VACCINE FOR EVERYONE? STRUCTURAL INEQUALITIES IN LATIN AMERICA
Author: Matías Mora
Translated into English by Gilma Cristina Sánchez Cossio
On December 31, 2020 (World Health Organization, 2020) the news about the creation of the vaccine against Covid-19 came out. Listening to the pharmaceutical companies talking about its effectiveness, I started wondering if this vaccine could be the solution to all the problems this year has brought to us. This will be the topic of conversation for this article, but I can anticipate that the answer may not be the one that all of us would like.
Certainly, the relation between the development of medicine and time has been exponential, every year we have more advances in the medical field. Vaccines are not the exception. It is recorded that they had their first breakthrough 200 years ago (healthychildren, 2006). Then, we had the same triala as today, a small dose of the virus is inserted into a person's organism, it creates antibodies that fight the virus, so it has its defenses ready for when it needs to fight the real virus. This is specially important, the advance in medicine allows us, as a society to save lives. These advances modify mortality rates in different populations.
Historically, health systems were exclusive to certain types of groups. People who had access to social services and could afford medicines were those who had well-paid jobs. Now, I would like to bring up this interesting reflexion to your consideration.
Our society has certain rules that define who can make money, who can have a “decent” job and its remuneration. In this scenario, we are facing the complex problem of the unpaid work of a group that has been historically segregated, women. This is a clear inequality towards them that is based just on their gender.
All forms of control and exploitation of labor and control of the production-appropriation-distribution of products were articulated around the capital-wage relationship (hereinafter capital) and the world market." (Quijano, 2014, pg 780)
Returning to this particularity, exemplifying very generally an inequality around the access of certain people to the different health systems, the problem of vaccination in Latin America can be addressed. Our region is a subcontinent where the realities constantly change and are different from country to country.
Our society, our political systems, our way of organizing ourselves is in the form of networks, as humanity, we have always organized ourselves this way, in families, in work teams, in schools by classrooms, and I could continue to provide examples, but the idea is clear.
Our economy and political system are not the exception. In Latin America, health systems are organized in different ways, some are more universal than others. In our continent (and in the world) public health systems have been organized and distributed in 3 levels: Universal-stratified, Dual and Exclusive (Filgueira, 1998). Each of these systems has its characteristics, but its main factor is the coverage that each one of these has for its population, and beyond coverage, the access it provides to citizens in each state.
Public services have historically been exclusive, from the beginning it was thought as a single line of work, that is, only for those who met certain requirements. However, during history we see that, slowly, they have become universal.
In the case of Costa Rica, from its initial thought, it was tried and achieved, to the point of having one of the most universalized health services in all of Latin America. This exemplification seeks to identify a group of people who have historically been displaced, to connect it with the theory of access to public services.
This correlation is interesting, since these inequalities that arose since colonial times, still continue to impact a part of the population in our country. This can definitely contribute a lot and bring benefits such as: employability, improvement in the quality of social services. It can definitely be said that historically there has been marginalization against certain social classes. A historical and theoretical approach is important in order to understand and try to modify discriminatory traditions.
Damián Nicolas, in an interview with Javier Arguello (2014), talked about public services from the perspective of the actors and how they relate to the state, insofar as the state allows them. That is, if there is a group of people who are not within this state organization, they cannot be served, even if they have the same needs as those who are.
For many years this group was women and until today they have unequal treatment, which places them at a disadvantage when trying to enter the labor market, for example. Auyero (2014), under this logic, talks about the citizenship that accesses these services, but who we are talking about today, have been considered second-class citizenship, since in many spaces they were not counted as such due to the sexual division of labor, which the interviewee also comments on in several extracts.
Now, not everything is negative. Efforts have been made to achieve this universalization of vaccines through public services. One of the most unusual cases is the case of vaccination against COVID-19 in the United States, making the exception that the United States is not part of Latin America, it is convenient to bring this example up in order to see how a country where the level of universalization of social services is super exclusive has made significant efforts to be able to get a large part of the population in a vaccination program against Covid-19.
The government entity "Center for Disease Control and Prevention" (CDC) has been implementing a massive vaccination agenda in the United States, guaranteeing access to the vaccine to different populations for free, maintaining a vaccination rate of 2 million people a day, according to reports from the CDC and the media such as “France 24” (Vásquez, 2021).
This contrasts with the historical traditions that have been formed due to the exclusion in the assurance of access to health services, especially in this pandemic. Many people died without prior attention because of the saturation of the health centers in the different countries; this due to the little preparation and importance that is given in the region to public health as a right of access for all people.
However, not all are good details. In a news item from "UN News" (UN News, 2020) it was said that to vaccinate 20% of the population of Latin America approximately 2 billion dollars are needed, so I began to think about what types of health systems we have in different countries
In order to reach more than 20% of the population that is elegible to be vaccinated and what is the role the state apparatus would in this regard, it seems that in countries where the pandemic has claimed many lives such as: Brazil, Mexico or Peru, access that the vaccine for the most vulnerable populations that need the support of the government could be left behind by the poor architecture of the medical public service, but let's consider access and their ability to acquire vaccines and how to administer them.
