Inequality and exclusion in the vaccine rollout

The COVID-19 pandemic has brought out in bold relief the inequalities that set nations and social classes apart. By the sheer magnitude of resources at their disposal, a few will endure this plague better than others. The vast majority, in contrast, are not only less equipped to adapt; they will also find themselves increasingly excluded from the institutional circuits that make survival possible.

To the inequality that has traditionally characterized social existence in hierarchical societies, we may now add the more cruel fact of social exclusion. Indeed, writes the German theorist Niklas Luhmann, such exclusion — more than inequality itself — will pose the bigger problem in today’s modern global society.

This basically means that exclusion from one domain of society will be replicated in all other institutional spheres. The modern state may attempt to mitigate the effects of inequality through compensatory programs in other spheres. But it will find these efforts frustrated by the increasing autonomy of the economy, law, science, etc. Politics will consequently be subjected to growing populist demands for more assertive and autocratic leaders.

This, in crude outline, is the broader context that defines the current worldwide scramble for the limited supply of COVID-19 vaccines. Governments have resolved that the speed at which they can inoculate their peoples against the disease will determine how soon they can hope to revive their flagging economies. Hence, the massive attention given to the starting date of vaccine rollouts and the pace at which the actual jabs are given to people.

Governments everywhere are being judged by their citizens for the swiftness or sluggishness by which they are able to hustle for a sizable portion of the available vaccines. It is no longer a question of how much money a country has. What matters more is how much a government was willing to commit to the purchase of these vaccines even in their early stages of development. Those who hesitated now find themselves at the end of the queue. Case in point: the Duterte administration.

Interestingly, even the rich countries of Europe have not been spared. Here’s a fascinating New York Times report dated Feb. 26: “In vaccine-hungry, cash-rich Europe, the hunt for more doses has nations trading with each other, weighing purchases from Russia and China, and fielding offers from middlemen ranging from real to outright frauds… An immense black — or at least gray — market has arisen, with pitches from around the world at often exorbitant prices. Sellers have approached EU governments claiming to offer 460 million doses of vaccines, according to the early results of an investigation by the bloc’s anti-fraud agency that were shared with the New York Times.”

That’s the situation worldwide at this point. There’s a global scarcity of COVID-19 vaccines. A handful of countries have cornered the limited supply, often in excess of what their own citizens actually need. But, what is unfolding within countries is equally disturbing. In some countries like the United States, glitches in the allocation of vaccines have meant that some local authorities could hoard supplies for second jabs while others have yet to get their first doses.

Well-defined and ethically sound systems of priority in vaccine distribution are willfully set aside in clear surrender to the imperatives governing traditional systems of privilege. In Latin America, people have watched with anger and dismay as the arrival of the first vaccines activated the virus of cronyism and preferential treatment. “Two ministers in Peru and one in Argentina have resigned for receiving or giving preferential access to scarce vaccines. A minister in Ecuador is being investigated for doing the same.” (NYT, Feb. 25)

Since we share structural similarities with Latin American societies, it is almost to be expected that the same privileged line-cutting ethos will be on full display when the highly regarded Western-made vaccines start coming in. We have seen early glimpses of this phenomenon in the widely-reported unauthorized distribution of China-made vaccines to favored parties late last year. Except that no one has felt duty-bound to explain how those vaccines got here and how they were administered to members of the Presidential Security Group without official FDA approval.

This exceptionalism, however, might be harder to criticize in the coming months because of the loophole provided by the existing tripartite scheme for vaccine procurement. The scheme, as we know, allows a few private companies and rich LGUs to order vaccines for their employees and constituents in partnership with the national government provided that, in the case of the private sector, half of the vaccines they buy are donated to the government.

What this means is that when the highly-rated vaccines like Pfizer, AstraZeneca, Moderna, and Novavax start trickling in, there will be separate lines of individuals who are exempted from the national government’s priority system. These lucky few will get the vaccine sooner than most because they happen to be residents of affluent cities or employees or relatives/friends of the owners of big companies.

They will also get the vaccine of their choice, while the rest will have to take whichever vaccine is offered to them free. But, the bigger tragedy is that countless others will simply be left out or excluded, either because they are unable to get into the distribution system, or because they don’t believe in the vaccine.