Covid-19 Vaccine Apartheid: Palestine
Abstract: The outbreak of Covid-19 has not merely caused a global economic recession in both advanced economic, and Low- and middle-income- countries, but further triggered social injustice regarding the non-equitable distribution of Covid-19 vaccinations. With the emergence of Covid-19 vaccinations through three international private corporations, socio and political-economic issues were on display. Manufactured vaccinations were associated with patent rights, thus preventing all other countries from manufacturing its own Covid-19 vaccines, leading to an insufficient amount of manufactured vaccines. Moreover, the process of distributing Covid-19 vaccinations mainly targeted powerful economies with no limitations or restrictions on the amounts to be purchased, for the purpose of sustaining profit. Several advanced economies like Israel and the United States of America were able to commence their second wave of vaccination, while most LMICs did not receive their first batch of vaccines. Lastly, the price fixation of Covid-19 vaccines was high and did not adopt an equitable “strategy” where LMICs would be able to purchase the same vaccinations but for lower prices. On the contrary, most LMICs, like South Africa, had purchased Covid-19 at a surge of 2.5 times the original price for smaller amounts. The inaccessibility of Covid-19 vaccines due to their high price has caused delays and shortages of vaccination in LMICs. This caused international humanitarian organizations to call upon international corporations to imply equitable strategies in the distribution of Covid-19 vaccines. Furthermore, a union of international organizations has been formed, in an effort to waive patent rights of Covid-19 vaccines, in order to produce sufficient units of Covid-19 vaccines for LMICs at equitable prices. This paper shall undertake the issue of Covid-19 vaccine’s non-equitable distribution in LMICs through a case study approach: Jurisdiction of Palestine, on both socio-economic and political stances. The Palestinian case study is unique for it does not merely provide a fertile research environment for socio-economic factors, but further provide political factors where the dynamic between an occupant -represented by “Israel” as a contrast case study-, and the occupied -represented by Palestine- is underlined in the context of Covid-19 vaccines distribution. In an effort to underline the Covid-19 vaccination apartheid system and propose a list of guidelines for states and international humanitarian organizations to adopt.
Keywords: Covid-19, Vaccination, Covid-19 vaccines, social justices. Covid-19 vaccine apartheid, LMICs, Palestine.
During the economic recession accompanying Covid-19, numerous social injustices were on display, Low -and Middle Income- countries were suffering from shortages of essential preventive tools, from testers to face masks and oxygen machines, or, in later stages, difficulties in accessing Covid-19 vaccines, while on the other hand advanced economic countries were having direct market access to Covid-19 testers’ kits and preventive tools.
Low- and middle income- countries were the last to receive Covid-19 testers due to their high prices, leading to a massive growth of Covid-19 cases with the presence of indigent to non-existent governmental provisional measurements. Europe including Italy, Germany and the UK had accessed its first batch of testers earlier 2020. On the other hand, LMICs were able to access and purchase Covid-19 analytical kits only several months post their market disposal and in limited quantities. This is due to two reasons - first, Europe exposure to Covid-19 in rapid numbers before the mere arrival of the virus to LMICs, second and most importantly, due to the ability of advanced economies to outbid Low- and middle income- countries for limited supplies.
The inequitable accessibility of Covid-19 testers was not the mere ground raising social injustices questions, but further the distribution of Covid-19 vaccines underlined the dilemma of equitable distribution. The market surged with three different vaccines late December 2020, manufactured by private national and multi- national corporations, associated with patent rights.
Due to the high prices of Covid-19 vaccines set by private corporations, and limitations of manufacturing by merely three corporations worldwide, advanced economic countries were able to obtain vaccines batches in early stages, while Low- and middle income- countries have been struggling to access Covid-19 vaccines until this very day. United States of America was able to purchase Covid-19 vaccines by the multi-national corporation “Pfizer”, leading to the administration of 40 million shots only by the first week of February 2021. On the other hand, Oman was able to purchase and distribute 20,000 vaccinations by end of January 2021 approximating to merely 0.24% of its population.
Socio-economic issues are not the sole social injustices arising from Covid-19 vaccine distribution, politico-economic issues have also been on display. Palestine as an occupied state with a captive economy, has not only been facing economic stagnation to access Covid-19 vaccines, but further political obstacles are straining the Palestinian government from providing the needed vaccines to the Palestinian people. This has led to a drastic increase of Covid-19 cases during the period of vaccine dispatch in the international market — December 2020 — February 2021.
