The global distribution of personal protective equipment (PPE) during the Covid-19 pandemic has been fraught with conflict, with only tenuous application of the principles of solidarity and justice. As members of People’s Health Movement (PHM) in North America, we are appalled at the weaponization of PPE as ideological warfare not only between Canada and the United States, but also worldwide, and we deplore the inequities that have highlighted its distribution in its scarcity, real or perceived. We believe that there are ways forward that are more effective, safe, and fair in protecting ourselves in proportion to the risks confronting our communities. We believe the mindset of scarcity and nationalist posturing must be replaced by principles of equity and solidarity with those most at risk.
Needs the COVID-19 Pandemic Revealed
Shortage of PPE for Health Workers
As the New York Times has shown, health workers are amongst the most exposed in any outbreak of infectious disease. Although media coverage typically focuses on nurses and physicians, low wage health workers continue to be particularly undervalued, and thus under-protected while responding to the Covid-19 pandemic. Not only does this reality create a huge personal burden on health workers and their households, but it doubles the impact on health systems — since trained personnel are very difficult to replace when sick; and health workers are key vectors in the transmission of infectious disease to others. The stories of family doctors in Italy and of homecare workers in Canada speak to these problems.
The lack of adequate PPE for healthcare workers has led to various types of counterproductive responses by governments, while masking systemic failures across the globe. Rather than acknowledging these systems built on inequity, chronic under-funding and unsustainability, countries have resorted to explaining away their lack of preparation by rhetorics of scarcity. For example, UK workers are being asked to take risks, and the US is hijacking and hoarding PPE for national use, exacerbating inequitable access to these resources globally.
There is a heightened need for PPE as public health authorities encourage the use of face coverings and some local authorities require them. However, this issue is being met with protest from some conservative groups, endangering the public’s health.
PPE Needs for the Public's Health
The use of PPE may also be recommended for the general public depending on the nature of the outbreak. Increasingly, the use of some face barrier to prevent droplet transmission of viable virus is being encouraged by public health authorities in many jurisdictions as a measure to prevent asymptomatic transmission in communities, resulting in a seeming competition of demand. In some places, orders from authorities to wear masks in public have been met with resistance and protest from conservative circles, contributing to the weaponization of this issue.
Systems Failures Exposed
Austerity has driven care and welfare systems worldwide to work with inadequate protections, and although in many jurisdictions powerful institutions like hospitals have been able to cope with surges, more peripheral care institutions such as nursing homes have been at the centre of outbreaks across Europe and North America, and some are even being ordered to accept Covid 19 patients despite struggling with capacity and resources.
Global Precarity of Health Systems
Health systems that have been damaged by colonial legacies and the contemporary global economic order are particularly vulnerable to the lack of fair distribution of PPE. Disinvestment in health as demanded by structural adjustment programmes and the privatisation of health systems have hampered the ability to coordinate responses to address these lacunae.
While health systems around the world are under stress, state-run healthcare systems are proving to be more robust to deal with the crisis.
The Global Market is not an Efficient Distributor
The current pandemic has highlighted deficient global market structures which fail to equitably allocate resources, undermining the ability of many jurisdictions to respond to the pandemic. Their impenetrability has also been difficult to navigate for health systems. As a result, governments have scrambled in their strategies, hoarding resources and restricting export of PPE and other supplies. Countries that are reliant upon global markets for imports (such as the US) are experiencing additional burden due to these protectionist policies. Internally too, markets fail to provide equitable access. Within the US, states are competing with each other and the federal government for supplies, participating in bidding wars that ensure resource allocation to the wealthiest — rather than the neediest –areas. Global financial mechanisms designed to assist low-income countries with pandemic preparation have failed to provide timely support, although they have continued to benefit the wealthy who invested in them.