"Without cocoa there is no chocolate" What does this mean? Of course, it is important how much money is allocated to health in the different countries according to their priority, but the important thing is how it is executed: in policies to attack a single problem, in making the institution more sustainable and accessible among other things. Governments and states must strengthen their vaccination systems, in order to guarantee the right and access to comprehensive health for all people.
At the end of the day, I believe that what we must do is to be aware of the actions that countries can take to be able to deliver this vaccine to the most vulnerable populations and who need an institutional apparatus to accompany them.
This pandemic has shown many shortcomings and has brought to the front the failures that we as a society have, especially in those countries where their system is an exclusive system. Good things will come with the vaccine: to embrace again, to live again, to feel again; however, we must not be fooled, Covid-19 has shown many of the main failures that we have as a society that are also part of the selfishness and little empathy that people and institutions have.
To conclude, I would like to make clear that the vaccine is seen as the end; however, in many cases the way to achieve the vaccine is left aside, that in this case is, as has been repeated in this text, the health systems. There is a reality that we must recognize, the inequalities, present in our region since long time. Writing about these topics not only allows us to read, inform ourselves and therefore create a criterion, but it is a call to be aware and seek for alternative to ensure the creation of a more inclusive society, and where the title of this small essay is nothing more than an old story.
Auyero, Javier (2014) “El Estado, la espera y la dominación política en los sectores populares: entrevista alsociólogo Javier Auyero Salud Colectiva, vol. 10, núm. 3, diciembre, 2014, pp. 407-415 Universidad Nacional de Lanús Buenos Aires, Argentina
Blofield, Merike y Juliana Martínez Franzoni. 2014. “Trabajo, familia y cambios en la política pública en América Latina: equidad, maternalismo y corresponsabilidad.” Revista Cepal 114, pp. 104-125. https://repositorio.cepal.org/handle/11362/37439
Damin, Nicolás (2014). El Estado, la espera y la dominación política en los sectores populares: entrevista al sociólogo Javier Auyero. Salud Colectiva, 10(3),407-415.[fecha de Consulta 24 de Noviembre de 2020]. ISSN: 1669-2381. Disponible en: https://www.redalyc.org/articulo.oa?id=731/73138581010
Filgueira, Fernando (1998) “El nuevo modelo de prestaciones sociales en América Latina: residualismo, eficiencia y ciudadanía estratificada” en Roberts, Brian (ed.) Ciudadanía y política sociales (San José de Costa Rica: FLACSO/SSRC).
Filgueira, Fernando. 2014. “Hacia un modelo de protección social universal en América Latina”. CEPAL, Serie Políticas Sociales 188, Santiago de Chile.
Filgueira, Fernando, Carlos G. Molina, Jorge Papadópulos y Federico Tobar. 2006. “Universalismo básico”. En Carlos G. Molina (ed). Universalismo Básico: Una Nueva Política Social para América Latina. Washington, D.C.: BID, pp. 19-55. https://publications.iadb.org/es/publicacion/14171/universalismo-basico-una-nueva-politica-social-para-america-latina
Martínez-Franzoni, Juliana y Diego Sánchez Ancochea (2019) La Búsqueda de una Política Social Universal en el Sur. San José: Editorial UCR, 3-31.
Noticias ONU (2020) “Vacunar al 20% de la población de Latinoamérica de COVID-19 costará más de 2000 millones de dólares”. Recuperado de: https://news.un.org/es/story/2020/11/1484302
Organización Mundial de la Salud (2020). “La OMS publica su primera validación para uso de emergencia de una vacuna contra la Covid-19 y hace encapié en la necesidad de un acceso mundial equitativo”. Recuperado de: https://www.who.int/es/news/item/31-12-2020-who-issues-its-first-emergency-use-validation-for-a-covid-19-vaccine-and-emphasizes-need-for-equitable-global-access
Quijano, A. (2014). Colonialidad del poder, eurocentrismo y América Latina. En: Cuestiones y horizontes: de la dependencia histórico-estructural a la colonialidad/descolonialidad del poder. Buenos Aires: CLACSO.
Vasquéz, Cristobal (2021) “Dos millones de dosis al dia: Así avanza la vacunación en Estados Unidos”. France 24. Recuperado de: https://www.france24.com/es/ee-uu-y-canadá/20210306-dos-millones-vacunas-diarias-eeuu
I am Matías Mora, a young lover of coffee, poetry and languages. I graduated from Political Science and I am currently a Data Science Engineering student. Identified with researching and studying about inequalities and democracy as a fundamental pillar for decision-making and societal change. I have worked in the legislative, diplomatic and academic fields. I collaborate in community projects for mobility and urban planning.