In this paper, the author shall provide a socio-economic and political analytical study of Covid-19 vaccinations distribution dilemma in Low- and middle income- countries through a case study approach: Palestine. The Palestinian case study is unique for it does not merely provide a fertile research environment for socio-economic factors, but further provide political factors where the dynamic between an occupant -represented by “Israel” as a contrast case study-, and the occupied represented by Palestine is underlined in the context of Covid-19 vaccines distribution. In an effort of underlining the Covid-19 vaccination apartheid system, and proposing a list of guidelines for states and international humanitarian organizations to adopt.
Covid-19 and the Palestinian Economy
Palestine is an occupied LMIC where most of its income is dependent on international aid and funds primarily due to the Oslo Accords where[i] international aid and funds to the Palestinians were regulated within the treaty itself, causing further economic dependency. In addition to international funds, Palestine as an LMIC is also severely dependent on imports, especially from Israel as a matter of de facto, and per the Oslo Accords’ annex: Paris Protocol[ii].
The captive economy of Palestine is indeed a unique case study. The incapacity of increasing and structuring the low economy of Palestine is not solely due to inadequate management and third-party exploitation of natural resources, but also due to economic restrictions imposed by Israel throughout the Oslo Treaty[iii] where under its Paris Protocol: Palestine is limited by the quantity and scope of materials it is eligible to import. The underlined “catastrophic” process of importation by Palestine is also subject to further restrictions per the Oslo Accords, where Israel acts as an intermediate party between Palestine and the Supplier for the purpose of collecting taxes, where the Palestinian revenues and importation or exportation taxes’ end up being hindered and delayed by Israel, leading to political economic injustices and pressures.
The Palestinian economy is subject to further Israeli peculiar restrictions, leading to its paralyzation and contribution of engineering the illusory status of the “Palestinian independent national Economy”. For instance, per the Oslo Accords, Palestine is deprived of having its own national currency. The underlined treaty imposes the Israeli currency “shekel” as the national circulated currency in the Palestinian market.
This unstable economic environment has provided a fertile soil for the Global Economic recession of Covid-19 outbreak, leading to a severe depression in the Palestinian economy. The Palestinian market has witnessed a decrease in an amount of 12% in its overall economy due to the plague of Covid-19.
Due to the Covid-19 recession, proportions of poverty in Palestine have escalated to 30% in comparison with the poverty statistics of 2019. In addition, unemployment ratios during the first trimester of 2020 increased by 25%, escalating to 26.6% during the second trimester. In addition, the productivity proportions have fell immensely in the Palestinian market, due to the inability of employees to attend their work place owing to the continuous lockdowns, and inconvenient transportation measures.
Unlike advanced economic countries, where timely and adequate provisional measurements were taken to provide the essential needs for the unemployed and limitation of poverty proportions, Palestine lacked the funds and means to impose precautionary measurements. For instance, in Israel unemployed state-funds were disposed to the unemployed due to the Covid-19 outbreak starting late February 2020. Not to mention that it was able to issue instructions pardoning tenants from paying rents. On the other hand, Palestine with its shell economy[iv]does not possess within its institutional infrastructure an unemployment state fund department, due to its scarce income. In other words, Palestinians who lost their jobs, and small businesses which shut down due to Covid-19 pandemic, had neither state support nor any alternatives.
The outbreak of Covid-19 in LMICs did not merely lead to economic depletions in Palestine, but social injustices as well: access and distribution of preventive Covid-19 tools and testers. Due to the purpose of this paper, we shall undertake vaccines as our case study.
· Covid-19 Vaccines’ Apartheid in LMICs
Due to high prices of Covid-19 vaccines set by private corporations, along with a production shortage due to vaccine manufacturing by merely three corporations worldwide, the dilemma of equitable distribution took a center stage once again. Covid-19 vaccination corporations have distributed their limited products in advanced economic markets at first, on the sole ground of making profit and without setting a limitation on the amount to be purchased by advanced economies prior to LMICs access to vaccinations. On the contrary, several advanced economies like the United States of America were able to commence their second wave of vaccination while most LMICs did not receive their first batch of vaccines.
