As part of the Black Agenda Report Book Forum, we interview scholars about a recent article they’ve written for either an academic journal or popular publication.
This week’s featured scholar is Ampson Hagan. Hagan is Dean's Research Associate Postdoctoral Fellow in the Department of Anthropology at Michigan State University. His article is “Coloniality of Waithood: Africa’s Wait for COVID-19 Vaccines amid COVAX and TRIPS.”
Roberto Sirvent: Can you please describe what you mean by “African waithood” in relation to colonialism, corporations, and COVID-19 vaccines?
Ampson Hagan: I lifted the concept of waithood from Mozambican anthropologist Alcinda Honwana who developed the framework to characterize and articulate the predicament of African youth stuck in the transition period between childhood and adulthood, where they experience the difficulty accessing stable employment opportunities that would allow them to support their families. Putting aside the focus on youth, the topology of waithood displayed considerable overlap with the situation African countries faced concerning the difficult and slow process of COVID-19 vaccine acquisition amidst the broiling COVID-19 pandemic. The pandemic threw into sharp focus a long-standing assemblage of actors and elements that revolve around vital medicines but conspire to disadvantage African nations and the Global South more broadly in order to turn profits. Because of this constellation of actors and conditions impeding cost-effective access to vaccines for African nations, those countries had to effectively wait for those conditions to change.
For years, pharmaceutical corporations have developed medicines and quickly patented them once they were deemed efficacious in order to get those drugs to market. Not only have the Euro-American nations that are home to these pharmaceutical giants greatly subsidized those companies and the important clinical trials to test those medicines in humans, but many of those countries—especially the United States, the UK, France, Germany and a few other notable nations—have defended the patent protections of those medicines from reproduction from needy nations of the Global South hoping to produce cheaper generics. Pharmaceutical control, patent protections, and the full-backing of the Europe and the United States empower these major drug companies to set and control prices for their drugs, and they can decide to charge poor nations the same price as wealthy ones for the same drugs, effectively leveraging the impoverished nations need for life-saving drugs (like the COVID-19 vaccines) in order to expropriate capital that could cripple their economies. This system of inequitable and predatory exchange echoes colonial economic organizations between Africa and France or the UK, where those countries (and companies therein) exploited pre-existing colonial ties and symbolic relations in order to extracted raw materials from Africa for cheap in order to refine and sell for large profits elsewhere. In order to make sense of what I saw playing out in the media about Africa not being able to secure affordable drugs in a pandemic where everyone around the world was at risk of contracting a deadly infection, it was important to articulate how contemporary colonial engagements, with companies relying on harmful drug pricing tactics and patent protections to effectively control who gets life-saving drugs, produced this vaccine waithood.
What role does intellectual property law play in preventing African nations from accessing affordable vaccines and other lifesaving technologies?
Intellectual property law (IP) plays a fundamental role in the global commodities exchange system and is central to the circuitry of value promotion and protection of goods within the global market of exchange. IP protects the patents for drugs and severely limits non-patent holders’ ability to reproduce those drugs without violating these international laws, which are heavily enforced by the United States, Europe, and the World Trade Organization (WTO). In 1995, all 164 WTO members signed and ratified the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), an agreement that establishes minimum standards for national governments to regulate various forms of IP in a manner similar to the application of IP to nationals of other WTO member states. TRIPS requires each of its members to establish copyright protections for creators and patent holders, and it stipulates enforcement procedures as well. In short, TRIPS is the definitive global set of laws that order how IP is created and protected across the world, and medicines fall under its purview, and access to medicines has been one of the highly contested issues regarding TRIPS. Patents ensure exclusive control and rights over a product, and patent-protected drugs, especially essential drugs, allow the patent-holder to maintain high, prohibitive drug pricing. This was a big issue in the in the late 1990s during the height of the AIDS crisis across Africa, as African nations had incredible difficulties securing the new anti-retroviral treatments that were highly effective at mitigating the impact of HIV on the human body. Drug makers knew that the prices for their medicines were high, higher than many needy African patients could afford, and that millions of Africans needed these medicines to survive. We’re talking about multi-billion-dollar corporations; they could give these medicines to poverty-stricken countries at low rates and still have plenty of money left over, but they decided not to. They could have allowed countries from the Global South with a high level of pharmaceutical capacity—such as China, India, and South Africa—to produce generic versions of these drugs and sell them to poor nations at affordable prices, but the big drug makers decided to block the creation of generics via their patent protections ensured by TRIPS. It is patents and IP that encourage this exclusionary behavior of the big pharmaceutical corporations, much to the detriment of African nations and other countries throughout the world who cannot afford the lifesaving medical technologies.
