By Svea Malmros
At the beginning of 2024, just before my exchange semester in Argentina, there was a huge outbreak of dengue fever. I was recommended to get vaccinated before I went. I walked into a vaccination clinic close to my home in Malmö, Sweden, and left 10 minutes later vaccinated and with a date booked for the second dose. They had the vaccine stocked in the fridge. Dengue fever is transmitted by certain types of tropical and subtropical mosquitoes. While the disease is often without symptoms it can lead to severe illness and death, especially if you have been infected previously, and there is no specific treatment. Once I had arrived in Argentina I realised that few people around me were vaccinated. Why is it
that people living in endemic areas are not vaccinated when tourists are? Turns out that vaccines, and how they are distributed, can show us a lot about global injustice.
Dengue fever in Argentina
In Argentina there were signs everywhere encouraging people to use repellent, covering clothes, and to turn on AC to prevent getting stung by mosquitoes and getting infected. The dengue outbreak of 2023/2024 was the biggest in the country’s history with over 400 dead. In May 2024 the Argentinian government decided to start a vaccination campaign and import doses of the only available vaccine Qdenga from the Japanese lab that creates it. However, only people in certain age groups living in especially endemic areas are included in the campaign. The majority of people have to turn to private vaccination clinics if they want the vaccine.
Why are so few vaccinated?
In December 2024 only 102,000 of the 46,6 million Argentinians were fully vaccinated against dengue fever. There are a few reasons for this low number. For one, getting vaccinated at a private clinic comes at the steep cost of around 95,000 ARS per dose with 2 doses needed for adequate protection. The price becomes an issue considering the minimum wage of 271,571 ARS per month and the high number of people, 52,9%, living in poverty in Argentina. The price is not the only issue; during the second half of 2024 it’s reported that pharmacies are without stock of the vaccine because of a shortage and the queues for people wanting the vaccine from the private sector, even at the steep price, are long.
However, these reasons are part of a bigger picture of global injustices that can be traced back to colonialism. Which countries have the resources to vaccinate a majority of their population against epidemic and/or endemic diseases and why? Especially in situations of vaccine scarcity in which countries may have to compete over the vaccines? In which countries are the vaccines developed and why is medical research more developed in some countries? These questions can be answered by looking at the structures and economic systems left behind by colonialism. It is the continuing legacy of colonialism that have shaped the economic and political factors of today that in turn have created a system of inequitable access to vaccines, where someone going on vacation may have better access to a vaccine than someone living in an endemic area.
Vaccine nationalism
The dengue outbreak in Argentina and subsequent lack of vaccination is just one example of global vaccine injustice. There is a long list of examples of vaccine nationalism where rich countries choose to prioritize stockpiling vaccines in situations of shortages.
One example is the 2016 outbreak of yellow fever in Angola. There is a highly effective and life-long vaccine for the deadly yellow fever, however the outbreak in 2016 led to a global shortage. During the shortage the US chose to stockpile vaccines to be able to offer it to American travelers instead of helping curb the spread of the disease in affected areas.
Another example is the current outbreak of mpox which has been spreading across the African continent since 2023. It is reported that rich countries have several hundred millions of doses of vaccines effective for mpox stockpiled. An estimated 18-22 million doses of the vaccine would have been needed to curb the spread of the disease, and due to the price of the vaccine donations from richer countries would be needed to reach that goal. However, the majority of the countries with big stockpiles choose to instead focus on being able to protect their own populations if the need should arise and keep their stockpiles, instead of curbing the spread of the disease early on by donating vaccines.
The global response to the Covid-19 pandemic is another strong example of vaccine nationalism where a few rich countries were able to “pre-purchase” stock-piles of the vaccine before it was even created while other countries couldn’t get any doses, meaning that some countries could get back to “normal activity” earlier at the cost of the possibility of an earlier ending to the pandemic through a more equitable distribution of vaccines.
While equitable distribution of vaccines is a huge issue there is also a story being told by which diseases are being studied. There is a large number of tropical diseases which lack vaccines all together and for which research is underfunded. These diseases, although affecting a large number of people, are not considered a threat by the ones funding research the same way that diseases spread in the west are and therefore don’t get the same response.
These examples illustrate how vaccine-nationalistic thinking is based on the idea that the security of one’s own nation is the most important and that what happens outside is at most a threat, instead of looking at the spreading of diseases as a global, borderless problem. A more equal approach would mean distributing the vaccines where they are most needed, not to who has the most resources and to research not based on profit but on need. Vaccine inequality, although just one of many global injustices, also illustrates a broader tendency to disregard colonial history and western responsibility to the formerly colonized.
