The distribution of coronavirus vaccine around the world is glaringly unjust. But many wealthy countries have an equity problem of their own.
Fair access to health services and the fight against unhealthy living conditions are the focus of the World Health Organization’s campaign for World Health Day on April 7th. Covid-19 has highlighted how some people live healthier lives and enjoy better access to health services than others. The vaccine supply reflects this injustice: the pandemic is a global problem, which can only be solved globally, but national self-interest dominates the politics.
Injustice is not only international, however, but also evident within the health systems of many industrialised countries. Underfinanced and inefficient, many have seen a deficit of care, resulting in long waiting times for necessary treatment. A two-tier set-up has emerged, clearly disadvantaging those with low incomes and little social security. The privatisation of services has reduced the ability of governments to allocate health resources where they are most needed. The discriminatory effects of health systems have even become dangerous drivers of the pandemic.
‘One observation made by many country experts is the rapid growth of private sector activity in health care, which undermines the principle of inclusive health care,’ according to the Bertelsmann Foundation’s latest Social Justice Index, which examines health as one of six measures of social justice in 41 industrialised countries.
A prime example is the United States. The most expensive healthcare system in the world lacks comprehensive insurance and doctors’ and hospital bills are responsible for around 60 per cent of private insolvencies. For fear of being bankrupted by illness, many have delayed being tested for the coronavirus or seeking treatment—a perfect breeding-ground for the pandemic.
Numerous studies in the US show that blacks and Latinos are at increased risk of contracting Covid-19, suffering severe symptoms and even dying. The Kaiser Family Foundation finds across states that black and Hispanic Americans are also disadvantaged in access to vaccination, even though their risk of illness and death is significantly higher than for whites.
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For a decade and a half, the Sustainable Governance Indicators (SGI) of the Bertelsmann Foundation have provided a benchmark for the policies and governance capabilities of members of the Organisation for Economic Co-operation and Development and the European Union. They specifically assess the extent to which national health policies enable high-quality healthcare which is accessible and cost-efficient. Experts see serious deficiencies in 13 countries—11 of them EU member states.
One is Greece, where austerity policies have wrought an oversupply of private medical services. Among industrialised countries, Greece has the highest density of doctors—yet there is a shortage of general practitioners and, above all, nurses. Most of the many specialists work in the private sector because, according to the SGI country experts, they lack incentives to work for the state healthcare system. The authors criticise the ‘high volume of unrecorded and untaxed transactions between patients and doctors as well as a differential in healthcare access based on the purchasing power of households’.
How this plays out amid a pandemic became clear last November, when the Greek Ministry of Health felt compelled temporarily to nationalise two private clinics in Thessaloniki—so that they would admit Covid-19 patients, which they had previously refused to do for fear of damaging their image. And in the third coronavirus wave of recent weeks, the health minister, Vassilis Kikilias, announced that if necessary he would compel the recruitment of private doctors to treat Covid-19 patients.
Hungary’s health system also has serious equity problems. According to the SGI country experts, ‘The Orbán governments have failed to tackle the widespread mismanagement and corruption in the health sector, the large debt burden held by hospitals, the discretionary refusal of services by medical staffers, and the increasing brain drain of doctors and nurses to other countries. Good quality services are available in the private sector, but only for a small share of society.’
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Despite such harsh comparative international assessments, the prime minister, Viktor Orbán, has always considered the system well-equipped in facing the pandemic. Indeed, the government has made a lot of progress: gaining broad support; starting its own production of disinfectants, protective equipment, medical consumables and ventilators; building temporary hospitals for Covid-19 patients; and, as part of Orbán’s ‘pragmatic foreign policy’, purchasing Russian and Chinese vaccines, while EU approvals remained pending.
The extent to which the Hungarian system remains nonetheless under pressure can be seen in a law which came into force last month: health-care workers face a three-year prison sentence if they accept ‘thank you’ money. Patients can also be sentenced to prison for offering bribes.
Even relatively upright Germany has experienced cases of people profiting from their connections, in terms of vaccinations and pandemic shortages.
Many studies of disadvantaged populations make clear that the fight against Covid-19 is a justice issue internationally, as well as within national borders. Giving privileged people preferential treatment and access to vaccination contradicts democratic values of equality for all citizens.
Even in the richest countries of the world, governments must ensure equity infuses all aspects of their pandemic response—so that public trust in their political systems is not squandered.
Translated from the German by Jess Smee