Vaccine sovereignty

How countries could sell immunity to the one percent

The Doctor. Luke Fildes, 1891.

This past semester, I took an anthropology class (on Zoom) about the concept of sovereignty: who has it, what it looks like, how it’s changed, and how it endures over time. Throughout human history, there’s pretty much always been something out there that represents to people a kind of supreme authority—whether it’s a single deity or a bunch of supernatural animal/mineral/vegetable spirits. It hasn’t always been bound by territory, and it certainly hasn’t always depended on a centralized state—these are relatively recent and Western concepts—but it’s been there in some form or another. Make of that what you will.

Today, we tend to think of sovereignty as the power that countries exert over their land and what’s on it. That includes the power to keep people out, let people in, detain people, wage war, issue currency, and write laws. Practically speaking, in December 2020, sovereignty also means holding the power to inoculate people against COVID-19: a supreme authority if there ever was one.

As far as I can tell, access to the vaccine remains, for now, firmly in the hands of individual states. They have struck deals with pharmaceutical companies either directly or through a supranational body like the World Health Organization to acquire doses for their population. They have decided, or are deciding, who will get the vaccine first. And as more and more drugs become available, states will be in charge of scaling up the inoculation process: again, partnering with a pharmacy chain or network of medical professionals, or doing it through their national health service, which sounds like a pretty nice thing to have. 

If you’re an average healthy youngish person in a wealthy country, you’ll probably get your shots by next summer. If you live in a poorer nation, you might not be so lucky. That also means your country probably won’t re-open as fast, its most vulnerable people will keep dying, and the cycle of inequality, death and destruction will keep pace. 

So there is absolutely nothing surprising about the spate of recent stories telling us that rich countries have bought up all the available doses and are even hoarding more than they can use. It’s also not news: anyone with half a brain cell saw this playing out from day 1 of the lockdown. Remember when all of downtown Manhattan went dark during superstorm Sandy but the lights at Goldman Sachs stayed on? We’ll get a version of that, but on a global scale as well as a national one.

It’s not yet clear if there will be additional options for citizens of one country living in another; it will probably depend on the countries. The U.N, which employs a large number of expats, issued a notice in November saying that while the “host” country should take the lead, it “recommends the creation of a small central stock to be strategically pre-positioned to meet the COVID vaccine requirements of UNCTs/UN Missions whose host country will be unable to meet their duty of care towards their UN population.” Translation: if you’re a peacekeeper in a supremely poor country with few resources, or an elderly assistant secretary-general in New York City, we’ve got your back. The rest of you, get in line. 

There’s also the possibility of states extending their vaccination drives beyond their borders. Being Swiss and Canadian and living in a country that has hardly inspired confidence throughout the course of the pandemic, I have a personal interest in this. I’m counting less on Canada, whose healthcare system is organized by province, and more on the Swiss, who are masters of disaster preparedness (my husband makes fun of me when I say the Swiss will show up at our door in a helicopter if/when the shit hits the fan, but I’m only half joking.) In any event, whether I’m in New York City or Geneva or Vancouver, I will probably be one of the last people to get it, and that’s how it should be.

What I’m currently obsessing over is what small, rich countries will do with a surplus once it is in their possession. In the best of worlds, they would donate it to poor countries, who will in turn give it to those who need it the most. But in our world—and, disclaimer, this is a bald projection based on a cynical hunch based on years of reporting experience—effective national monopolies over the COVID-19 vaccine could easily turn into a money-making enterprise not unlike previous attempts at commercializing state sovereignty. 

In other words: states could easily use their ability to acquire and distribute the vaccine to benefit the wealthiest foreigners.

You can easily imagine a Switzerland or a Singapore buying (or manufacturing) a surplus of doses; efficiently and swiftly vaccinating everybody who resides within their borders in order to re-open their economy; and then getting into the business of offering COVID-19 vaccines to foreigners with enough money to a) pay for the shots and b) spend a couple of months between injections in the country, possibly under quarantine. You might package this offering up as a spa vacation in the Alps, or a wellness package at the Marina Bay Sands. I also see countries bundling residence or citizenship with access to “health” or “insurance” services—code for a Covid-19 vaccine?—or even letting consuls around the world give out shots for money. The more you think about it, the more dystopian it gets; all I’m saying is that these hypothetical practices aren’t so far off what countries already do.

Now, I don’t believe this possible future is necessarily a worse one than if private enterprise controlled the vaccinations. There are unthinkably unjust downsides to that, too. But I do think this scenario illustrates how the qualities and powers of a sovereign—the things you can only do if you are an independent country—lend themselves to money-making, and ultimately constitute a kind of market of their own. 

Island nations used to sell postage stamps or lease area codes to phone-sex operators to make an extra buck: their state sovereignty gave them a monopoly over these utilities, and they saw little downside to meeting demand from philatelists and pornographers. Countries then got into the business of selling passports to rich people, or slashing taxes for corporations: somewhat less whimsical variations on the same theme.

This leads us to 2020 (or should I say, #2020): when the confluence of globalization, medical tourism and inequality in a pandemic gives countries the power not just to “make live and let die” to borrow a phrase from Michel Foucault (can you tell I’ve been taking a class at Harvard!?) but to potentially make money off of the decision. As per usual, some states will prove themselves to be more sovereign than others.