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Akanksha Singh is an India-based journalist and political commentator.

In April, 2020, two French doctors suggested that a potential COVID-19 vaccine should first be tested on people in Africa. Their logic: To see whether a tuberculosis vaccine would prove effective against the novel coronavirus in a place where “there are no masks, no treatment or intensive care, a little bit like it’s been done for certain AIDS studies.” Debates about “white saviour” attitudes rightly followed, even as “experts” in the West continued to wonder why Africa’s COVID-19 numbers were so low.

Pharma companies raced to develop the first safe and effective vaccine, with the Pfizer-BioNTech shot earning that title when it was approved quickly by Britain – “ahead of the U.S. and Europe,” as headlines reminded us – giving rise to vaccine nationalism. The lower-income countries known euphemistically by some as comprising the “Global South” will get a vaccine eventually – around mid-2021, by most estimates – but only once wealthy countries have had their fill. The implicit message is that there must be a winner, which will get to heal its economy while protecting its population before everyone else.

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This is all imperialism, by its very definition: policies by which a country extends its power and advantages to gain political and economic control of other territories and peoples. Indeed, on Monday, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, warned that inequitable vaccination efforts have put the world “on the brink of a catastrophic moral failure.”

White men have long felt the burden to “civilize” the non-white world with food, medicine, faith and morals – for a price, of course. The smallpox vaccine, pioneered by an English physician named Edward Jenner, was deployed accordingly in the rising British empire; people in colonial India were vaccinated to save “numerous lives, which have yearly fallen a sacrifice” to the virus, with the promise of “increased resources derived from abundant population.”

The COVID-19 vaccine represents more of the same. Just as the pandemic had no regard for human-made borders, vaccine access shouldn’t either – and yet, there is clearly an order to things. “In keeping with the longstanding pattern of political behaviour during pandemics,” wrote David P. Fidler, fellow at the Council on Foreign Relations, “vaccines will eventually reach most populations, but only after powerful countries have protected themselves.”

We should know better by now. We know that pandemics disproportionately affect marginalized communities. We know that the 1918 Spanish flu pandemic spread to countries such as India by ship, killing more than 10 million people there, compared with 675,000 in the United States. In Canada, First Nations people living on reserves died from the influenza at more than five times the national rate. And the groups responsible know we need change: Just this past summer, the Black Lives Matter movement prompted organizations, including Pfizer, to “speak up against racial discrimination and injustice.”

Health care services remain largely constructed on the remnants of colonial pasts, and to address that, we need to accept that the playing field was never level to begin with. Medical “advances” in gynecology came at the cost of enslaved Black women, upon whom experiments were conducted. Trials for a plague vaccine were carried out on prisoners in Bombay, much as COVID-19 vaccine trials in India have fallen along caste lines. The vaccine developed for rotavirus was effective in Europe and North America but not in Africa because it was only developed for strains in those regions. Europeans brought sickness to the New World.

Decolonizing the structures undergirding the latest vaccine race starts at the grassroots: addressing who attends conferences, how research teams are built, and whose research gets to be in mainstream literature. The WHO itself failed to understand the differences between the West and the Global South, proposing social distancing measures and 20-second rigorous handwashing even though congested slums lack clean, running water and a bar of soap.

Most crucially, we need to start holding those with capital accountable. If pharma companies are truly committed to fighting global health care inequities, they need to be willing to share – even at the risk of their profit margins. The People’s Vaccine Alliance, a network of organizations that includes Amnesty International and Oxfam, has declared that if the pharma giants made their technology and research public, more doses could be made available, more affordably. Instead, while the wealthiest countries can vaccinate their populations nearly three times over by the end of 2021, “nearly 70 poor countries will only be able to vaccinate one in 10 people against COVID-19.”

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Pandemic recovery won’t be easy for any country. But if one country’s vaccines create obstacles for others, we have to reflect on whether a cure should come at the cost of our humanity.

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