THE hunt is on for a vaccine to help populations across the world fight the SARS-CoV-2. Many scientists predict, however, that this search could take 18 months at a minimum.
Meanwhile, the COVID-19 pandemic is revealing the deep social fault lines within and between countries. People who are already poor, have precarious employment, high levels of existing debt, have poorer access to quality health and social services, are living with disabilities, are socially marginalised, and have the least social capital are feeling the devastating impacts of this pandemic the most. Homeless people, migrants and refugees live in conditions that make social distancing and adequate hand washing impossible. In the US, African Americans are dying at a greater rate than white people. In many rich countries, governments have provided income support for people who have lost or are at risk of losing their jobs, but in low and middle income countries such support is not available.
Professional journals and social and mainstream media are awash with opinion pieces about how the recovery from the pandemic provides an opportunity to address climate change and the inequitable distribution of power, money and resources (here, here and here). Achieving these transformative goals requires a social vaccine – “a metaphor designed to shift the dominant biomedical orientation of the health sector towards the underlying distal factors that cause disease and suffering”.
Such a vaccine would be applied to populations rather than individuals. It will also have to be applied in multiple sectors that affect health, including education, employment, welfare and housing. It comprises government and other institutional policies that aim to keep people well and mitigate the structural drivers of inequities in daily living conditions, which make people and communities vulnerable to disease and trauma. The target of the social vaccine would be the conditions that underpin four basic requirements for global health and equity to flourish:
- a life with security;
- opportunities that are fair;
- a planet that is habitable and supports biodiversity; and
- governance that is just.
Table 1 outlines the components of a social vaccine that addresses these basic requirements.
Table 1. Global social vaccine for equitable human and planetary health
|Requirements for equitable human and planetary health||Components of a social vaccine|
|A life with security||Universal system to guarantee health services, income, employment housing and energy for all
Progressive taxation system including national and international agreements to prevent individual and corporate taxation avoidance
Binding and enforced treaties to avoid war, occupation and conflicts
|Opportunities that are fair||Universal free or affordable education from early childhood to tertiary level
Racial, sex and disability discrimination legislation and enforcement
Fair and decent employment
Urban, rural, food environments that support healthy living choices for all
|A planet that is habitable and supports biodiversity||Rapid transition to zero carbon emissions
Action to support biodiversity and halt rapid rate of extinction
Removal of subsidises and supports for fossil fuels
|Governance that is just||Universal franchise
Transparency and accountability measures embedded in all political processes
Legislation that supports strong civil society movements
Conceptualisation of demands for healthy policies and the achievement of the policies as a social vaccine have a couple of advantages. First, the conceptualisation brings the social into the medical realm and so gains some of the power and prestige that the institution of medicine has gained in our society. Second, the metaphor works to reduce the political nature of social determinants of health and points more to the evidence behind the policies by drawing on the recognised effectiveness of vaccines in combatting infectious disease.
Biological vaccines require an efficient supply chain to ensure their delivery and effectiveness. In a similar way, the delivery of public policies at the heart of a social vaccine require considerable civil society advocacy to ensure their development and effective implementation. See, for example, the abolition of slavery, women’s franchise and civil rights in the United States. Such social movements are vital to good governance and the development of effective social vaccines.
With or without a vaccine, the COVID-19 pandemic will come to an end at some point, but the inequities highlighted by it will remain unless a social vaccine is developed and applied. A global social vaccine will enable a new way of living that is healthy, just, convivial and sustainable, and will inoculate future society against a return to a world growing increasingly less healthy, sustainable and equal.
Fran Baum is Matthew Flinders Distinguished Professor, Director of the Southgate Institute and the WHO Collaborating Centre on the Social, Political and Commercial Determinants of Health Equity at Flinders University.
Sharon Friel is Professor of Health Equity and Director of the Menzies Centre for Health Governance at the School of Regulation and Global Governance (RegNet), Australian National University.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.