C-19 vaccine: A symbol of rising horizontal inequalities
Without an effective policy to reach the disadvantaged groups, the apparent desire to make vaccines available to all is bound to remain a crippled initiative, serving prospective ambitions of international actors rather than their stated goals
The COVID-19 vaccination process has been accompanied by a discussion on the global inequalities in accessing health services from its very early days. While the dominant rhetoric among international actors stresses the need to reach the developing world, delivering necessary services to disadvantaged groups within developed countries is a significant challenge. The current situation reveals that, if not scrupulously channeled in the opposite direction, vaccination takes place in line with the existing horizontal inequalities in various countries, potentially exacerbating the already precarious situation of ethnic or religious minorities.
Under the current policies of developed countries, vaccination has become yet another cause of rising inequality. On the other hand, the actions taken by a few exceptional governments became outliers within the general trend, demonstrating that, if effectively managed, it is actually possible to carry out public vaccination in a way that overcomes current horizontal disparities in these societies.
Vaccination in developed countries:
A closer look at the vaccination processes in developed countries reveals the depth of cleavages across various communities in terms of healthcare access. Since the initial weeks of the vaccination, one of the major issues in the US has been the fact that Black citizens are vaccinated at a much lower rate than white people. The persistence of the racial gap in vaccination after months reveals the significance of structural factors in channeling horizontal inequalities into access to vaccines.
Accordingly, Black communities in many US counties must commute significantly larger distances to reach vaccine centers. In addition, Black workers are more likely to work in front-line positions, indicating that although they have a greater risk of getting infected, it is often more difficult for them to take time off to access required health services. Taking into account the lack of investment in Black communities, recent statistics show that the disparity between black and white people in the United States could be worse than before the vaccination.
However, focusing only on the US would ignore a much wider trend in the interaction between horizontal inequalities and the vaccination process. The exclusionary practices of vaccination towards disadvantaged people in other developed countries reveal the challenges in achieving equality in healthcare provision. According to research carried out at Queen Mary University, minority ethnic communities in London have a significantly lesser chance of reaching vaccines than white people. Similarly, in France, the disparity in vaccine access between white natives and colored immigrants living in urban areas persists to this day.
Last but not least, in Israel, there is a similar connection between vaccine provision and horizontal inequalities. While Israel has been enormously successful in providing vaccines to its citizens, the Israeli government has left Palestinians living in the occupied territories out of the program. Beyond the legal status of these marginalized communities, such as Palestinians in the West Bank and Gaza and immigrants in France, the common thread in both of these situations is the increased importance of horizontal inequalities that comes with the vaccination process.
Outliers can become a new hope: A concerted effort to recognize existing disparities in society during vaccination, on the other hand, may yield different results. In this regard, the German vaccination policy can be considered as a positive outlier in the overall trend. The country began its vaccination process with healthcare workers and 85+ citizens. In the second and third stages, the German government dealt with chronic patients and people aged 70 and up, and then civil servants and citizens aged 60 and up. However, the significance of the German case lies in its relationship with the disadvantaged groups. As opposed to countries such as the US and France, Germany put asylum seekers and homeless shelters in category two, together with 70+ citizens, in addition to administering the COVID-19 vaccine free of charge.
Similarly, Turkish efforts to include all its citizens in the vaccination process regardless of the regional and ethnic inequalities should be seen as another outlier within the overall trend. Even though Germany started its national COVID-19 vaccination campaign fifteen days before Turkey, Turkey caught up with Germany first and then surpassed it in terms of total administered doses. The most important decision that was made by the Turkish government was making the COVID-19 vaccine accessible and free to all citizens.
Furthermore, there is no significant difference between provinces in the percentage of people who have been vaccinated. By determining four different stages (1-2-3-4), Turkey implemented a massive vaccination program. The immensely inclusive and strong healthcare infrastructure of Turkey, free access to vaccines, and non-discriminatory vaccine administration have made Turkey one of the few countries in the world to have a more equitable and transparent vaccination program.
Readjusting the focus: Feverish expressions by international actors to combat global inequalities in vaccination need to be heard and put into practice in a way that can genuinely address domestic horizontal inequalities as well. Without an effective policy to reach the disadvantaged groups in these countries, the apparent desire to make vaccines available to all is bound to remain a crippled initiative, serving prospective ambitions of international actors rather than their stated goals.
Ubeydullah Ademi is a graduate student in political science and international relations at Bogazici University. Mehmet Yasin Bozkus is a graduate student in International Relations at Koc University.