Today for #nationalhealthcaredayofaction Baylor St. Luke's @CHI_StLukes— Liana Lopez (@LianaLisa) April 15, 2020
in #Houston is firing #healthcare workers demanding/wearing #PPE. TODAY & EVERYDAY, I stand w/healthcare workers. SHARE IF U STAND w/them TOO! #protecthealthcareworkers #coronavirus #cabronavirus #covid_19 pic.twitter.com/NfdS8Q2upA
Health-Harming Anti-Worker Context
With poor worker protections in place, individuals are being targeted and punished for attempting to balance their own personal risks with the essential services they continue to provide. Scapegoating individual workers for failures of larger systems has become a recurrent theme. In some even relatively well-resourced contexts, workers are being forced to use inadequate PPE or punished for trying to protect themselves with their own. In an era of perceived scarcity, and in the ensuing economic insecurity, some are attempting to profit from fear and uncertainty as well, by producing and marketing substandard PPE at inflated prices. Disaster capitalists are also profiting off the sale of businesses that are key to the supply chain of PPE under current market conditions, and companies producing PPE are being celebrated as heroes while making exorbitant profits off of increased demand.
Lessons from the Global Community
We can learn from the struggles of communities to protect themselves from infectious disease outbreaks globally and throughout history. Communities in West Africa adjusted traditional funeral rituals to protect themselves from Ebola, longstanding Ayurvedic variolation practices in India stymied the spread of smallpox, and activists fought for widening access to condoms in the early years of the HIV epidemic. We must consider how to leverage our own resources and knowledge in responding to this outbreak as a global community, rather than a divided world.
We Stand in Solidarity
People’s Health Movement in North America stands in solidarity with initiatives that advocate for equitable distribution of personal protective equipment, and supports the rights of workers to be able to do their jobs safely. We believe networks of mutual aid with autonomous community action helps fill the gaps in need while we hold authorities to account on this front. We will highlight some of the actions we have learned about here, and invite you to learn about them and support them too.
At PHM, we strongly believe in advancing worker rights so that they engage in their tasks at no risk to themselves. We support workers who refuse work that is unsafe, and reject any attempt at penalising them for doing so.
We believe it is possible to address the distribution of PPE by recognizing the principles of equity and solidarity. Rather than hoarding resources, we can pool them to make sure that places with the most need are able to benefit from our collective goods. We can look to the European Union, which is attempting to launch such a mechanism, and the province of Alberta, which is sending excess supplies to other provinces within the Canadian federation. We believe that it is the responsibility of more resourced countries such as the US and Canada to distribute resources to under-resourced areas in the global South. We can push these mechanisms to become more widespread and systemised.
We should also remember that communities that are already vulnerable often start many miles behind in being able to protect their workers and themselves, and thus need *more* care, not less, and more equipment than other historically well-resourced places. Countries such as the DRC which are coping with triple outbreaks of Covid-19, Ebola, and measles have greater needs. Within countries too, certain populations such as Indigenous and Black communities across North America need additional focus and resources due to systemic racism and colonialism which have created weakened health systems. Actions that work against historical injustices are essential to mitigate the disastrous outcomes we see in some communities today as a result of Covid-19.
Communities have been responding to the lack of PPE by finding ways to source, to make, and to repurpose their own. We applaud these efforts and believe they should be supported. Developing a people’s science that helps communities stay the safest, while using the resources at their disposal is key — while at the same time advocating for equitable resource allocation moving forward. This approach can also empower people within these communities to offer contributions and mitigate feelings of helplessness for those unable to work on the frontlines.
The inability of workers and communities to protect themselves requires action at the level of governments and institutions. We should act in our own communities to make sure those most at risk are protected, while also demanding government action.
- Governments should be investing in resilient care systems with built-in surge capacity, and appropriately compensating labour that provides care and well-being as the central feature of our economies.
- Health authorities and government should be compelling corporations to be working for the greater good, making and delivering PPE to the places with the most dire needs and the most vulnerable populations during this emergency.
- Global bodies should be preparing to protect the places and people that are most vulnerable to outbreaks on this planet and widespread cooperation is needed to effectively address these issues.