For example, Israel as an advanced economy and the captive of the Palestinian economy by virtue of the Oslo Accords, was one of the first countries worldwide to access Covid-19 vaccination in massive amounts, while Palestine on the other hand until this day suffers from its incapability to provide vaccinations for its people. Israel has been able to vaccinate 44.1% of its population only by the second half of February 2021.
LMICs are currently short of Covid-19 vaccines, for they lack the needed income and funds for the purpose of manufacturing, not to mention that the potential of Covid-19 vaccines manufacturing is currently out of play for LMICs, due to patent rights associated with the Covid-19 vaccines.
In addition, dependency of LMICs on advanced economic countries for the purpose of importing Covid-19 vaccines was faced with unusual obstacles if not being out of reach for most. This goes back to a couple of reasons: first, most LMICs lacked the funds to import Covid-19 vaccines in the first place, due to its high price, second, Covid-19 vaccines manufacturers are targeting mainly large markets like Europe and North America where profit can be achieved and sustained.
Covid-19 Vaccines’ Apartheid in Palestine
Upon the dispatch of Covid-19 vaccines in December 2020 into the “free” market, Israel was one of the first successful countries to purchase five and half million of Pfizer vaccines, and later on to place further orders for the US vaccine: 'Moderna', post one month of Covid-19 vaccines dispatch in the international market.
By mid-January Israel was able to vaccinate more than a quarter of its nine million population, in a record time of less than a month. The Israeli vaccination process is indeed a case study to be further analyzed under international law and the fields of social justice. Israel commenced its vaccinations immediately after the dispatch of vaccines in the market, and efficiently in all of its territories to all of its nationals and residences under the “equitable priority criteria” –eldest first.
The only residences in which Israel has left at the back end of its vaccinations process are Palestinians of Eastern Jerusalem. Regardless of the fact that residences of Eastern Jerusalem hold Israeli national ids, pay their taxes directly to the Israeli government, and obtain health insurance and coverages from Israel. Health insurances held by Palestinian residences in Eastern Jerusalem are variant in quality and quantity of the offered health services, in compassion to other “non-Palestinian” Israeli residences. Thus, it is evident that Israel's vaccination is not merely colonialist[v], but imposes a systemic apartheid system upon Palestinians.
On the other hand, Palestine as a Low-income country and occupied state with a captive economy, mainly dependent on international aid and funds, along with de facto importations from Israel, was not able to purchase nor access vaccinations. De facto importations are a set of goods and materials that Palestine by a de facto circumstances starting from the stipulated lists of the Oslo Accords where an exhaustive set of materials are to be imported from third party states bind the Palestinians, along with the complex and prolonged procedures of importation due to Palestinian borders control by Israel. Thus, Palestine finds no other alternative but to accept the purchase of stipulated and non-stipulated materials and goods under the Oslo accords from Israel itself, along with other materials to dodge the hurdles of third-party importation.
The unique situation with the Palestinian inability to access Covid-19 vaccines in an equitable matter to advanced economic countries exceeds the frame of insufficient income. Palestine as occupied territory has demanded Israel per Geneva the fourth[vi] and Oslo Accords -where Israel undertakes the duty of providing medical and health assistance as an occupier- to provide vaccinations for the Palestinians. However, Israel did not approve nor uphold its duties under international law, leading to the delay of vaccination, and thus a continuation of economic and health depression deriving from the incapability of limiting the outspread of Covid-19.
International humanitarian organizations, from the Humanitarian Committee of the UN, to Amnesty International, urged Israel to oblige with its duties as an occupier power under public international law, in order to provide and allow the vaccinations of Palestinians. Post international pressures from humanitarian organizations, and most importantly requests placed by nationals of Israel to vaccinate their Palestinian employees in fear of further spread in the Israeli territories, Israel approved upon the vaccination of Palestinians by late January 2021.
Palestine as an LMIC is not merely limited by its importations per Paris Protocol lists, or by the need of obtaining an Israeli approval upon its importations —as witnessed under the Covid-19 vaccinations— but further limited by the scope of its importation on the de facto customs and actions by Israel. According to Paris Protocol, vaccinations are not listed as non-importable materials, or even limited by their quantity. On the contrary, Paris Protocol explicitly indicates that Israel shall provide its medical, health, and even share its medicinal knowledge with Palestine. Nevertheless, Israel has breached the bilateral treaty through its forced de facto importation customs by conditioning the nature and type of vaccinations Palestinians to be entitled to.