You write, “Multinational corporations (MNCs), the US, and Europe have long considered Africa as a site for scientific experimentation on vaccines to deadly diseases, as well as a site for capitalist expansion.” How does this challenge some of the more romanticized and “benevolent” understandings that many westerners have about global public health?
Yes, global public health has enjoyed a great public reputation of late, a result of a slow but steady transition of power and influence, from states being primary actors and facilitators of global health activities to corporations, with their slick advertising of their “innovative ideas” and promotion of their benevolent goals. Through NGO implementing partners, the US funds about $11 billion per year in global health programs, with the WHO spending about $6 billion per year on health care initiatives. In the span of a little more than a century, global health went from several meetings of medical doctor emissaries from countries trying to stop cholera and other communicable diseases to a multi-billion-dollar, international industry. The committed dollar amounts to initiatives and the amount of money spent on projects look impressive, and they contribute to the impression that global public health is dedicated to saving lives all over the world. However, as an industry, profit generation is the primary goal, and one of the important commodities within global health is medicines, commodities that commercial pharmaceutical companies—not states or foundations—produces.
Pharmaceutical companies have long relied on Africa for drug experimentation as other MNCs have extracted raw materials from the continent to generate profit for shareholders at the expense of Africans. Global public health relies on these medications to facilitate many of its projects and achieve its goals, and serves as a reminder that no industry operates on altruism or benevolence, but rather profit margins and expense reports. Johnson & Johnson, Merck, Pfizer, Novo Nordisk and the other pharma giants are not producing medical technologies strictly for the benefit of mankind; they have shareholders to which they are held accountable. Health care in the US is incredibly expensive, with drug costs being a burden for millions of Americans. The drug companies have been accused of price-gouging many times over the past 20 years, and with the recent massive penalty for the opiate maker Purdue Pharma and politicians’ comments about reining in drug prices as a win for the middle class, they have a poor reputation with the American public. However, Africa is their ace in the whole; by promoting its discounted drugs to poor, sick Africans and publicly demanding that their competitors do the same as a gesture of a good faith commitment to providing life-saving drugs to the poor, these companies get to burnish their image as drug “providers” and improve their public standing around the world. Laundering their image through gifts to Africa is how these companies secure their moral reputation in order to continue to extract capital from the world. Africa is central to that project, and it the original site of pharmaceutical extraction. As an industry, global public health is as messy, money-obsessed and predatory as any other.
Nanjala Nyabola wrote an article in 2020 called, “How to Talk about COVID-19 in Africa.” In it, she responds with outrage to the common question asked throughout western media outlets and political circles: “Why aren’t more Africans dying of COVID-19?” “To ask why more Africans aren’t dying of COVID-19,” she argues, “is to suggest that more Africans should be dying of COVID-19—in a normative rather than a descriptive sense. It exposes the expectation that when the world suffers, Africa must suffer more.” What are some of the reckless ways that the U.S. mainstream media, political and economic elites, and public health professionals perpetuated such anti-Africa discourses and ideologies in their analysis of the COVID-19 outbreak?
These US entities were simply “confused” (outraged really) about how Americans, with access to much stronger medical capabilities and resources in the US than exist in Africa, were contracting the virus and dying at such higher rates than Africans on the continent. I think it is important to ground the reckless American response to the lack of major African death tolls in American exceptionalism fueled by a recognition of Blackness relegated to death. Nyabola’s assertion that the Western media frame the lack of African deaths to COVID-19 under the assumption that more Africans should be dying, is ultimately correct. Politicians, economic elites, and the media all think that Americans should not be dying at all from diseases (except in movies), as the scientific community and society have framed infectious diseases and pandemics as problems caused by structurally unsanitary conditions and poor public health infrastructure; conditions that characterize Africa, not the US (or the Global North). American exceptionalism during COVID-19 means a strong belief that disease and infirmity due to the virus should be blamed on the wet markets of Asia or travelers to the US from the Global South. It is a very racial view that locates the coordinates of morality in the US and Europe, and the locus of blame in Asia. But death resides in Africa.
