Winnie Byanyima, executive director of UNAIDS and under-Secretary-General of the United Nations, has issued a forceful call for equity in global access to COVID-19 vaccines, urging zero discrimination when it comes to health.
Her message comes on the occasion of Zero Discrimination Day, where “UNAIDS is highlighting the urgent need to take action to end the inequalities surrounding income, sex, age, health status, occupation, disability, sexual orientation, drug use, gender identity, race, class, ethnicity and religion that continue to persist around the world.
“Inequality is growing for more than seventy percent of the global population, exacerbating the risk of division and hampering economic and social development. And COVID-19 is hitting the most vulnerable people the hardest—even as new vaccines against COVID-19 are becoming available, there is great inequality in accessing them. Many have equated this to vaccine apartheid.”
As Health Issues India covered last year, as an example, sex workers are an especially vulnerable group during COVID-19. Our report outlined
“For sex workers, life was hard even before the COVID-19 pandemic – and life has become harder since. Access to healthcare – or lack thereof – is a significant challenge.
Limited accessibility to healthcare is an issue sex workers regularly face despite, as a 2017 study emphasises, “commercial sex workers…are a vulnerable section of the society with diverse health problems.” As Kranti, a Mumbai-based non-government organisation (NGO) that works with sex workers in the city’s red-light district Kamathipura (itself home to an estimated 4,000 workers according to Kranti), has pointed out, “access to healthcare is anyway difficult for sex workers due to the stigmatisation surrounding their work. Even at normal times, many doctors don’t want to touch or examine them because they think they will get sexually-transmitted diseases or other diseases from sex workers.”
The statement by Byanyima underscores the need for equity. “We demand an end to discrimination, stigmatization and criminalization,” it reads. “We challenge all institutions and all people of influence to not only be non-discriminatory, but to be anti-discrimination. Discrimination kills. It exacerbates emergencies and it perpetuates pandemics.
Byanyima fingers the problem of HIV/AIDS. “The world is off track to end AIDS by 2030 not because of a lack of knowledge, capability or means but because of structural inequalities that stand in the way,” the statement said. “For example, research shows that punitive laws regarding sexual orientation double the likelihood of acquiring HIV for gay men and other men who have sex with men. Repealing such laws is central to beating the HIV pandemic.” While having made progress in fighting HIV/AIDS in recent decades and repealing antiquated laws discriminating against the LGBTQ+ community in India, the country has a fair way to go before achieving zero discrimination against sexual and gender minorities. Dr Sameera Jahagirdar outlined the existing challenges poignantly in an interview with my colleague Nicholas Parry in 2019.
Vaccine nationalism is in the crosshairs too. As the statement notes, “we are seeing the discrimination that scars our countries play out also at the international level. As new vaccines against COVID-19 have become available, there has been gross inequity. Just ten countries have administered more than 75 percent of all COVID-19 vaccines, while more than 130 countries have not received a single dose. South Africa has called this vaccine apartheid. As the United Nations Secretary-General has said, “Vaccine equity is ultimately about human rights … Vaccine nationalism denies it.” Around the world, and in every country, we must value every person as equally precious.”
The message from UNAIDS is apposite, but it is important to emphasise that the inequities we are seeing are pre-existing conditions in themselves. “COVID-19 has magnified the fissures in society,’ the statement reads. “It has seen marginalised communities, who were already on the edge, taking the hardest economic hit, getting stuck at the back of the line for vital services and getting scapegoated for the crisis.”
India has witnessed inequities when it comes to global health for decades such as vast disparities in availability of and access to health infrastructure between urban and rural areas and between different states and union territories. The path towards zero discrimination ought to have been walked along long before now. The country’s advances in health are not insignificant, but to be of effect, they must be felt equally.