On our minds: The story behind concerning statistics out of Africa and parts of Asia. |
How Covid Revealed the Still-Raw Legacy of Colonialism |
 | | A polio vaccination in 2005 during a nationwide push to inoculate every child under 5 in Nigeria.Chris Hondros/Getty Images |
|
The coronavirus pandemic has played out along some of the deepest-seated issues in the world today — inequality, social distrust, the hurdles to global coordination among great powers, even when it is in their interest to work together. |
Now, as vaccines finally, belatedly reach poorer countries in Africa and Asia, the pandemic is highlighting something else: the pernicious legacy of colonial and post-colonial abuses. |
As vaccines arrive, a lot of people in those countries are eagerly receiving the shots — but not as many as you might expect. In South Africa, weekly vaccine uptake began dropping when about 36 percent of adults were fully vaccinated. The country even turned away new vaccine shipments last week, announcing its already-stockpiled 16 million shots were at risk of spoiling. Several other countries in Africa also asked donors to pause vaccine deliveries for similar reasons. |
This is partly because of weak or underfunded public health systems that struggle to administer the shots. But it is also related to a longstanding issue: vaccine hesitancy among rural and marginalized communities within these countries. |
"There's no doubt that vaccine hesitancy is a factor in the rollout of vaccines," Matshidiso Moeti, the Africa director of the World Health Organization, told my colleague Lynsey Chutel for an article we wrote on this issue. |
There are two important pieces of context here. First, vaccine hesitancy is a problem in a lot of places, including the United States and Europe, so it's hardly unique to Africa or Asia. Second, hesitancy is not the main reason for low vaccination rates in many countries. Rather, it is that vaccines have simply not arrived because of sluggish and insufficient foreign donations. But, as doses do arrive, the scale of hesitancy is becoming apparent. |
Part of the issue, said Saad Omer, a Yale University epidemiologist with long experiencing in lower-income countries, is a disparity in wealth and health care services. Many people are (or remain) "soft" hesitants — not naturally inclined to leap at being vaccinated but not absolutely opposed, either. In wealthier countries, efforts to persuade those people have been extensive and pretty successful. Billboards and advertisements. Exhortations from leaders and celebrities. Online registration systems, pop-up clinics and mobile vaccination centers to lower the barriers to access. |
But those persuasive systems are weak or nonexistent in parts of the world's poorest countries. As a result, the fence-sitters are never nudged onto the vaccination side. |
"Why do we expect that all we will have to do is drop vaccines at an airport, do the photo op, and people will come running to the airport and grab the vaccine?" Dr. Omer said. |
But the other major driver of this problem is one that has shown up in past global inoculation campaigns: skepticism of public health authorities — especially those seen as being aligned with the West — as a result of generations of abuse and exploitation. |
Colonial authorities used the guise of public health to commit horrifying abuses. During the early 1900s in what is now Namibia, for example, German officials injected some civilians with arsenic, sterilized others and deliberately infected many with diseases like smallpox. Even when British authorities in India sought to spread legitimate vaccines against cowpox, they sometimes did so by force and with little explanation. |
Abuses committed after colonialism have perpetuated distrust of outside health authorities for many in Africa and Asia. |
"I broke the door down and vaccinated — with a struggle — every member of his family," Stanley Music, an American official with the World Health Organization, wrote in the 1970s, referring to a man in Bangladesh who had barricaded his door against vaccination workers. |
Dr. Music, in his recollections of the global smallpox campaign, described many such encounters in formerly colonial South Asia. |
"She said that if I didn't care whether or not she died of starvation, why should I care if she got smallpox," he wrote of a woman in Bangladesh. "After explaining that she was a risk to others in villages where she might beg, I told her that I had no choice but to vaccinate her with or without her consent. I promised to arrange some food for her and then vaccinated her myself." |
Perhaps as a result of this, the smallpox campaign took 28 years to complete, much of that spent physically imposing the vaccines on reluctant communities in these countries, which just deepened hesitancy. |
Another important bit of context: Issues with hesitancy are not universal to post-colonial Africa and Asia. Uptake is often high in cities. The issue is specific to rural areas and marginalized people, who have the longest and deepest history of facing exploitation. |
