Access to Vaccination and Economic Justice

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Christina Ohenewaa, a street vendor in Accra, Ghana
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By
Christy Braham

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Across the globe, over two billion people are engaged in informal labour. Informal workers continue to face an accumulation of vulnerabilities which have been exacerbated during the COVID-19 pandemic—the precarious nature of their work, the often unsafe environment in which they must carry it out, as well as multiple systemic failures in providing them with adequate social protection to guard against disease and financial insecurity. Access to COVID-19 vaccination for informal workers to address these vulnerabilities more than a year after the outbreak was declared a pandemic, is therefore undoubtedly an issue of economic justice.

Health and the global economy are interdependent: there is decades of research measuring the impact of disease on labour and human productivity. Achieving greater access to health care (including through health insurance provision) is likely to improve health outcomes, namely reduced disease morbidity and mortality. Improved health outcomes allow workers to lose less productive work time to illness and thus increases their economic output. In addition, a worker with sufficient access to health care generally faces lower out-of-pocket expenditure on health care, which results in increased disposable income to spend on goods and services. As well as increasing revenues through taxation, this additional spending generates benefits for suppliers and strengthens the wider economy, in the form of a multiplier effect. A stronger economy, in turn, increases the likelihood of also being able to address other societal needs that are inherently health-promoting, such as fair employment, adequate housing and access to education.

Vaccination is one facet of healthcare access, given that vaccines are a commercial healthcare product. The ability to access vaccination is determined by a range of factors, including local/national purchasing power to obtain vaccine products and the affordability of vaccines among the population (in cases where they are not administered free of charge). Vaccination is noted as being one of the most cost effective tools to prevent ill health and avoid an inevitable high burden of costs associated with hospital admissions for emergency care and other curative health services. Countries in the Global South, in particular, have benefitted from a significant return on investment via smallpox and polio vaccination programmes in recent decades. Accessing vaccination is undoubtedly of economic benefit, with authors of a recent reflective piece on COVID-19 vaccination describing it as an act of investment in human capital, providing enduring impact on economies worldwide”

Vaccination against COVID-19 is poised to be a key consideration in the movement for economic justice for informal workers. Absenteeism from work—and presenteeism at work with reduced productivity—as a result of enforced COVID-19 restrictions or illness is likely to have a huge impact on an informal worker’s income security, as well as on the wider economy. This has already been observed in Bahia, Brazil, where reduced informal worker activity in the labour market was associated with significant negative effects on the economy. This would also be compounded by socio-economic inequalities routinely experienced by informal workers, which materialize in the form of relative poverty, poor access to health care and a lack of social protection. Data from WIEGO’s COVID-19 Crisis and the Informal Economy Study has already illustrated COVID-19 absenteeism among informal workers: almost 70% of all informal workers surveyed reported having stopped working during the initial lockdowns. This issue is compounded further by the risk of workers’ dependent family members contracting COVID-19 and falling ill, which increases the care burden on women informal workers in particular and will likely further increase absenteeism/presenteeism with reduced productivity, and consequently limit workers’ economic output. 

Vaccine nationalism—that is, governments securing huge quantities of vaccine products for their own nations at the expense of others—poses a major economic risk, with the International Chamber of Commerce recently estimating that up to USD9.2 trillion could be lost from the global economy as a result. Similar warnings have also been voiced elsewhere, with indications that global growth could be half of the World Bank’s estimate of 4% if global vaccine delivery remains inequitable and slow. 

At national level, access to vaccination for informal workers is also likely to lead to economic impacts if these workers are not perceived by governments as being a part of a priority group within certain country contexts. For example, in South Africa, there are currently multi-stakeholder negotiations underway (which include representatives of informal workers) to reach agreement on which workers (formal and informal) should be included under the definition of ‘essential workers’ in the second phase of vaccination rollout, following completion of the first phase targeting health workers. Additionally, there may be issues around the accessibility of vaccination centres/clinics for informal workers with regards to location and opening hours, the cost of receiving the vaccine (if it is not free of charge) and the level of reimbursement through health insurance schemes that would be available to informal workers. All these factors could pose significant barriers to informal workers when attempting to access a vaccine and, ultimately, when seeking to address their income insecurity and any reduction in productivity.

As long as existing programmes of vaccine distribution remain fundamentally unchanged at both global and national levels, the impact of COVID-19 on informal workers’ incomes and on the wider economy could be catastrophic. Furthermore, any ensuing economic uncertainty would potentially occur against a backdrop of emerging vaccine-resistant variants of COVID-19 infection. The longer it takes to distribute the necessary quantities of vaccine to offer protection to all, the more likely it is that these variants will occur. Yet, these scenarios may be largely avoided if vaccines are distributed equitably, more strategically and at greater speed.

A year after the World Health Organization declared COVID-19 a pandemic, access to vaccination for informal workers is critical to ‘softening the blow’ of a triple health-economic-care crisis. While informal workers must not merely be reduced to their economic output, viewing the vaccination issue through an economic justice lens—which is, in many ways, inseparable from access to healthcare concepts—is crucial to understanding the depth of the impact of COVID-19 on informal workers.

Photo: Christina Ohenewaa is a 50 year old trader in Cosmetics in Accra, Ghana. Credit: Benjamin Forson

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