the most affluent countries in the world truly acknowledge their commitments made to poor and low-income countries in October 2005 and in September 2020, i.e., of making sure that the most vulnerable inhabitants in every country will be first in line when it comes to vaccination and treatment against Covid-19. At this point, this means resisting the justifications for and actually acknowledging the concerted crime against humanity in the global south.[20] It also means stepping up and actually facilitating all possible regulatory and trade measures that effectively enable countries in the global south “to have unhindered, timely access to quality, safe, efficacious and affordable diagnosis, therapeutics, medicines and vaccines”, as stated in the UN Assembly resolution of September 11, 2020.  

 

 

[1]https://www.worldometers.info/coronavirus/coronavirus-death-toll/.

[2] Kretchmer, H. Vaccine nationalism – and how it could affect us all. World Economic Forum, Jan 6th, 2021. Accesible at: https://www.weforum.org/agenda/2021/01/what-is-vaccine-nationalism-coronavirus-its-affects-covid-19-pandemic/.

[3] Akmaklı, C., Demiralp, S¸ Kalemli-Ozcan, S. et al. The Economic Case for Global Vaccinations: An Epidemiological Model with International Production Networks. Accesible at: https://iccwbo.org/publication/the-economic-case-for-global-vaccinations/

[4] General Assembly of the United Nations. Comprehensive and coordinated response to the coronavirus disease (COVID-19) pandemic. September 11, 2020. Accesible at: https://www.un.org/pga/74/2020/09/10/draft-omnibus-resolution-on-the-covid-19-pandemic-2/

[5] IFPMA. (2020). Innovative and generic & biosimilar pharmaceutical industries unite on commitment to equitable access to COVID-19 medicines and vaccines, while flagging where further help is needed from others February 2, 2021. Accesible at https://www.ifpma.org/wp-content/uploads/2020/11/PRESS-RELEASE-IGBA-IFPMA-considerations-on-equitable-access-to-COVID-19-medicines-and-vaccines_-003.pdf

[6] Cao, S. COVID-19 vaccine prices revealed from Pfizer, Moderna,and Astra Zeneca. Observer. November 23rd, 2020 Accessible at https://observer.com/2020/11/covid19-vaccine-price-pfizer-moderna-astrazeneca-oxford/

[8] Sharma. M. Will Pfizer Covid-19 vaccine come to India? India Today,  January 11th, 2021 Accessible at https://www.indiatoday.in/coronavirus-outbreak/vaccine-updates/story/will-pfizer-covid-19-vaccine-come-to-india-1757992-2021-01-11

[9] Polack, F.P., M.D., Thomas, S.J., M.D., Kitchin, N. et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. NEJM.  2020; 383:2603-2615. DOI: 10.1056/NEJMoa2034577

[10] Voysey, M., Costa Clemens, S.A., Mahdi, S.A. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. The Lancet; 397: 99-111. Accessible at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext#seccestitle70.

[11] Dewan, A. A fight between the EU and UK reveals the ugly truth about vaccine nationalism. CNN, January 30th, 2021 Accesible at: https://edition.cnn.com/2021/01/30/europe/uk-eu-astrazeneca-vaccine-nationalism-gbr-intl/index.html.

[12] Williams, B.A.O. (1995). Who needs ethical knowledge? In: B.A.O. Williams (Ed.), Making

sense of humanity and other philosophical papers 1982–1993. Cambridge: Cambridge University Press. (203–212): p. 212.

[13] Häyry M. Rationality and the Genetic Challenge: Making People Better? Cambridge, UK: Cambridge

University Press; 2010, p. 33ff.

[14] Segal, E. The death of comedy. Massachusetts: Harvard University Press, 2001, p. 31.

[15] Silk, M.S. Aristophanes and the definition of comedy. Oxford: Oxford University Press, 2000, pp. 56-58.

[16] The Hannah Arendt Papers at the Library of Congress
Correspondence---Scholem, Gershom Gerhard---1963-1964, n.d. (Series: Adolf Eichmann File, 1938-1968, n.d.)

[17] Parsons. L. Pfizer/BioNTech reach vaccine supply agreement with COVAX. PMLive. January 25th, 2021 Accessible https://www.pmlive.com/pharma_news/pfizerbiontech_reach_vaccine_supply_agreement_with_covax_1361849

[18] Oxfam (2021) The Inequality Virus. Bringing together a world torn apart by coronavirus through a fair, just and sustainable economy. Oxfam International January 2021: 11, Available: https://oxfamilibrary.openrepository.com/bitstream/handle/10546/621149/bp-the-inequality-virus-250121-en.pdf

 

[19] UNESCO. Universal Declaration on Bioethics and Human Rights, 2005. Accesible at: https://en.unesco.org/themes/ethics-science-and-technology/bioethics-and-human-rights#:~:text=UNESCO%20has%20contributed%20to%20the,in%201998%2C%20and%20the%20International

[20] The use of the phrase Global South marks a shift from a central focus on development or cultural difference toward an emphasis on geopolitical relations of power. For this, see: Dados, D. and Connell, R. The Global South. Accessible at: https://journals.sagepub.com/doi/pdf/10.1177/1536504212436479#:~:text=The%20phrase%20%E2%80%9CGlobal%20South%E2%80%9D%20refers,politically%20or%20culturally%20mar%2D%20ginalized

Emneord: Koronavirus, Koronviruset, Nord-Sør-samarbeid, Globalisering Av Jan Helge Solbakk and Shereen Cox,  Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, UiO, Rosemarie Bernabe, University of Southeastern Norway and researcher II at Centre for Medical Ethics, Institute for Health and Society, Faculty of Medicine, UiO and Susana Maria Vidal Suarez, The UNESCO Latin-American network of bioethics guest researcher at Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine'
Publisert 12. mai 2021 10:13 - Sist endra 18. mai 2021 01:48

“I cannot give any scientist of any age better advice than this: the intensity of the conviction that a hypothesis is true has no bearing on whether it is true or not.” ― Peter Medawar (1915-1987)

tgs@ntnu.no - 25. mai 2021 10:12
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