On April 9, 2021, only two days after receiving its first shipment of the COVID-19 vaccine, St. Vincent and the Grenadines suffered an enormous volcanic eruption. Plumes of smoke and ash billowed across the main island, necessitating a large-scale evacuation of its residents to neighboring countries. But, as Prime Minister Ralph Gonsalves explained in an emotional press conference, only vaccinated residents could be evacuated. The transporting ships, and the islands themselves, had vaccine mandates. This meant that only residents with preferential access to the vaccine—at the time, 10,805 out of a population of approximately 111,000—had the opportunity to flee.
The relationship between health status and freedom of movement is nothing new. A year earlier, in March 2020, as COVID-19 cases skyrocketed around the world, national leaders sought to protect their domestic populations by closing national borders. “Heath nativism,” we wrote in this magazine, was more than just public-health policy; it was an illogical attempt “to keep out that which is already inside, put borders around a problem that is borderless, and shore up an illusion of safety by projecting the origin of the problem as always somewhere else.” It was no surprise that Donald Trump would respond to a major health crisis by promoting a border wall and attacking China on Twitter. Trump, like many leaders before him, was leaning on a nationalistic association of disease and the enemy. COVID-19 is “our big war,” he declared in March 2020. “It’s a medical war. We have to win this war.”
At the time, we cautiously hoped a global response to the pandemic might still materialize. Scientists were only beginning to learn about the virus. There was still time for world leaders to form a collective plan. In the ensuing months, there was a Herculean effort to develop effective vaccines. But, despite the successful delivery of several vaccines, health nativism has only grown more entrenched. The problem is not just right-wing xenophobia but the purportedly science-based general response of the world’s richest nations to a major global threat. Policies regulating vaccine access and border closures have been dressed up as public-health initiatives but, in reality, have tended to support the same nationalistic agendas. The international cooperation needed to end this pandemic—and prepare for future ones—appears as far off as ever.
When Joe Biden became president, one of his first actions was to rescind Trump’s travel ban against travelers from primarily Muslim and African countries. On his second day in office, Biden signed an executive order saying the ban had “jeopardized our global network of alliances and partnerships” and “dulled the power of our example the world over.”
Apparently the same was not true of Trump’s other travel bans. Under Biden, the country’s borders with Canada and Mexico remained closed to non-essential travel. The administration also extended Trump’s ban on travelers from the United Kingdom, Ireland, Brazil, and the twenty-six countries in the Schengen border-free area of Europe. South Africa was added to the list of restricted countries. At the end of April, citing concerns about the spread of the Delta variant, Biden imposed restrictions on travelers from India.
Biden has used scientific language to distinguish his reasons for imposing travel restrictions from the racism and xenophobia of his predecessor. But border shutdowns rarely work to stop the progression of disease. Travel bans could, in theory, keep out the coronavirus, if they were near total and rigorously enforced. This is not what has happened. Instead, border policies have been implemented in a haphazard manner based on market imperatives rather than public-health policy. A large proportion of the initial spread of COVID-19, in early 2020, was due to people scrambling to airports before selective border closures went into effect. Since then, domestic case numbers have soared in rich nations, even as governments have continued to ban travel from countries deemed higher risk. The recent identification of the Omicron variant by scientists in South Africa has produced a rerun of March 2020, with many Global North countries rushing to block air travel from Africa, as if a new form of the virus can be stopped by border closures alone. When these COVID-19 travel bans are eventually lifted, it will not be because the virus itself has been eradicated or tightly managed. Bans will be lifted because of business, tourism, and trade interests. We have already seen that a number of countries slackened their COVID-19 border policies during holidays—a blatant acknowledgement of the primacy of politics and economics over public health.
The patchy implementation of border closures has in practice amounted to a large-scale version of “hygiene theater”—a term coined by the Atlantic’s Derek Thompson to describe the false sense of security provided by largely ineffectual measures such as temperature checks and plexiglass barriers. This false security has proved to be enormously profitable. Travelers to Canada and the UK, for instance, have been required, as a condition of entry, to pay anywhere from $200 and $400 for COVID tests administered by private companies. If the primary interest of these governments were public health, tests could have been provided free of charge. The tests themselves cost only a few dollars to make. Instead, the COVID protocols have lined the pockets of private companies, while making travel even more prohibitively expensive than it already is.
