JONNY STEINBERG: The healthy rich and diseased poor in a 21st century dystopia

It is looking increasingly as if the Covid-19 pandemic will be remembered for the global politics of the vaccine. It started with so much promise — a worldwide collaboration of universities, governments and industry to produce a vaccine in rapid time; and an international regime, Covax, to ensure its equitable distribution across the world.

But already the goal of equitable distribution is a slipping away; most of the projected stock of vaccine to be manufactured in the next year has been bought by high- and upper-middle-income countries. The consequences will be horribly dystopian.

During the first wave of the virus it seemed, improbably, that Europe and the US would face the brunt of illness and death, while Africa was getting off lightest. But if the rich get vaccines and the poor do not, that is going to reverse as the pandemic proceeds. And what will follow from that reversal is very dark indeed. The greatest legacy of the pandemic will have been to compound problems of underdevelopment and poverty. And that the cause of the pain, an inequitable distribution of vaccine, is too obvious to hide, will bring a string of nasty consequences.

One is that the legitimacy of the international order and its various institutions will plummet. Who, after all, will invest in global co-operation that fails? A second is that China’s global influence will increase dramatically as governments across the developing world become increasingly disenchanted with the West; indeed, the vaccine debacle offers China an extraordinary opportunity to exercise soft power.

A third consequence is that the grounds for grievance and radicalisation will have grown exponentially across many parts of the globe — an inequitable vaccine is tailor-made for end-of-world stories of anger and vengeance. A fourth is that conspiracy theories will grow wild. If Bill Gates is already the subject of a worldwide myth, imagine the tales that will circulate when the rich world recovers and the poor does not.

But the most foreboding part of the story is this. Covid-19 is no black swan. There will be more pandemics. And there will be many new global emergencies as climate change brings fire and flood. If humanity cannot orchestrate a global response this time around, what will happen the next time and the time after that? We are on the brink of an era when global governance will count for everything, and we appear to have made a bad start.

SA’s place in this dystopian story is very strange indeed. As an upper-middle income country it is well-placed to come out OK in the nasty, Hobbesian politics of the Covid-19 vaccine. It can afford to buy what it needs bilaterally; it has the health system to deliver vaccine into the arms of its population; and its government has the legitimacy to persuade most of its people to be vaccinated. What precisely has gone wrong becomes more opaque by the day. Health minister Zweli Mkhize speaks darkly of extortionate middlemen. His deputy director-general talks of Big Pharma’s prejudice against Africans. None of it adds up.

There is an eerie echo from the Aids pandemic. Back then a victorious battle over patents made antiretroviral medicine affordable, only for SA’s president to decide that HIV was a hoax invented by pharmaceutical companies for the purpose of selling drugs. During the pause that followed hundreds of thousands of his citizens died. Has the same happened all over again? Did SA hesitate to buy vaccine because it imagined a conspiracy among the powerful few? And, in so doing, did it fail to grasp that it was actually itself among the powerful few?

One wonders if the true story will ever become clear. But if that is indeed what happened it is spectacularly unhappy: a sovereign nation robbing itself of its own agency precisely when everything is at stake. Only the most cynical of storytellers could have made it up.

• Steinberg is a research associate at Oxford University’s African Studies Centre.