Western drug companies have also played a significant role. In the 1990s, some conducted drug trials in Africa without informing people, essentially treating them as unwitting participants. Only a decade ago, Pfizer made financial payments to the parents of children who died in Nigeria after a research trial went wrong. |
Civil wars and internal conflicts that erupted after colonialism deepened the problem, extending many communities' distrust to their national governments. |
In Nigeria in the early 2000s, amid a spike in religious tensions, unfounded rumors circulated that foreign health workers were using polio vaccines as cover to sterilize the country's Muslim population. Boycotts and local bans led to a polio resurgence there, with cases spreading to 15 other countries as far as Southeast Asia. |
"Ten years ago all seemed to be going well with poliomyelitis eradication," the public health experts Heidi Larson and Isaac Ghinai wrote in a 2011 article for Nature. But that effort, which is still ongoing, has slowed and sometimes stalled among these communities. |
"Families closed their windows and doors when they heard vaccinators approaching," they wrote of their efforts in India. "One vaccinator showed us scratches on her arms where household members had physically resisted immunization." |
The consequences of this are already becoming apparent with Covid-19. |
Though outright opposition to Covid vaccines is low overall in India, for example, soft resistance is higher and is often clustered in poorer regions. Up to one third of vaccines are at risk of spoiling in some Indian states. In a survey of 15 African countries, 49 percent of the respondents said they believed that Covid had been planned by a foreign actor and 45 percent said they believed that Africans were being used as unwitting participants in vaccine research. |
My colleague David Leonhardt, in writing up our story for The Morning newsletter, drew an important parallel between this trend and hesitancy in the United States: public distrust. |
In the United States, the causes of this distrust are different, but the effect is similar: Polarization is leading a large minority of Republicans to avoid vaccines that they associate with Democrats and with government institutions in general. |
This makes the U.S. version of the problem even harder to address because it is ingrained in the American political system as a whole. Persuasion, mandates and other methods can curb the effects of this distrust. But the distrust cannot be fully solved without fixing the political polarization that causes it. But many actors in the United States benefit from polarization, making it hard to create consensus for easing it. |
In Africa and South Asia, that distrust is something that everyone, at least in theory, should have an interest in resolving. If the world wants to exit from the pandemic, dealing with distrust may be a global necessity. But this would most likely require addressing the very real roots of that distrust. Rather than merely overpowering these communities as they have in the past, international health authorities and national governments may have to, at long last, win their trust. |
Writing in The Atlantic, Barton Gellman looks at the risk of another event like the Jan. 6 attack on the Capitol. He examines not just the political machinations but the bottom-up social causes of this: |
Counties won by Trump in the 2020 election were less likely than counties won by Biden to send an insurrectionist to the Capitol. The higher Trump's share of votes in a county, in fact, the lower the probability that insurgents lived there. Why would that be? Likewise, the more rural the county, the fewer the insurgents. The researchers tried a hypothesis: Insurgents might be more likely to come from counties where white household income was dropping. Not so. Household income made no difference at all.
Only one meaningful correlation emerged. Other things being equal, insurgents were much more likely to come from a county where the white share of the population was in decline. For every one-point drop in a county's percentage of non-Hispanic whites from 2015 to 2019, the likelihood of an insurgent hailing from that county increased by 25 percent. This was a strong link, and it held up in every state. |
- Why TikTok is becoming a center of digital vigilante justice — sometimes with devastating consequences.
- People become more supportive of immigration if they are told that their country's borders are secure (and less supportive if they're told the borders are not secure), according to a new study by the social scientists Ryan Briggs and Omer Solodoch.
- Do you remember Stephen Glass, the New Republic journalist revealed to have committed plagiarism so egregious it became the basis of a Hollywood movie? Whether you do or don't, you will want to read Bill Adair's unforgettable chronicle of Mr. Glass's life since.
|
|
No comments:
Post a Comment