This conditioned approval on vaccinating Palestinians with a different type of vaccine than the one given to the Israelis, and previously rejected for usage in Israel itself, Sputnik Vaccine, is an evident form of a systematic apartheid regime.
Therefore, by end of January the Palestinian government was able to receive its first free 5000- unit batch of Sputnik vaccinations granted by Russia, to its five million and a half population, which was merely allocated to first aid and front line Covid-19 emergency workers.
Palestine has discussed its interest and need of obtaining further vaccination batches with Sputnik. However, the manufacturing corporation offered pricing of USD 18 per unit. Due to the arbitrary fixation of prices to an LMIC and occupied territory, Palestine wasn’t able to place further orders but instead has been going through a negotiation process with Sputnik regarding its pricing policy.
Thus, it is evident that the distribution of Covid-19 vaccines to LMICs and especially to occupied Palestine is inequitable and further impose a systematic form of apartheid regimes, along with monopolies on limited supplies to Low- and middle-income- countries whether by advanced economies or private corporations.
Social injustices deriving from epidemic vaccines’ and manifesting in the form of inequitable distribution, is indeed not a newfangled issue in our third decade of capitalism. During the Influenza Pandemic, social injustices deriving from distribution of vaccinations had also occurred. In response, the World Health Organization-WHO had issued a planning checklists and guidelines for countries and states to adopt, where it stipulates that states plans’ should include and undermine “ethical issues”. Despite the effort, the ambiguous terminology and guidelines of “ethical issues” did not limit social injustices in distributions of vaccines, nor did countries include the poor or minorities to participate in the preparation of those checklists.
In light of the above, several guidelines can be taken into consideration whether by states, international organizations, or advocates and scholars, in order to avoid socio-economic crisis, and provide an equitable distribution mechanism through undertaking the following measurements:
a. World Health Organization (WHO) to amend its “Influenza guidelines” planning checklist for states and countries to adopt, by further elaborating on vaccines and preventive tools equitable distribution under the section of “ethical issues”.
b. World Health Organization (WHO) to issue recommendations and resolutions on preventing the association of patent rights to vaccines by private corporations, at times of epidemics and crisis.
c. Private Corporations to adopt ethical planning and price fixation within their strategies, especially for materials in association with health crisis and epidemics. Deriving from their duty to oblige by international law, where it is a human right for all to access vaccinations.
d. Support the “Covid-19 People’s Coalition”: an alliance constituting of international organizations such as Amnesty International, Frontline AIDS, Global Justice Now and Oxfam, advocating and demanding the waiver of patent rights on Covid-19 vaccines. In order to produce sufficient and more reasonable prices of Covid-19 vaccines to LMICs, minorities and the poor.
e. Scholars or news platforms writing and advocating for social justices regarding Covid-19 vaccination distribution, shall emphasize on the fact that this is a matter of equity in distribution and not equality.
However, the question remains wide open: would the issue of global vaccine apartheid be limited by mere technical solutions and proposals? Or does it require a more in-depth reformation of the global system of distribution in general and vaccinations in specific? A reformation capable of attaining the root of our modern distribution dilemma, decolonizing international economy and its governing laws.
[i] Oslo Accords, Annex IV of the Declaration of Principles (DoP). [ii] “Under the Paris Protocol, the Palestinian Authority was made dependent on Israeli rebates of Customs and import taxes.” The Palestinian Economy Macroeconomic and trade policymaking under occupation*, United Nations Conference on Trade and Development, 2012. [iii] Bilateral treaty signed between Israel and the Palestinian Liberation Organization, with the supervision of United States of America government, in 1993. [iv][iv] Shell Economy: an economy in which its apparent status and conducted transactions coveys an independent national economy, while its being captivated and monopolized by a third-party economy. [v] “Colonialism is a practice of domination, which involves the subjugation of one people to another.”, Stanford Encyclopedia of Philosophy, 2017. [vi] Geneva the Fourth 1949, Article. 55.
This piece has been authored by Nawal Hend.
She is a lecturer of Law at Jindal Global University, and a previous International Arbitration Lawyer at Herbert Smith Freehills Law Firm- New York. She has also worked as an international lawyer at Equity Legal Group in Jerusalem: ICC representative of Palestine. She has obtained a master's degree in law from Pennsylvania State University, and a certificate in Intellectual Property Law from Harvard University.