Equity cannot end at America’s borders, the price of Covid care, how federal aid unleashes potential, and more, in this week’s Covid, Race, and the Revolution.
Issue No 53. May 26, 2021
An Equity Agenda Cannot End at America's Borders
By Priti Krishtel
Like many who work to advance equity, I was heartened to hear President Joe Biden insist upon an equity agenda for all government agencies. There have been promising signs this commitment will be acted upon: from the most diverse cabinet in history to economic policies that have an outsized positive impact for people of color, it is clear we are on a path toward a more just America.
But our duty to equity cannot end at America’s borders.
You would be hard-pressed to conjure a more stark illustration of the artificiality of borders than the unrelenting spread of Covid-19. The pandemic has demanded we grapple with the fact that we live in an increasingly interconnected world, and brings home the quote by Martin Luther King Jr., that “injustice anywhere is a threat to justice everywhere.” We are currently living in a world of vaccine apartheid. When we look at the map of who has been vaccinated globally, it is primarily those in wealthy, majority-White countries. Unsurprisingly, it is the same map of where the world’s wealth is concentrated.
There is promising movement toward equity on the vaccine access front, with recent news that the Biden-Harris Administration is supportive of an intellectual property (IP) waiver that would allow global vaccine production to scale up dramatically. The announcement has brought widespread attention to the ways in which America’s patent system fosters pharmaceutical monopolies, drives up the prices for medicines, and hurts patient care around the world and at home — especially for people of color.
All who are advocates for civil rights and racial equity should join the fight for more equitable, global access to Covid-19 vaccines — as a show of deep understanding of our intertwined struggles for justice.
Americans will not be safe from Covid-19 until everyone is safe
Just as our struggles for justice are intertwined, so are our fates: none of us are safe until all of us are safe. Currently, most of the world’s population will not have access to a Covid vaccine until 2023. This will allow a proliferation of virus variants, which threatens us in the United States. And as we have seen all along, the physical and financial toll will disproportionately fall on Black and Brown Americans.
Our system, the one that prioritizes the “free market” over the public good, is at the heart of America’s patent problem. “Free market” is actually a misnomer. A truly free-market economy would require that business risk and profit exist in the same realm of responsibility: that of private interests. The dominant neoliberal ideology over the past 40 years has instead led to a system in which critical knowledge that is often publicly funded results in private gain.
Take the vaccine owned by Moderna, which was nearly 100 percent publicly funded. This knowledge, developed almost exclusively with US taxpayer dollars, is being kept out of reach from countries devastated by the surge, while Moderna could be worth over $100 billion in the coming years. We must demand a new system, one in which medicines are recognized as a public good rather than solely driven by market incentives.
Unchecked monopolies are disproportionately harming people of color
The organization I co-founded, the Initiative for Medicines, Access & Knowledge (I-MAK), found that, on average, 131 patents are filed on each of the top 10 drugs in the US. This behavior leads to extended monopoly periods and unsustainable price increases. While politicians on both sides of the aisle have promised to curtail these soaring costs, leaders have failed to rein in the power of corporations. The system fuels racial and economic inequality, placing a disproportionate burden on people of color to afford high-priced prescriptions.
This is not just a pocketbook issue, but a matter of life and death. Thirteen percent of Americans have lost a loved one in the past five years because they could not afford the cost of their medication. That figure is double for people of color.
Prioritizing equity at the federal patent office
Congress is taking important action, including a recent hearing on unsustainable drug pricing. But to ensure these hearings lead to meaningful action, we need to start at the root of the problem: the Patent and Trademark Office (PTO). President Biden must pick a PTO director who is independent of industry and will prioritize equity. I-MAK has developed a 10-point agenda for the Biden-Harris Administration that outlines critical steps to integrate equity into the patent system — from sharing intellectual property with lower income countries in the midst of a global health crisis to ending the patent gaming by drugmakers that extends monopolies and increases prices.
We are on the cusp of creating major structural changes not just to public health, but to our economy in general. To turn this moment from one of potential to fruition, we must demand relentlessly, tirelessly, that our country, and world, reflect values of equity for all.
Priti Krishtel (@pritikrishtel) is a veteran of the access to medicines movement. She is a Co-Founder and an Executive Director of the Initiative for Medicines, Access & Knowledge (@IMAKGlobal), a nonprofit organization working to address structural inequities in how medicines are developed and distributed.
News, Analysis, and Commentary, Curated from Around the Web
Eliminating barriers to vaccination
As the US struggles to boost vaccination rates, most counties with the sickest residents lag while counties with healthier, wealthier populations are making brisk progress, according to a ProPublica analysis. Counties with high levels of chronic illnesses, which make people vulnerable to severe Covid complications if they get infected, had immunized 57 percent of people 65 and older by April 25, on average, compared to 65 percent in counties with the lowest levels of chronic illnesses.
The ACLU says a flaw in the algorithm used by California to distribute vaccines left some hard-hit Oakland communities behind, The Oaklandside reports. The state tried to ensure equity by prioritizing vaccine distribution to zip codes with the highest rates of Covid infections and deaths — generally zip codes with large Black and Latinx populations. While the strategy mitigated racial disparities in vaccination, it overlooked people of color in some smaller, hard-hit neighborhoods outside the boundaries of the priority areas. Targeting by census tract, a smaller zone than zip code, could have achieved better results.