American reactions to the 2013–2016 Ebola outbreak in West Africa revolved around antipathies towards Black Africans that did not revolve around blame, but on death, specifically, leaving them to die. Any calls from scientists and public health professionals to protect Africans and stop Ebola to save African lives were drowned out by fears of a new plague from Africa infecting and destroying America, and a media characterization of Africans as deserving of their fate due to living in dirty conditions and the consumption of “bush meat”. American fixation on African consumption of bush meat was the through-line connecting the American image of the Slave to the African in the contemporary moment, as the simple act of eating animal flesh, something communities do across the world, is transformed into death via Blackness. The lack of this symbolic transformation into death via COVID-19 in Africa compared to the levels of death from the infection in America and other white populations was what was shocking to them. Had Africans died at rates Americans expected—as Black death is always on the mind of white society, the fundament that coheres white humanity—than everything about the course of the disease would make sense. COVID-19 transmission, with low levels of infection in Africa relative to Europe and North America, did not make sense, given what the scientific community, politicians, and elites predicted; that owing to the relatively poor public health infrastructure and expertise across the African continent, that more Africans would die as a result. The low numbers of African deaths did not make sense, given that Americans should be spared and Blackness is subject to ritualized death.
What is “philanthrocapitalism” and how is it connected to the “coloniality of waithood”?
Philanthrocapitalism characterizes the growing role of “private sector actors in addressing the biggest social and environmental challenges facing the planet” (Bishop & Green, 2015, 541). Private sector actors increasingly deploy business management strategies and market-based solutions to address social problems. Tech icon Bill Gates created an incredibly valuable company that netted him the billions he enjoys today, and founded philanthropic initiatives to leverage his wealth to charitably fund development projects. The Bill and Melinda Gates Foundation (BMGF) strategy for development promotes neoliberal economic policies and corporate globalization, with the foundation donating more money to global health projects than most other governments in the world. Through its vast resources along with the WHO’s stagnant funding since the late 20th century, the BMGF has challenged the role of the WHO as the international leader and coordinator of global health. Despite its legal classification as a non-profit entity, the BMGF operates like a tech startup with no mission statement and a charismatic leader whose strong-minded attitude and naïve technology-oriented approach to global public health characterize the consolidation of power of the large foundation within one individual.
The BMGF, along with the reverential Bill Gates, have changed the direction of the global health industry. For example, many of the world’s leading malaria scientists are caught within a network of scholars whose research is funded by the BMGF, such that each scientist has a vested interest in protecting the work of the others. This has made it quite difficult to get independent reviews of research proposals, effectively capturing all the top scientists (within a priority area determined by the foundation) with BMGF funding and undermining scientific independence (Butler 2019). The foundation is also a staunch advocate of vertical health programming rather than horizontal, health systems strengthening. Despite its several billion dollars devoted to polio, HIV/AIDS, tuberculosis, malaria, and vaccine delivery and development, very little money is targeted at strengthening health systems in low-income settings. GAVI, the BMGF-funded public-private partnership dedicated to increasing access to vaccines in poor countries, encapsulates the broader division within the global health community that is situated in two opposing camps: the vertical, disease-targeted approach to health care advocated by the BMGF, and the horizontal, health care system strengthening approach supported by many other entities within the global health community. This focus on medical technologies, especially vaccines, reflects a preference for technological, rather than social solutions to global health challenges. Bill Gates’ philanthrocapitalist approach to global health heavily depends on vaccines as the silver bullet to solve these health challenges in one fell swoop, but he is also a firm supporter of patent protection and IP. In 2021, foundation officials echoed the pro-patent sentiments of pharmaceutical companies and said that technology transfer, not patents, was the main road-block to COVID-19 vaccine production (Vijay & Fletcher 2021). It is clear to see how the single-minded focus on vaccines as the technology-based solution global health challenges and the support of patent protections and exclusive licensing lead to the vaccine waithood noted above. With these structural and economic conditions in place, poorer nations cannot access these drugs, unless patent protections are waived. By steering considerable resources, and the broader global health community, towards vaccines and eschewing health sector strengthening, poorer nations are positioned to primarily accept vaccines, as their health systems are ignored and artificially maintained as unviable for other health care approaches. These conditions seeded the ground for African waithood for vaccines to emerge.
What role has the IMF and World Bank played in limiting vaccine access to African nations? For readers who are unfamiliar with these institutions, how do their actions fit within their longer tradition of colonial, imperial, and neoliberal violence in Africa?