COVID-19 travel restrictions are built on the idea that they help keep us safe. For many people in the world, however, life has become considerably more dangerous as a result of border restrictions. During the first wave of the pandemic, offices in charge of filing asylum claims were closed in Europe, leaving refugees legally stranded. Camps run by nongovernmental organizations were also closed, and overcrowded boats of migrants were left adrift outside receiving ports, a form of de facto detention. Migrants trying to get to Australia were held indefinitely offshore in cramped, crowded detention facilities—prime conditions for the spread of the virus.
The disconnect between travel bans and public health was perhaps most pronounced at the U.S.-Mexico border last fall. After he was elected, Biden quietly extended Trump’s use of Title 42, a rarely invoked provision from the 1944 Public Health Service Act which allows immigration officials to expel migrants on the assumption that they will spread communicable disease. Against the advice of his own health officials, including Anthony Fauci, who stated that “expelling [immigrants] is not the solution to an outbreak,” Biden used the policy to justify deporting thousands of Haitians driven out of their country by a devastating earthquake. The horrific images of Border Patrol agents whipping back migrants in Del Rio signified more than American cruelty. They epitomized the audacity of a nation trying to blame outsiders for a pandemic of its own making. Not only did the United States fail to support a global vaccination program that could have minimized the spread of more infectious variants, such as Delta and Omicron; it has not adequately addressed widespread vaccination refusal among its own citizens, including the Border Patrol agents tasked with keeping out migrants in the name of public health.
Targeted border bans are gestures of control in a crisis, and they often accelerate anti-immigration initiatives that were in play long before the pandemic. Vaccines, by contrast, are legitimate public-health tools that can stop the spread of deadly disease, as demonstrated by the history of the smallpox and polio vaccines. A global rollout of vaccines would have undermined the apparent need to shore up national borders to end the pandemic. Instead, the scarcity of vaccines has made health nativism all the more pronounced. Because pharmaceutical companies like Pfizer and Moderna have sought to protect their vaccine patents (unlike the mid-twentieth-century makers of the polio vaccine), supply has remained extremely limited. Rich countries have simply paid to have priority access to this scarce supply, leaving most of the world’s population unvaccinated.
This uneven rollout has proved disastrous. The highly infectious Delta variant was spawned in India during a time of inadequate vaccine coverage. The Omicron variant likely arose in regions where vaccination rates were inadequate. Yet leaders of the richest nations still choose to back the intellectual-property regimes that created this disaster. Moderna, which received large-scale government investment in the development of its vaccine, has almost exclusively supplied rich nations. The company has faced little criticism and has dragged its feet when repeatedly asked by the World Health Organization to facilitate wider access. The global collaborative scheme COVAX, which aims to provide vaccines to the world based on need, was trampled by rich countries stampeding to get more supply for themselves. Born out of an idea that universal access and global solidarity were possible, COVAX has been hamstrung by individual nations looking to secure preferential supply and by companies more than happy to sell to the highest bidder. Researchers across the world raced against time to develop life-saving vaccines only to end up with world leaders, both in industry and government, restricting their distribution.
Biden has tried to mitigate the appearance of health nativism with splashy announcements of vaccine donations to poorer countries, many of which remain undelivered. A far more effective approach would be for him to demand that pharmaceutical companies open up access to their technology to allow for the rapid expansion of production in other countries. Though it is in the interest of the United States to support wider vaccine distribution—a higher global vaccination rate would prevent the emergence of new variants—the Biden administration appears more interested in staying on the good side of vaccine makers in order to ensure preferential American access. It is not hard to guess why. The United States has chosen to focus exclusively on its immediate interests—including access to boosters while much of the world awaits its first dosages of the vaccine—rather than use its leverage as a major customer to negotiate global access.