The push to vaccinate people left behind by the health-care system is increasingly relying on President Biden’s so-called “community corps” — thousands of volunteers, advocates, and local leaders who are reaching out to people, often door to door. The New York Times profiles the Black Doctors Covid-19 Consortium in Philadelphia. The New Yorker reports on the pastors and community leaders driving efforts to boost vaccination rates among New York City’s Latinx population.
And Los Angeles Times columnist Erika D. Smith follows formerly incarcerated community residents as they canvass the largely Black and Latinx neighborhoods of South LA, talking with thousands of unvaccinated people and helping hundreds, so far, to make appointments for shots. Picking the right messengers is key, Linda Gomez-Evans, the civic engagement specialist for Community Coalition, told the paper. “It’s just knowing it’s not coming from the government,” she said. “This is coming from our community.”
How federal aid unleashes potential
States are seeing a wave of new businesses, and it’s strongest in predominantly Black neighborhoods, Quoctrung Bui writes for the New York Times. The increase has coincided with federal relief measures, which sent direct payments to Americans and strengthened confidence in the economy. Andre Perry, a fellow at the Brookings Institution, says the small-business activity in Black communities may be more about survival than wealth creation, as people scramble to capitalize on side hustles after losing jobs and income. But other experts say the start-up surge shows what’s possible when money flows to neighborhoods that typically don’t have access to economic support. “You really do unleash potential,” Catherine Fazio of Boston University told the paper.
Covid-era student loan relief changed the lives of millions of people, allowing them to pay off other debts, start families, or save for a home or their children’s college education, BuzzFeed News reports. But the reprieve is scheduled to end after September. The news site asked readers how federal loan forbearance affected them. More than 1,400 people replied. “My peers make the most ignorant statements to me about money and I have to explain: I'm a Black woman, so, one, I'm not getting paid as much as you; two, I had to go into debt for my education; three, that debt is looming over me every day and influences every decision I make,” wrote Autumn Cottrell, 26, of Phoenix, who owes $45,000. Black college graduates bear more student debt than any other racial or ethnic group. More than 85 percent of Black recipients of bachelor degrees in 2015-16 graduated with debt. The average: $34,000, but interest and fees push it much higher over time.
The Navajo Nation is now the largest tribe in the United States: official enrollment increased 30 percent last year, to 399,494, as people raced to secure hardship benefits provided to tribes through federal pandemic aid, Indian Country Today reports. The growth occurred even as the nation experienced some of the deadliest coronavirus outbreaks in America. “This is the brighter side to a really bad time in the pandemic when we watched so many people go,” Traci Morris, executive director of Arizona State University’s American Indian Policy Institute, told the New York Times.
More than 3.6 million Americans will lose pandemic unemployment benefits in the coming weeks and months, as 23 states drop out of the federal program that provides $300 a week to people who remain jobless or don’t qualify for standard unemployment insurance, CNET reports. The governors say, with no evidence, that the benefits discourage people from returning to work. Progressives argue there’s no labor shortage, but a shortage of jobs that pay a decent wage and good benefits. The federal government cannot force states to stay with the program until it expires in September, or intervene to provide benefits after states cancel. You can dive into state-by-state unemployment data here.
The price of Covid care
A growing number of people in the United States survived Covid only to have their lives upended by astronomical medical bills, the New York Times reports. Americans routinely face a devastating, bewildering pile of bills after treatment for serious illnesses but health plans wrote special pandemic rules waiving copayments and deductibles for Covid hospitalizations, and many doctors and hospitals received bailout funds on the condition they wouldn’t try to extract additional money from patients. But some providers aren’t abiding by those agreements, or they’re using incorrect billing codes to skirt coronavirus protections. Some providers are trying to collect the debts of patients who died. The average cost of a Covid hospital stay is $23,489, but bills can reach $1 million or more. No federal policy — or aid — addresses the impact of exorbitant Covid bills.
The pandemic’s deadly disparities spurred urgent calls for health equity from the public health and medical establishment. But the first study ever to rank hospitals on inclusivity finds that racial segregation is common among urban hospitals, including elite medical centers. Among the 20 US News Honor Roll hospitals, 11 ranked in the bottom third for racial inclusivity, and only five ranked in the top third. The analysis, by the Lown Institute, covers 3,200 hospitals. You can check how yours measures up.
Schools fail special-ed students
While some students with disabilities have thrived in remote schooling, away from peer pressures, school districts across the country have largely failed to educate the more than seven million students eligible for special education, the Washington Post reports. Many children have suffered significant developmental setbacks and fallen behind in reading and math. President Biden has proposed a multibillion-dollar increase in special education funding. But a national shortage of special-education teachers, speech pathologists, and other specialists means that children with the greatest needs are often taught by the least-qualified professionals, an issue that has gone unaddressed for years.
Almost 70 percent of the nation's students attend schools that are now offering in-person learning full-time, NPR reports. But children of color, Black and Asian American especially, have been less likely to return. New Jersey and New York City have announced plans to fully open schools and end remote options in the fall, and New York State is expected to follow suit, raising questions about how parental concerns about health and safety will be addressed.
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Michael McAfee and Angela Glover Blackwell are grateful for the contributions of Fran Smith, Milly Hawk Daniel, Rachel Gichinga, Glenda Johnson, Jennifer Pinto, Heather Tamir, Ana Louie, Janet Dickerson, and Mark Jones to produce the COVID-19 & Race commentary.