The Vaccine Distribution Crisis: Capitalism in its Death Agony


(reprinted from issue No. 19 of The Organizer Weekly, Feb. 1, 2021)

It is but one year since the World Health Organization (WHO) issued an alert worldwide that the SARS-CoV-2 outbreak was a “Public Health Emergency of International Concern,” for which governments throughout the world should prepare. Since that Jan. 30,2020 warning, more than two million people have died (2,235,401), nearly one in five (19.8%) in the United States (442,962). (Johns Hopkins Coronavirus Resource Center, Feb. 1)

The numbers keep growing: in January 2021, as the much-heralded vaccinations program was rolled out across the country, 82,000 Americans had died of COVID-19, turning the first month of the year into the deadliest one to date. By Feb. 20, the total number of deaths could soar to 514,000, according to the Center for Disease Control (CDC). If the U.S. continues on the same trajectory, the number of deaths will reach 654,000 by May 1, according to the University of Washington Institute of Health Metrics and Evaluation, even if — and it is a big “if” — there is a steady flow of vaccination.

The two approved vaccines (Pfizer and Moderna, each requiring two doses) are in short supply since private-sector supply chains and current manufacturing capacity cannot meet this demand. This requires setting priorities and rationing vaccine distribution. Even while health-care workers and residents of nursing homes were the obvious priority, vaccinations to date demonstrate an inverse proportion between community deaths and who is getting vaccinated. Three examples highlight the problem: the Black population of Washington, D.C.; Black and Latino residents of Dallas, Texas; and New York state prisoners, who are overwhelmingly people of color.

Washington D.C. is divided into 8 wards (districts): Ward 2 has a population that is 81% white and that of Ward 3 is 64% white. These wards are the most affluent, while Wards 7 and 8, each with 92% Black residents, are among the poorest. As of Jan. 15, there were 42 deaths from COVID-19 in Ward 2 and 42 as well in Ward 3, while the death tolls in Ward 7 and 8 reached 128 and 162 respectively. Yet once the vaccination program began, Wards 7 and 8 had the lowest number of vaccine appointments booked, while the affluent white Wards 2 and 3 had the highest: 197 in Ward 7 and scarcely 94 in Ward 8, while 1274 residents were scheduled in and almost twice that number (2,465) had appointments in Ward 3. Put simply, almost four times the number of people died in the impoverished Black Ward 8 than in the affluent white Ward 2, yet 26 times more people were scheduled for immunization against COVID-19 in Ward 2.

“In Dallas, as in other major Texas cities,” noted the Texas Tribune (Jan. 20), distribution sites are more commonly located in white neighborhoods, and early data showed the North Texas county had distributed most of its shots to residents of whiter, wealthier neighborhoods.” Yet, the state came down hard upon Dallas County Commissioners who voted to prioritize the limited number of vaccines allocated to the public health system, a portion of which were to be used at a distribution center serving mostly Black and Latino neighborhoods disproportionately hard-hit by the pandemic. Even this limited attempt at more equitable distribution was scuttled after the Texas Department of State Health Services, responsible for vaccine allocation, threatened to reduce the weekly vaccine allocation to Dallas County Health and Human Services and no longer designate it a “hub provider.”

One in five state and federal prisoners in the United States has tested positive for the coronavirus, a rate four times that of the general population. In some states more than half of the prisoners are infected, according to data collected by The Associated Press and The Marshall Project. Furthermore, prisoners are twice as likely to die from the virus compared to the general population. Twelve prisoners died of the virus in recent weeks in the New York State prison and jail systems, five of them during the 10-day period between Jan. 4 and Jan. 14, outpacing the rate from the early days of the pandemic.

How could it be otherwise given the congested living conditions, the prevalence of underlying health conditions, and the rationing and denial of health care? Yet, reported The New York Times on Jan. 26, “When New York announced new vaccine guidelines …, one particularly hard-hit group remained unmentioned: the nearly 50,000 people incarcerated in the state’s prisons and jails.”


Vaccination efforts have begun in more than 50 countries. Yet as of last week, the West African nation of Guinea was the only low-income country to have begun vaccinating its population. The number, however, is startling: Just 55 people out of a population of more than 12 million have been vaccinated, with most of them government officials, including President Alpha Condé, who received the Sputnik V vaccine from Russia.

“Many developing countries, from Bangladesh to Tanzania to Peru, noted The New York Times (Jan. 25),“will likely have to wait until 2024 before fully vaccinating their populations.”

“Together, Britain, Canada, the United States, and the European Union,” reported the Washington Post (Jan. 26), “have purchased the lion’s share of the global vaccine supply.”