The protection of vaccine companies’ intellectual property rights has created the perfect conditions for nativist ideas to proliferate. The media’s breathless coverage of vaccine development and distribution over the past year—publishing weekly rankings and headlines about which country is winning the “vaccine race”—has made global health seem like an Olympic-style competition. All of this has been stunningly shortsighted and incredibly expensive, and it has led to more global deaths than there needed to be. According to Oxfam International, the estimated cost of providing a vaccine to everyone on the planet would be 1 percent of what COVID-19 has cost the global economy. Of course, these numbers pale in comparison with a more important figure: 5.1 million, the number of people who have died from the coronavirus as of November 2021.
The world population is now split between the vaccinated and unvaccinated. In the United States, which sits on hundreds of millions of vaccines, a vaccine passport is required for non-citizens entering the country, with no such requirements for citizens. Vaccine passports are meant to promote public health. They encourage people to get vaccinated by withholding the privilege of travel and keep public spaces safer by slowing rates of transmission. For most of the world, however, vaccination has not been a choice. And thus a solution thought by many to make good sense domestically has produced yet another form of health nativism. The motivation is understandable: rich societies are anxious to re-open, and unvaccinated people have a higher risk of carrying and transmitting the disease. Yet by restricting movement based on a good that remains inaccessible to much of the world, the United States has effectively made entry into the country dependent on a person’s country of origin. In the absence of concerted efforts to scale up vaccine access globally, this approach will only worsen existing inequalities.
In 1965, Frantz Fanon wrote that “science depoliticized, science in the service of man, is often non-existent in colonies.” He was referring to French restrictions on the importation of tetanus vaccines into Algeria during the country’s war of independence. While rich countries have not outright banned the export of vaccines today, the Global North has proven that its actions (or inactions) can still deny the supply of life-saving medical treatment to the Global South by limiting poorer countries’ ability to produce vaccines themselves. After recognizing the emergence of a familiar pattern—the reliance on a paltry and unpredictable stream of donations from vaccine-rich nations—scientists in South Africa, supported by the World Health Organization, have been working like Prometheus to reverse engineer the mRNA vaccine and break the chains of intellectual property for African countries. Using fragments of publicly available information to recreate the vaccine, these scientists are attempting to redress the power imbalance promulgated by pharma companies. We hope they succeed. Yet it is a shame that precious time that could have been used to make and administer vaccines must be used to rediscover already known science.
The past two years have given very little hope that powerful decision makers will work together to turn the tides. And, in the United States, we no longer have Trump to blame. Faced with the worst health crisis in modern times, Biden and other world leaders have chosen to support the interests of a few enormously rich companies. The same people who loudly disavowed Trump when he called COVID-19 the “Chinese virus” have embraced their own variety of nativism, exerting reckless privilege while claiming to act in the interest of public health. All of this should be a scandal, but it isn’t. For the most part, people in rich countries have been relieved and content to have themselves and their families vaccinated after months of restrictions. Other countries remain an afterthought. Years of jingoistic policy under Trump and other nativist leaders worldwide have not inspired hope for global solidarity.
The task ahead is to forge this cooperation. COVAX was an early seed of a vision of global solidarity and a system free from domestic agendas, but it faltered when the wealthiest counties pushed past its purpose to fulfill their own shortsighted goals. At the moment, discussions are underway among countries and multilateral agencies for the development of an international “pandemic treaty” that could alleviate some of this self-interest. The treaty would foster international cooperation for widened global vaccine distribution (especially to the Global South), data sharing, and pandemic alert systems. Like other treaties on climate or health, however, a pandemic treaty will be difficult to implement and enforce. It will also take considerable time to work out. Already, several members of the World Trade Organization, including the European Union, do not support the waiver of the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which would allow manufacturers to expand vaccine production. Can we anticipate that rich countries will sacrifice their priority access to a limited good for the sake of a pandemic treaty? If what is past is prologue, global cooperation in public health remains ever elusive.
Stephanie DeGooyer is an assistant professor of English at the University of North Carolina at Chapel Hill. She is the co-author of The Right to Have Rights (Verso). Her new book, Acts of Naturalization: Law, Literature, and the Making of the Paranational Subject, is forthcoming from Johns Hopkins University Press.
Srinivas Murthy is a clinical associate professor in the department of pediatrics at the University of British Columbia.