This piece has been authored by Bhakti Makhija ,O.P Jindal Global Law School
Introduction:
Colonialism in the modern era is very different from colonialism in the past. In order to maintain influence over less powerful nations today, economically developed nations do not need to invade, establish physical colonies, or use force to impose their will. Today’s neo-colonial power dynamics and strategies are more nuanced and subtle. One significant distinction is the advent of global health in the 1990s and early 2000s, which has evolved into a means to impose soft power political pressure on country-led decisions in favour of countries providing help. The impact of these relationships which are built on reliance, submission, and Shylock-like debt—are problematic. Nonetheless, they persist through public health and global health, offering humanitarian relief, INGOs, and global health governance, operating within a colonial paradigm.[1]
This paper aims to trace the roots of colonialism and global health, its evolution into neo-colonialism, and its impact on contemporary global health hazards such as COVID-19 Pandemic.
Roots of Colonialism and Global Health:
“Colonialism is ‘control by one power over a dependent area or people’. It occurs when one nation subjugates another, conquering its population and exploiting it, often while forcing its own language and cultural values upon its people. By 1914, a large majority of the world’s nations had been colonized by Europeans at some point.”[2]
It is important to explore the history because of the tangible impacts colonial legacies have on contemporary global health scenarios.[3] [E21] The methods colonists employed to take control of the colonies and keep it that way, as well as to continue to exploit the people and lands they colonized for economic gain, included discrimination, racism, oppression, and, at times, terrible brutality and murder. These wrongdoings infiltrated the field of public health. As a result, even centuries later, colonial practices and power dynamics related to health and non-health still affect how people today perceive and reject global health programs. Around the 1960s, a surge of African independence movements brought an “official” end to European countries’ direct colonization of other lands and peoples. Nonetheless, there are still economic and social policies in place today that were developed and implemented by previous colonizing countries decades beyond the 1960s. Neo-colonialism is the term used to describe this form of political and economic dominance. Beginning in the middle of the 20th century and continuing to the present, neo-colonial strategies have shaped global health policy and planning.[4]
Foundation laid by Colonial Medicine:
One of the primary objectives of colonialisation was to make profits off the colonized states by forcing the indigenous population to work for minimal to no wages. Poor health among the colonized inhabitants would make it difficult for them to work as hard, prevent them from having healthy children, and make the colony unprofitable. Hence, colonial medicine played an important role in the early spread of colonialism and sustained the profitability of the colony.[5]
Colonizing powers had a constant need to maintain the physical and mental fitness of both their agents and native labourers. Westerners referred to geographical areas or regions in Africa and Asia with a specific climate or latitude as “the Tropics.” Tropical diseases are the specific illnesses that plague settlers, colonists, and local populations in “the tropics,” such as yellow fever and malaria.[6] [E22] Lack of knowledge about these illnesses along with developments in germ theory made by scientists like Louis Pasteur, who demonstrated that diseases were caused by germs, led to the formalization of colonial medicine into the area of tropical medicine.[7]
“colonialism and, therefore, tropical medical interventions including interventions such as examinations, injections and procedures forced upon native populations in gross violation of human rights were justified in the name of the ‘civilizing process,’ including the moral and racial superiority of white populations.”[8]
Tropical medicine is still practiced and researched by medical, public, and global health institutes today. The colonial history still exists despite the fact that these institutions have, in principle, moved far away from the racialized, racist, and “civilizing” objectives for which they were formed and that any participation in scholarly work that seeks to remove the legacies of their colonial past[E23] .[9] For instance, the London School of Hygiene still goes by its original name: “hygiene is direct reference to the original colonial aims of improving local populations’ hygienic practices and so civilizing them.”[10]
De-Colonialisation, Emergence of Neo-Colonialism and International Health:
De-Colonisation as a movement essentially gained momentum in the last years of the first half of the 20th century. While the globe, especially Europe, recovered from the devastating impacts and aftermath of the war, World War II also signalled a transition in world politics. The first international institutions to promote world peace, well-being, and economic and social progress were founded in the latter years of the war and the years right after it. These organizations included the United Nations, the World Health Organization, the World Bank, and the International Monetary Fund.