The BMJ, the journal of the British Medical Association, looked specifically at pre-orders for the coronavirus vaccines when nations rushed in their orders before the various vaccine options had received regulatory approval. According to the study, by Nov. 15, 2020, high-income countries representing only 14% of the world’s population had reserved over half (51%) of expected doses. The result, noted Misha Gajewski, writing for Forbes (Dec. 15, 2020), “is uncertain access to supply for the rest of the world, AKA the other 85% of the global population. … Furthermore,” stressed Gajewski, “because the coronavirus vaccine costs between $6 and $74 per course, poorer countries will likely struggle to even afford it.” 

This will have consequences throughout the world, warned Tedros Adhanom Ghebreyesus, director general of the WHO in his Jan. 25 Twitter post: “Truly, no one is safe until everyone is safe. Until we end the pandemic everywhere, we won’t end it anywhere. … Every day that passes, the divide grows larger between the world’s haves and have-nots.” (Washington Post Jan. 26)

Just how extensive is that divide was calculated by the People’s Vaccine Alliance (PVA), a network of organizations that includes Amnesty International, Oxfam, and Global Justice Now. In December 2020, PVA estimated that nine out of 10 people (90%) in nearly 70 low-income countries would not be inoculated in 2021 because wealthy countries had bought up much of the initial supply, including a supply to hoard!

While Kenya, Myanmar, Nigeria, Pakistan, and Ukraine had 1.4 million COVID-19 cases between them in December, they may have access to vaccines only through COVAX, a global non-profit vaccine sharing program.

The COVAX Facility was set up by the WHO last year with Gavi, the UN-backed vaccine alliance, and the Coalition for Epidemic Preparedness Innovation to provide vaccines to 92 countries where the gross national income per capita is under $4,000. COVAX depends upon donations, but to date it has secured commitments for less than $11 billion toward a $38 billion target. The plan is to distribute 2 billion doses to immunize health-care workers and notably the most vulnerable populations in these countries. This, however, represents at most only 20% of each country’s population, and the distribution will not begin until the end of 2021 at best.

There are 1.3 billion people living in Africa. The 54-member African Union arranged to purchase 270 million doses from Pfizer and Astra-Zeneca through the Serum Institute and Johnson & Johnson at a cost of $5 billion with payment stretched over five years. The arrangement, however, is dependent upon loans from the World Bank, which, as yet, has not made any commitment. Even if the loan comes through, 270 million doses fall far short of immunizing 1.3 billion people, especially as immunization with the Pfizer and Astra-Zeneca vaccines requires two doses.

“A few months from now,” The New York Times reported (Dec. 28, 2020) “a factory in South Africa is expected to begin churning out a million doses of COVID-19 vaccine each day in the African country hardest-hit by the pandemic. But these vials,” remarked The Times, “will probably be shipped to a distribution center in Europe and then rushed to Western countries that have pre-ordered them by the hundreds of millions. None have been set aside for South Africa.” The global cost of such policy is apparent as South Africa became the country in which the most contagious COVID-19 variant has evolved.

India, which manufactures about 60% of vaccines globally* began mid-January what is billed as “the world’s largest COVID-19 vaccination drive.” Three hundred million people (22% of India’s 1.366 billion population) are expected to be vaccinated starting with 30 million doctors, nurses, and other front-line workers, to be followed by 270 million people who are either over 50 or have underlying health conditions, that render them more susceptible to COVID-19.

At the same time, India began shipping free COVID-19 doses to countries in the region, except Pakistan. Doses have been sent to Bhutan (150,000), Maldives (100,000), Bangladesh (2 million), Nepal (1 million), Myanmar (1.5 million), and to the Seychelles, Sri Lanka, and Bahrain. This is a beginning but still a drop in the bucket. Bangladesh, for example, which has received 2 million doses from India, has an adult population — people 18 years or older — of 105 million.

China, too, has committed to sending vaccines as they are approved to countries that have conducted last-stage trials for its leading vaccine candidates. Five vaccines from four companies have reached phase 3 clinical trials in 16 countries. Among those cited are Cambodia, Myanmar, Laos, Thailand, Vietnam, Afghanistan, and Malaysia.

This distribution still will not reach the entire world.

Haves and Have-Nots:

Today, 71% of the world’s population lives in countries where inequality has been growing. Oxfam, which studies income inequality, found that from 1990 to 2015, the share of income going to the top 1% of the global population increased in 46 of the 57 countries with data. This is true especially in the most developed countries, now more than ever as a result of the pandemic.

The United Nations reported that as of October 2020, 37 million more people had been pushed into extreme poverty (living on less than $1.90/day). Then in December 2020, the U.N. warned that 207 million more people globally will be pushed into extreme poverty by 2030 given the long-term effects of the pandemic.