The World Bank has opposed vaccine IP waivers that would allow pharmaceutical makers in the Global South to produce cheap generics of vaccines. The IMF has not explicitly denounced such a waiver, but has cautioned that such a waiver must include other measures to ensure effective use and non-abuse of the protected technology information (Martin 2021). Remember, all the members of the WTO signed the TRIPS agreement, as patent protection is a major concern of international trade. The IMF and the World Bank are two institutions that are committed to promoting global trade and economic growth in the Global South, and primarily achieve this by extending loans to African nations and by carrying out economic development activities. African leaders have sought large loans from these institutions to fund their purchase of vaccines. In 2021, South African president Cyril Ramaphosa demanded that Africa receive more than the $33 billion already earmarked for the continent, and said they “need more because our economies are going to need a lot of support and it is only fair,” and “The continent has been growing by leaps and bounds and should receive that type of support because all of us must get out of this economic slump that has been brought on to us by Covid-19” (Siwele 2021). IMF and World Bank funds have been important resources for African nations in the COVID-19 pandemic, with the World Bank joining the COVAX platform to create a financing mechanism to increase the speed of vaccine supply to developing countries, through advanced purchases (Shalal 2021). It is mainly the World Bank that has doubled down on its support of COVAX, which already allowed wealthy donor states to make back-channel deals with drug makers to access vaccines before they are placed in reserves for African nations, that helped limit vaccine access to African countries.
However, both the IMF and the World Bank have had incredibly damaging effects on Africa since the moment of decolonization in the mid-20th century. As emerging but struggling economies in the second half of the 20th century, the recently-independent African states could not give bonds to its citizens in order to borrow money and no other nation wanted African bonds, so they had to go to the IMF and World Bank for loans. The IMF promotes global economic and financial stability by “providing policy advice and capacity development support,” in addition to short- and medium-term loans, while the World Bank “promotes long-term economic development and poverty reduction by providing technical and financial support to help countries implement reforms or projects” via long-term bonds (IMF 2022). However, because of the low credit rating of these African economies issued by credit agencies and the paternalistic and racist attitudes of white political and governance structures toward African nations, the IMF and the World Bank required loan-seeking African nations to enroll in Structural Adjustment Programs (SAPs), which consisted of structural adjustment loans and policies that reorganized countries’ economic structures. SAPs economic reorganization primarily implemented policies of increased trade liberalization to welcome foreign investment, privatization of public industries, and the reduction of government expenditures, which include spending on education, public infrastructure, and healthcare. Both institutions have hamstrung African economies with poison pill loans that trade Africans loan monies for the dissolution of African governance and sovereignty, all to remake African nations into neoliberal satellite states at the peripheries of Europe. SAPs, an instrumentalization of IMF and World Bank will to remake African states into more liberalized markets, are tools of colonial and imperial violence against Africa, dressed up as economic reform.
References
Butler, Colin D. 2019. “Philanthrocapitalism: promoting global health but failing planetary health.” Challenges 10(1): 24.
Green, Michael, and Matthew Bishop. 2008. Philanthrocapitalism: How the Rich Can Save the World. New York: Bloomsbury Press.
IMF. 2022. “THE IMF AND THE WORLD BANK.” IMF. https://www.imf.org/en/About/Factsheets/Sheets/2022/IMF-World-Bank-New.
Martin, Etic. 2021. “IMF Sees Strong Economic Arguments for Removing Vaccine Barriers.” Bloomberg. https://www.bloomberg.com/news/articles/2021-05-06/imf-sees-strong-economic-arguments-for-removing-vaccine-barriers#xj4y7vzkg.
Shalal, Andrea. 2921. “World Bank, COVAX unveil plan to speed vaccine supplies to developing countries.” Reuters. https://www.reuters.com/world/world-bank-covax-unveil-plan-speed-vaccine-supplies-developing-countries-2021-07-26/.
Siwele, Khuleko. 2021. “Ramaphosa DemandsMore IMF Reserves for African Virus Recovery.” Bloommberg. https://www.bloomberg.com/news/articles/2021-06-21/ramaphosa-demands-more-imf-reserves-for-african-virus-recovery.
Vijay, Svet, Elain Fletcher. 2021. “Gates Foundation: Technology Transfer, Not Patents Is Main Roadblock To Expanding Vaccine Production.” Health Policy Watch. https://healthpolicy-watch.news/patents-are-not-main-roadblock-to-expanding-vaccine-production-says-top-gates-foundation-official/.
Roberto Sirvent is editor of the Black Agenda Report Book Forum.
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