However De-Colonisation wasn’t a hassle-free transition. Several countries started as independent states with populations that were primarily illiterate and struggling with undernutrition and other health issues. From the viewpoints of America and the Soviet Union, newly independent Asian and African nations were prospective allies, and it was essential that each bloc increase its political and economic power around the world. Promoting and assisting economic development in underdeveloped nations abroad was one approach to achieving the objective. President John F Kennedy stated that “the rich nations should help the poor not only to gain their allegiance, but because it is right.”[11][E24] It is significant to note, however, that as President Kennedy’s words illustrate, there is no explicit mention of the root causes of the ‘mass misery’ experienced by people in huts and villages of half the globe. [12]
Neo-colonialism in global health is that under-developed or developing nations have health issues that can only be cured by white men from developed countries. Arguably, this concept of White saviours formed the basis of TRIPS agreement, which allowed Multi-National Corporations based in first-world countries to profit from pharmaceutical drugs and procedures.[13]
TRIPS Agreement and Access to Medicines:
The time-limited legal rights known as intellectual property rights (IPRs) are given to creators and innovators. Copyrights, trademarks, patents, trade secrets, and geographical indications are examples of intellectual property rights (IPRs), whereas brands, inventions, designs, and biological materials are just a few examples of protected subjects[E25] .[14] IPRs are important since a product may be protected by a number of rights. For instance, trade secrets, trademarks, and patents are used to protect pharmaceutical medicines, which are defined by Britannica as “substances employed in the diagnosis, treatment, or prevention of disease.”[15]
The most popular form of IPR used to protect pharmaceutical innovation is a patent. Patents give innovators a certain amount of commercial exclusivity for their innovations, but in return, the inventor is required to release enough information to allow rivals to enter the market. With this information, a rival can get ready to enter the market after the monopoly has ended. Due to this contractually required exclusivity, patent owners—typically large corporations—have the authority to bar others from producing, utilizing, or commercializing a patented innovation. A minimum of 20 years’ worth of patent protection is offered by the TRIPS Agreement, which was reached as part of the Uruguay Round of multilateral trade negotiations and has been in effect since 1995. The idea is that the length of time enables businesses to recuperate the costs of creating, testing, and scaling up a novel pharmaceutical product.[16]
Patents, by their very nature, give pharmaceutical companies the ability to set prices above marginal costs, recoup their costs of R&D, and turn a profit. The relationship between TRIPS and health has come to light as a result of the AIDS pandemic in Africa and mounting proof of the harmful effects of patents on the poor’s access to medications. With more than 30 million HIV-positive individuals worldwide, the majority of whom reside in the most underdeveloped nations, addressing the issue of access to patented medications has become a top priority.[17]
As an unfair continuation of a colonial trading system, several low-income countries have long been engaged in opposing the IP system.[18] [E26] The Doha Declaration on TRIPS and Public Health was adopted by governments within the World Trade Organization (WTO) at a time when the HIV pandemic was at its worst and millions of individuals in the Global South were denied access to life-saving medications. In addition to recognizing the necessity for access to medications in a public health emergency, this WTO Declaration permits nations to employ all of the “flexibilities” provided by the TRIPS framework to protect public health.[19] [E27] Pharmaceutical corporations and the governments of their host countries, mostly in the Global North, have, however, consistently vigorously disputed this worldwide agreement on intellectual property.[20]
This very strong opposition to using TRIPS flexibilities has persisted throughout the current COVID-19 crisis, as evidenced by the failure of attempts by nations, primarily from the Global South, to secure a TRIPS waiver in order to enhance their supply of COVID-19 vaccines.