In contrast, “Ten of the richest people in the world [including Amazon founder Jeff Bezos, Facebook founder Mark Zuckerberg, and Microsoft co-founder Bill Gates] have boosted their already vast wealth by more than $540 billion since the coronavirus pandemic began as their businesses were boosted by lockdowns and financial crises across the globe” (The Observer Dec. 19, 2020). Their increased wealth “is more than enough to prevent everyone on Earth from falling into poverty because of the virus and to pay for a COVID-19 vaccine for all,” Oxfam exposed in its January 2021 briefing report titled “The Inequality Virus.”

In total, the collective wealth of the United States’ 651 billionaires* rose by $1.1 trillion over the same nine-month period, reported Americans for Tax Fairness (ATF). “Their pandemic profits,” stated Frank Clemente, ATF’s executive director, “are so immense that America’s billionaires could pay for a major COVID relief bill and still not lose a dime of their pre-virus riches. Their wealth growth,” he added, “is so great that they alone could provide a $3,000 stimulus payment to every man, woman and child in the country, and still be richer than they were nine months ago.”

Interesting speculation, but re-distribution of wealth never has been on the capitalist agenda. Nor is the more modest recommendation by non-governmental organizations (NGOs), such as Oxfam, for a wealth tax to pay specifically for vaccines, nor a call upon President Biden to have the federal government construct vaccine-manufacturing plants for low-cost worldwide distribution of the Moderna mRNA vaccine!

Operation Warp Speed paid $12 billion to vaccine makers to develop and manufacture COVID-19 vaccines for the United States. To put this in the context of the capitalist state’s priorities, Congress allocated $11 billion to the purchase of 98 F-34 strike fighter aircraft just this year.

James Krellenstein and Peter Staley (co-founders of PrEP4All), and Wafaa El-Sadr, professor of epidemiology and medicine at Columbia, wrote in “How to Get the World More Shots,” (New York Times, Jan. 14) that “Building the capacity for an mRNA vaccine like Moderna’s is estimated to cost less than $4 billion — significantly less than the U.S. government spends already each day on COVID-19 relief — and the cost of each dose is about $2.”

“Viruses know no borders,” the authors state. “Protecting Americans from COVID-19 requires protecting all people. We will not end the pandemic until everyone, across the world, can receive effective vaccines.”

From a financial perspective as well, “All economies are connected,” stressed the International Chamber of Commerce Research Foundation. “No economy will be fully recovered unless the other economies are recovered.” The global economy, the ICC concluded, will suffer losses exceeding $9 trillion if only the population of “advanced economies” are vaccinated. Nine trillion dollars, the ICC notes, far exceeds the expense of an internationally coordinated effort in which these economies manufacture and distribute vaccines globally free of cost.

The historical legacy of the COVID-19 pandemic will be an even greater divide between the haves and have-nots caused by the abject failure of capitalism — the private ownership of the means of production — and the political power that serves it.

This concentration of wealth in the hands of the few is an inevitable feature of capitalism. As Karl Marx and Frederick Engels explained succinctly and significantly in the Communist Manifesto: the bourgeoisie “has concentrated property in a few hands.”

No economist or financial manager today disputes this critical fact. Rupert Younger and Frank Partnoy, identifying themselves as “true believers in free-market capitalism” (one being a partner in a corporate advisory firm and the other a professor of law and finance), wrote in the pages of the Financial Times (March 9, 2018) 200 years after the publication of The Communist Manifesto:

“By the start of our 21st century, we are faced with the extraordinary fact that the top one per cent of the world’s population own the same resources as the remaining 99 per cent. Those at the bottom are less upwardly mobile than in previous generations; entrance to wealthy gated communities is blocked, not only by private security forces, but also by the increasingly prohibitive costs of healthcare, technology and education. There is the dominant force of mass incarceration, with millions of poor, minorities and powerless walled off from the rulers they might threaten. The Haves have never in history held so much advantage over the Have-Nots.”

Tedros Adhanom Ghebreyesus, director general of the WHO, said that the world is on the brink of “catastrophic moral failure” as poor countries are unable to access vaccines. More than a “moral” question, should we not conclude that the hoarding of existing supply and the refusal to create a vast public infrastructure capable of producing and distributing COVID-19 vaccines are inherent consequences of capitalism — just as the imperialist wars and the concentration of wealth from the exploitation and pauperization of the working class and oppressed communities throughout the world are consequences of the capitalist system?

Yes, we must conclude that socialism — the democratic organization of the means of production deriving from the political power of the proletariat, that is the working class and communities of the oppressed is, of necessity, on the agenda.


*Among vaccines manufactured in India are the Oxford-AstraZeneca COVID-19 produced there as Covishield and Covaxin which was developed domestically.

*Oxfam estimated one year ago that there were 2,153 billionaires in the world and that they have more wealth than the 4.6 billion people who make up 60% of the planet’s population.

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