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Access to COVID-19 vaccines, key to ending the pandemic and its devastating consequences, is characterized by vast inequalities. High-income countries pre-purchased most of the initial supply of vaccines licensed to big pharmaceutical companies and approved in Europe and the United States, vaccinating their own populations ahead of the global interest in vaccinating healthcare workers and vulnerable people everywhere. The proposed multilateral solution to vaccine supply, the World Health Organization- and GAVI-backed COVAX initiative, has suffered from ‘vaccine nationalism’. While India was projected as the key source of COVAX’s initial supply, its vaccine production has also been redirected to domestic distribution. China and Russia have instead emerged as alternative sources of supply with their domestically developed vaccines. Amid overall scarcity, enormous controversy has emerged over how to scale up vaccine production and increase vaccine accessibility. The chapter reveals layers of vaccine inequalities not just between the Global North and South, but also within the Global South – especially between middle- and low-income countries. The chapter concludes that the challenge of providing COVID-19 vaccines, and the inequalities involved, appears indicative of wider challenges related to 21st-century global development.
COVID-19 is transforming national policies on an unimaginable scale: ‘austerity’ has vanished and (hyper)Keynesian spending is back; neoliberal regimes are making unimaginable welfare interventions; income support is favoured in some countries; and hyper-globalization policies are being reined in. Seemingly everything has changed. The initial pressures for these transformations focused on proximate problems: rapid responses to risks of premature death from a new disease and temporary support for employment, incomes, household food security and the economy. But, at a structural level, the coronavirus pandemic could help transform the institutions and norms that have underpinned global development in the early 21st century, for better or worse.
This may be a critical juncture (Green, 2020), where actions taken now could have legacies for decades to come. The pandemic could be a time for what Naomi Klein (2007) has called ‘shock doctrine’, where it is exploited for questionable purposes to create an unappealing future, or it could set the course for a better future. In this chapter, we explore three scenarios of ‘what’ the future might be like, rather than predictions, as an aid for those thinking about how to shape global futures.
The proximate impacts of the coronavirus pandemic have been extremely negative: public fear, increased mortality, loss of jobs and reduced or cessation (for example, especially for informal-sector households) of income, collapsed businesses, strained public health services, a massive rise in public debt, loss of personal mobility and threats of social and political breakdown. These negative impacts create processes that could greatly increase the likelihood of structural changes that undermine the prospects for human development. At the extreme, they include apocalypse.