The COVID-19 Pandemic and Vaccine Colonialism:
Without much consideration or planning, vaccine administration began in several First World Countries in December 2020 without much thought to Third-World nations availability. This strategy has been referred to as “vaccine apartheid” or “vaccine colonialism.” In a speech to the public in May 2021, WHO Director-General Tedros Adhanom Ghebreyesus described vaccine apartheid as follows: “HICs (High-Income Countries) make up 15% of the world’s population, but they possess 45% of its immunizations. About half of the world’s population lives in LMICs (Low- and Medium-Income Countries), but only 17% of people there have access to immunizations.[21]
World health professionals concur that fair access to immunization is necessary to end the pandemic. However, only around 35% of the world’s population has received at least one dose, and only about 42% of people are fully immunized. 79% of the populace in high- and upper-middle-income countries has received at least one dose, compared to 14% in low-income nations.[E28] [22] John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, has been vocal about the unequal distribution of vaccines to the developing world as wealthy nations buy vaccines in excess; for instance, Canada bought enough doses to immunize their nation five times over, while poorer nations were left with only enough doses to immunize one out of every ten people.[23]
The Corbevax vaccine, created by American researchers, is 90% effective against the original COVID-19 strain and 80% effective against the Delta subtype[E29] .[24] It’s also affordable, costing about $1.50 each dose. In Washington, though, the choice was made to fund pharmaceutical corporations instead. Pfizer and Moderna refuse to license its mRNA technology in poor countries, claiming falsely that these nations are unable to create high-quality vaccines despite the fact that taxpayer money has been utilized to subsidize vaccine development for the greater good[E210] .[25] The manufacture of mRNA vaccines in low and middle-income countries (LMICs) is sadly not supported by some of the most well-known global health foundations aiming to eradicate unfairness, perpetuating the very inequities they are purportedly fighting against.[26]
Almost sixty World Trade Organization (WTO) members have been attempting to waive trade-related aspects of intellectual property rights (TRIPS) for the technology required to prevent, contain, or treat COVID-19, but the European Union has continued to resist their efforts. Even though this plan has the support of over 100 low-income nations, several high-income nations (HICs) are still opposed to it, which is preventing the TRIPS Council of the WTO from moving further. Barriers that are still in place put unnecessary strain on health systems all over the world that are already in danger of collapsing. [27]
HICs have only acted in their limited self-interest and indifference. They’ve turned to charity, merely a continuation of the colonial mindset to exercise control and authority, rather than adopting a rights-based strategy.
The IP system appears to have compelled Global South nations that might have preferred not to rely on the COVAX program’s charity approach to join high-income nations in dealing directly with producers to buy COVID-19 vaccinations.[28] [E211] Notwithstanding the African Union’s condemnation of the injustices by IP law protections, this has encompassed African nations. By reproducing colonially entrenched power relations, this trend has led to poorer countries paying far more than wealthy, developed nations since they lack the negotiating strength to achieve competitive rates. More generally, unfair global economic systems and IP laws force nations in the Global South to take part in international trade systems that lead to the exploitation of their own populations.[29]
As we’ve seen with the Delta and Omicron varieties, HICs don’t appear to understand that the colonization of global health has effects on everyone. It can be argued that this “vaccine neo-colonialism” has backfired on HICs because the virus continued to mutate in areas where vaccinations were unavailable, putting Global South countries far behind the recovery curve.[30] [E212] As a result of a second wave that hit unvaccinated nations like India in June 2021, the global COVID-19 death rate exceeded that of 2020. The COVID-19 strains that emerged from India’s second wave were more dangerous, such as the most recent version at the time of this study, the Delta variant, which is ravaging the globe.[31]
It is important to acknowledge that decolonization is in the best interests of the entire world if we are to make significant improvements toward decolonizing global health and health justice. Leaders in colonization are placing the burden of decolonization on their shoulders. The majority of decolonization talks take place in HIC institutions, and there is little outreach to institutions in the south. The classic quote by Audre Lord goes, “The master’s tools will never tear down the master’s house.” Allowing people who are being colonized to lead the charge is the first step.[32]
Conclusion:
This Covid-19 pandemic demonstrated that the development discourses frequently promoted by developed countries to assist countries in the Global South ‘catch up’ is hollow when the basic medications needed to survive are wilfully withheld and weaponized. IP used to encourage innovation is yet another tool in the service of private profits, much like the free-market reforms intended to promote “development”. The reality of modern capitalism, including the IP regime that supports it, is competition between corporate titans motivated by profit rather than a need for humanity, as this pandemic has demonstrated. Compared to the revenues of large businesses and their home states, the needs of the poor are far less important.
