Vaccine transparency and accountability in South Asia
A reported 6.9 million people lost their lives in the Covid-19 pandemic, highlighting the prodigious human cost, aggravated by the humanitarian fault lines the world over. Kunwar Khuldune Shahid explores the role played by vaccine transparency
Covid-19, which according to the World Health Organization's (WHO) notification last month is no longer a: "Public health emergency of international concern," has unravelled the challenges facing the world’s crisis-struck regions that continue to remain varyingly vulnerable post-pandemic. Information accessibility, equity, and accountability are the focus of Innovation for Change – East Asia Hub (14C-EA) as they unveil their study on vaccine transparency in Asia.
Through online sessions with members of the civil society and field experts in 2022, I4C-EA has put together its research findings spanning 11 Asian countries, four of which are from the South Asian region. With individual reports dedicated to those countries, including Afghanistan, Bangladesh, India, and Nepal, the study aims to rally for global vaccine equity, stress the lack of transparency in government procurement processes, and narrate the Chinese influence on the region’s pandemic-driven struggles.
All four South Asian countries under discussion used digital and information technologies to disseminate data and guidelines pertaining to Covid-19, with barriers to information excess contrasting in accordance with online crackdowns in these countries. In addition to misinformation and disinformation widening the inequity, the supply constraints in each of Afghanistan, Bangladesh, India, and Nepal made the priority sequences in their vaccination strategies even more vulnerable to manipulation. As a result, vaccine inequity was witnessed across South Asia, with all four of the countries in the study showing disparity along gender lines and marginalised groups such as refugees and migrant workers also being discriminated against.
Even so, despite the many common fractures shared by the South Asian countries, there remain unique predicaments given the variation in specificity or intensity of some of the cited challenges. And the study elaborates on these in separately published reports on each country.
Afghanistan, with one of the most limited healthcare systems in the world, already faced ominous medicinal gaps before the coronavirus began spreading. The pandemic arrived as the country was on the verge of jihadist usurpation. The dispute over the 2019 presidential election and the Taliban’s growing control of the country’s territories meant that the pandemic hit Afghanistan as it was on the brink of collapse. Once the Taliban took over in August 2021, all measures of equity and accountability plummeted. Since then, the Public Health Ministry hasn’t issued Covid-19 updates, with no disclosure of vaccination efforts over the past 18 months, rendering non-existent any policymaking to tackle the then-precarious health crisis.
In one of the largest refugee-hosting countries, Bangladesh, the pandemic wreaked unparalleled catastrophes. But despite being one of the first states to issue a National Preparedness and Response Plan vis-à-vis Covid-19, Bangladesh excluded Rohingya refugees from the onset, underscoring its own discriminatory lines. While the country then went on to become one of the first to vaccinate refugees, the inequity that it displayed from the get-go led to the rise of pandemic-related stigma, distrust, and misinformation, which had sociological repercussions for a country fighting many human rights battles. The issues posed questions related to governance and financial misappropriation by the Bangladeshi government.
Allegations of corruption and ill-governance also marred Nepal’s battle against Covid-19. Even though the country became one of the first to roll out the Covid-19 vaccination programme, some of the committees given charge of implementing the healthcare policies were deemed ineffective amidst accusations of overlapping mandates. The study finds Nepal guilty of ‘vaccine nepotism’ illustrating how the country disregarded global guidelines, and its own policy, to prioritise influential figures in the queue for vaccination dosage. Meanwhile, the urban-rural disparity in access to vaccination, which impacted the South Asian region as a whole, was prevalent in the country as well. The study also establishes Nepal’s discrimination against its Chepang, Tharu, Squatter, and Muslim populations in its pandemic policy.
Similarly, India, the largest country in the region, saw its marginalised castes, women, and religious and tribal minorities disproportionately affected by Covid-19 and insufficiently protected by the ensuing healthcare policies. The gender divide was also evident in the digital sphere, with these discriminatory policies aggravating the country’s information accessibility, which also suffered from asymmetrical dissemination and over-bureaucratisation. Like other countries in the region, this disparity overlapped with disinformation pertaining to Covid-19 and the vaccines, which predominantly targeted vulnerable segments of society. The study stresses the need to enhance the health infrastructure of what is now the most populous country in the world. It further necessitates bridging the trust deficit between the state and the citizens of an India that has growing global ambitions.
India’s influence in the region can be gauged by the fact that it supplied Covid-19 vaccinations to the other three countries in the study. Another major focus of the I4C-EA study was the influence of China, which supplied vaccinations to 10 of the 11 countries in review – India being the only exception – with the diplomatic rivalry between New Delhi and Beijing playing a critical role in the development of the South Asian states, which has been showcased in the vaccine diplomacy across the region.
Beijing sent Sinopharm doses to Afghanistan beginning in June 2021, with the Taliban declaring China their main partner in rebuilding the country and filling the massive vacuum left by the departing US and Nato forces. While the totalitarian Taliban regime would readily facilitate any Chinese aspirations to keep the nitty-gritties of the bilateral arrangements under the radar wherever necessary, Nepal officially signed a non-disclosure agreement to keep the prices of vaccines imported from China secret. Over a fifth of doses in Nepal came from unaccounted vaccines. In Bangladesh, the Chinese vaccinations arrived amidst Beijing’s insistence that Dhaka not join the Quad Alliance, deemed the 'Anti-Beijing Club' in China. Like other countries in the region, a lack of transparency also engulfed China’s vaccination agreements with Bangladesh.
To address both regional and domestic inequalities hinging around healthcare matters, the I4C-EA study urges all nations to bolster their public health infrastructures rooted in their respective states, focusing on self-reliance. The study also emphasises the need for these states to decentralise to improve transparency and, in turn, ensure that all citizens get more egalitarian access to both healthcare and fundamental human rights.