Global medical citizenship in light of rising nationalism

Governments around the world have valued their own interests with utmost priority in their COVID-19 response, but at what cost?

Writer: Lia Bote
Editor: Similoluwa Ayeniyegbe
Artist: Sophie Maho Chan

The COVID-19 pandemic has tested the resilience of our social and political systems, inviting many significant changes. One such change is the resurgence of nationalism, the belief that one’s nation should occupy greater socio-political importance than others. This is coupled with deglobalisation, which although key to reducing international transmission of SARS-CoV-2, has posed new challenges. Specifically, medical nationalism has seen public health policies and allocation of medical resources prioritise a country’s own needs, regardless of wider global repercussions. This was seen in the EU at the beginning of the pandemic, where restrictions on the export of medical supplies resulted in shortages of equipment elsewhere. Thus, the resurgence of nationalism and the resulting limitations to freedom and information have resulted in a less collaborative, less cooperative global medical field. 

Often, the unfortunate price of self-preservation is the neglect of anything that is ‘other’. Migrant workers comprise 14% of Europe’s working population. For key workers, the number is even higher, with immigrants making up 23% of doctors in major cities. Despite this, migrant workers are also some of the least protected. In the name of nationalism, governments have prioritised the safety and security of their own citizens. As a result, migrant workers have been the first to lose their jobs, and are often forced into unsafe and unsanitary working conditions. This is true across the globe, with COVID-19 outbreaks in Malaysia or Singapore starting at crowded dormitories where migrant labourers are forced to stay. 

But is a strong national identity always harmful? The COVID-SCORE was an international survey that measured people’s satisfaction with their government’s pandemic response, evaluated on criteria like medical preparedness and international cooperation. There was a positive correlation between satisfaction and government trust, which resulted in higher degrees of compliance. As such, countries with higher average scores also had better responses to COVID-19 when measured through metrics like mortality rates and survey respondents having relatives who had been infected. This makes the case for the value of a strong sense of national unity. In fact, the highest satisfaction measures with lowest heterogeneity among respondents were in countries like China and South Korea with strong nationalist policies. In contrast, the US had the highest heterogeneity and a weaker central response, where the lowest-earning demographics reported lower satisfaction measures. 

Still, strong government responses need not be mutually exclusive with international cooperation. Economic and socio-political forces will not allow borders to remain closed forever, but unless COVID-19 is eradicated everywhere, it cannot really be eradicated anywhere. This is perhaps best exemplified by the problems arising from vaccine distribution. Countries like Germany plan to vaccinate their population entirely by the summer, while Sudan and others will likely not achieve this until 2024. The UK has vaccinated 50 people in every hundred as of March 2021, which is well above the world average of 7%. Moreover, over 130 countries have not received their first vaccines yet, while just 10 countries have administered 75% of the world’s current available doses. 

International programmes to address this and promote global medical cooperation have been met with limited success. The World Health Organization’s (WHO) COVID-19 Technology Access Pool repository was launched to allow companies to share their manufacturing and research knowledge. The major vaccine producers have expressed support for this but are yet to join. Canada, which has vaccinated 62% of its healthcare workers, and has enough vaccine orders to inoculate its adult population five times over, has taken vaccines from the Covax scheme, which aims to pool resources from higher income countries for vaccine distribution to low- and middle-income countries. The result is widening global health inequalities in the name of self-preservation. 

It does us a disservice to think of health crises as isolated from the social contexts within which they exist. Effectively managing the pandemic relies on a degree of international cooperation that, at present, seems to be as far from reach as the end of the pandemic itself. In an increasingly interconnected world, global health solutions must be human solutions, because the only way out of the pandemic is if we can get out of it together.

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