The decolonization of human rights in health is a potentially radical and transformational strategy for Global South nations, helping to ensure that vaccines are supplied universally, fairly, and transparently at the point of access.[33] [E213] It would help stop the cycle of regressive and rigid application of patents functioning as the primary factor in all decisions regarding vaccine manufacture and distribution. One of the biggest global health issues of our day is the COVID-19 vaccine campaign, so we must make sure we take advantage of this opportunity to improve how we conceptualize the universal right to health.[34]
[1] Vineeta Gupta & Mervyn Christian, The COVID-19 pandemic response: A microcosm of neo-colonialism that hurts us all BMJ Global Health (2022), https://blogs.bmj.com/bmjgh/2022/03/16/the-covid-19-pandemic-response-a-microcosm-of-neocolonialism-that-hurts-us-all/ (last visited Apr 9, 2023).
[2] Erlin Blakemore, what is colonialism? National Geographic (2019), https://www.nationalgeographic.com/culture/article/colonialism (last visited Apr 9, 2023).
[3] ‘Home’ (PUBH 110) https://pubh110.digital.uic.edu/section-1-5-tracing-historical-determinants-of-health-intersections-of-colonialism-neocolonialism-global-health-policies-practices/ accessed 15 December 2023
[4] Sara Lowes & Eduardo Montero, The legacy of Colonial Medicine in Central Africa, 111 American Economic Review1284–1314 (2021).
[5] Dumbaugh M, Hanneke R, Kalaitzi V, Kim S, Swatscheno J, Valencia A, Peters K. (2021). Public Health and Global Societies: A survey course in Global Health. https://pubh110.digital.uic.edu/
[6] (A brief history of malaria – saving lives, buying time – NCBI bookshelf) https://www.ncbi.nlm.nih.gov/books/NBK215638/ accessed 15 December 2023
[7] Ibid.
[8] Ibid.
[9] ‘Home’ (PUBH 110) https://pubh110.digital.uic.edu/section-1-5-tracing-historical-determinants-of-health-intersections-of-colonialism-neocolonialism-global-health-policies-practices/ accessed 15 December 2023
[10] Ibid.
[11] ‘John F. Kennedy Quotes (Author of Profiles in Courage)’ (Goodreads) https://www.goodreads.com/author/quotes/3047.John_F_Kennedy#:~:text=One%20person%20can%20make%20a%20difference%2C%20and%20everyone%20should%20try.&text=A%20man%20may%20die%2C%20nations,Ideas%20have%20endurance%20without%20death.&text=If%20we%20cannot%20end%20now,the%20world%20safe%20for%20diversity. accessed 16 December 2023
[12] Dumbaugh M, Hanneke R, Kalaitzi V, Kim S, Swatscheno J, Valencia A, Peters K. (2021). Public Health and Global Societies: A survey course in Global Health. https://pubh110.digital.uic.edu/
[13] Rafael Escamilla, Neo-colonialism and Global Health Outcomes: A Troubled History Yale School of Public Health(2020), https://ysph.yale.edu/news-article/neocolonialism-and-global-health-outcomes-a-troubled-history (last visited 2023).
[14] Staff T, ‘[Solved] Intellectual Property Rights (Iprs) MCQ [Free Pdf] – Objective Question Answer for Intellectual Property Rights (Iprs) Quiz – Download Now!’ (Testbook, 14 November 2023) https://testbook.com/objective-questions/mcq-on-intellectual-property-rights-iprs–5fc42b81a1bc541cc2ffd6f0 accessed 15 December 2023
[15] On Intellectual Property Rights, Access to Medicines and Vaccine Imperialism, TWALIR (2021), https://twailr.com/on-intellectual-property-rights-access-to-medicines-and-vaccine-imperialism (last visited 2023).
[16] ibid
[17] Carlos Correa, TRIPS AGREEMENT AND ACCESS TO DRUGS IN DEVELOPING COUNTRIES SUR International Journal on Human Rights (2005), https://sur.conectas.org/en/trips-agreement-access-drugs-developing-countries (last visited Apr 18, 2023).
[18] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021) https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[19] ‘World Trade Organization’ (WTO) https://www.wto.org/english/tratop_e/trips_e/healthdeclexpln_e.htm accessed 15 December 2023
[20] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021) https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[21] Dhruv Shah, Mrunmayi Kulkarni & Poonam Mathur, The Impact of Neo-colonialism on India’s COVID-19 Response National Library of Medicine (2022), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122003 (last visited Apr 18, 2023).
[22] ‘Global Dashboard for Vaccine Equity: Data Futures Platform’ (UNDP) https://data.undp.org/insights/vaccine-equity accessed 15 December 2023
[23] Vineeta Gupta & Mervyn Christian, The COVID-19 pandemic response: A microcosm of neo-colonialism that hurts us all BMJ Global Health (2022), https://blogs.bmj.com/bmjgh/2022/03/16/the-covid-19-pandemic-response-a-microcosm-of-neocolonialism-that-hurts-us-all (last visited Apr 9, 2023).
[24] Miller K, ‘A New COVID Vaccine Called Corbevax Could Help Vaccinate the World’ (Verywell Health, 14 January 2022) https://www.verywellhealth.com/corbevax-covid-vaccine-5215738 accessed 15 December 2023
[25] Nolen S, ‘Here’s Why Developing Countries Can Make Mrna Covid Vaccines’ (The New York Times, 22 October 2021) https://www.nytimes.com/interactive/2021/10/22/science/developing-country-covid-vaccines.html accessed 15 December 2023
[26] Ibid
[27] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021) https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[28] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021) https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[29] ibid
[30] Shah, Dhruv. ‘The Impact of Neocolonialism on India’s COVID-19 Response.’ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122003/. accessed 15 December 2023
[31] Dhruv Shah, Mrunmayi Kulkarni & Poonam Mathur, The Impact of Neocolonialism on India’s COVID-19 ResponseNational Library of Medicine (2022), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122003 (last visited Apr 18, 2023).
[32] Vineeta Gupta & Mervyn Christian, The COVID-19 pandemic response: A microcosm of neo-colonialism that hurts us all BMJ Global Health (2022), https://blogs.bmj.com/bmjgh/2022/03/16/the-covid-19-pandemic-response-a-microcosm-of-neocolonialism-that-hurts-us-all (last visited Apr 9, 2023).
[33] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021)https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[34] Sekalala S and others, ‘Decolonising Human Rights: How Intellectual Property Laws Result in Unequal Access to the COVID-19 Vaccine’ (BMJ Global Health, 1 July 2021) https://gh.bmj.com/content/6/7/e006169 accessed 15 December 2023
[E21]Paraphrased from – https://pubh110.digital.uic.edu/section-1-5-tracing-historical-determinants-of-health-intersections-of-colonialism-neocolonialism-global-health-policies-practices/
[E22]Paraphrased from – https://www.ncbi.nlm.nih.gov/books/NBK215638/
[E23]Paraphrased from – https://pubh110.digital.uic.edu/section-1-5-tracing-historical-determinants-of-health-intersections-of-colonialism-neocolonialism-global-health-policies-practices/
[E24]Plagiarism can be reduced by proper citation.
[E25]Paraphrased from – https://testbook.com/objective-questions/mcq-on-intellectual-property-rights-iprs–5fc42b81a1bc541cc2ffd6f0
[E26]Paraphrased from – https://gh.bmj.com/content/6/7/e006169
[E27]Paraphrased from – https://www.wto.org/english/tratop_e/trips_e/healthdeclexpln_e.htm
[E28]Source of these statistics has not been provided.
[E29]Paraphrased from – https://www.verywellhealth.com/corbevax-covid-vaccine-5215738
[E210]Paraphrased from – https://www.nytimes.com/interactive/2021/10/22/science/developing-country-covid-vaccines.html
[E211]Paraphrased from – https://gh.bmj.com/content/6/7/e006169
[E212]Paraphrased from – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122003/
[E213]Paraphrased from – https://gh.bmj.com/content/6/7/e006169