How much is the inequality alive? In years marked by the pandemic and ever closer conflicts, the need to reflect on these issues and poverty is becoming increasingly urgent. To answer this question, Oxfam – a non-profit organization committed to the fight against inequality and poverty - organized in Florence the 1st edition of the Oxfam Festival. Two days of meetings and debates are scheduled on 12 and 13 May to meet the inequality in Italy, spread the stories and testimonies of those who live injustices on their skin, and create a more inclusive society. Oxfam Italy wants to make a change that lasts over time because everyone deserves a future of equal opportunities to thrive and not just to survive.
Roberto Barbieri, general manager of Oxfam Italy, said that the Festival was born, above all, to contribute to the production of changes with the sharing of good practices. Oxfam hopes to stop injustice, violation of rights, exclusion, and abuse by opposing inequalities altogether. Creating a future of equality is the ambition that must animate the commitment of institutions, companies, associations, and the world of culture, starting from the denunciation of what today produces and perpetuating the growth of injustices, and making the most of the many positive experiences present in our society.
The work, in crisis, is damaged in its dignity, and it is not enough to lead a dignified life. In Italy, already before the pandemic, more than 1 in 8 workers were in poverty at work, 2.5% above the European average. Additionally, too low wages affected over 5 million employees in the private sector, one worker out of 3, especially penalizing women. Within this framework, Oxfam is a direct witness to the fight against poverty and exclusion that it carries out with the network of Community Centers in the suburbs of many Italian cities.
The meeting Health: Rights and Equity has particularly interested me because it prioritized inequality of access to health globally with a focus on Tuscany.
Food aid in Tuscany has grown by 13.3% between 2019 and 2021. In 2020, more than 1.000 more families applied for food aid because of the state of poverty in which they found themselves.
Between 2020 and 2021, 47.4% more people turned to Caritas, with 7000 new families who applied for help for the first time at a listening center. Those new poor workers belong to the world of tourism/commerce. Only 49% of students who have a diploma in hospitality find a job related to their academic career. Only 13% of these have a permanent contract. 1 of 5 workers in 2017 received low pay with a large gap between men and women: 27% of women against 17% of men. Protection and remuneration are not adequate. Therefore, sustainable tourism discourse is inserted here: alternative mobility that relocates tourist flows and the quality of work. The objective is to lessen territorial differences and monitor them to provide useful information to public administrators. In addition, the EU calls for policies’ consideration based on the ecological and digital transition that is taking place. A shift that must not forget social justice.
It is necessary to put climate change at the center of urban planning. For this reason, the support from the National Research Council and the Department of Agriculture and Architecture is pivotal to mapping those places where the temperature increases the most, causing cardiovascular and respiratory diseases. Thus, investing in a green economy results in a healthier environment for everyone and better air quality. Green areas provide everyone with the same opportunity. Florence is one of the 100 cities selected by the European Commission committed to achieving the 2030 goal of climate neutrality involving sustainable mobility, urban, and forestry.
Covid-19 has widened the inequalities: wealthy countries have a percentage of vaccination of 75% (complete cycle) while the poor have a rate of 13%. Inequality in access to vaccines is inequality in access to health services and quality care because not every country has the license to produce the vaccine. Inequalities characterize the global context. There are five general medical practitioners per 1000 inhabitants in the EU. Five and a half million people die each year from lack of access to quality care. The pandemic has put tremendous pressure on the best-performing health systems, not to mention the already fragile health systems of low- and middle-income countries. The WHO has launched an exciting report: six million and 200,000 deaths from Covid-19 are related to dead people with one positive swab, but it is underestimated because there were no tests available or data collection and transmission in many countries’ systems. Moreover, the number does not count deaths from neglected diseases because health systems couldn’t treat those people. So, it is evident that the world faced a catastrophe considering the difference between the number of deaths during a pandemic and the number of deaths according to statistics in a normal situation. The victims are around 15 million. Furthermore, the death toll is four times higher in low-income countries than in high-income countries because there is no access to diagnostic techniques and vaccines.
The dramatic situation involves the number of countries that has the license to produce vaccines. If the patent is not abolished, 70% of the worldwide population will be vaccinated in the next 2 two and a half years. As stated by the international organizations: this is a moral failure in terms of public health. If we don’t get vaccinated, we will never defeat the pandemic. The tools used to reduce this difference in access to vaccines haven’t worked. Sharing instruments is appreciable, but everyone must do more. At the Second Global Covid-19 Summit promoted by Biden, Italy is committed to donating more than 31 million vaccine doses to low-income countries. It is a valuable initiative, but we must think about what vaccines we give. Suppose we present those vaccines that we have not offered to our citizens and expire in 2-3 months. It could be a problem because a country with a fragile health system can’t set up a vaccination campaign in that limited period. Another critical issue is related to what vaccines donate in terms of category: AstraZeneca and Johnson&Johnson are inadequate for people under 60 years old.
A WHO initiative promoted COVAX, which is the vaccines pillar of the Access to Covid-19 Tools (ACT) Accelerator, to accelerate the development, production, and equitable access to Covid-19 tests, treatments, and vaccines through donations or purchase of large quantities of vaccines that are given to low-income countries. Currently, it is essential to act on the causes that have determined the inequality in access to vaccines: a system that grants the pharmaceutical companies the monopoly of the vaccines they have invented and developed.
Science has done a miracle in creating vaccines quickly, and the pharmaceutical companies have made a significant effort thanks to a substantial public investment: 83 billion euros between 2020 and 2021. Despite this, the pharmaceutical companies have a monopoly on vaccines, so they are the only ones with the right to produce that vaccine and, therefore, the power to decide to whom, how, and when to sell that vaccine. It was evident that for pharmaceutical companies is convenient to sell vaccines to countries that can pay more than those who spend less.
Considering the estimated cost of producing vaccines, some countries paid twenty-four times the cost of a single dose of vaccine, while African countries paid COVAX five times more. 80% of the quantities produced have been used by the G20 countries and only 1% by the poorest countries.
However, in October 2020, the World Trade Organization proposed that Covid-19 patents must be suspended for the duration of the pandemic. The Marrakesh Agreement establishing WTO states that it is possible to stop the rules of the agreement in case of emergencies. More than one hundred member countries agreed to the possibility of suspending patents, but the proposal is discussed cyclically.
During the ’90s, with HIV diffusion, Nelson Mandela, thanks to the medical act, imported drugs from other countries to fight against HIV. More than thirty-nine pharmaceutical companies sued the South African state for mentioning this act even if a considerable mobilization of HIV-positive patients occurred.
What can be done now after this epochal crisis? Oxfam calls for the suspension of intellectual property rules on vaccines and treatments and the sharing of know-how by pharmaceutical companies. What successes and failures of the pandemic have there been global? Inequality is evident between the North and South of the world. What is lacking today is political leadership.
In 1996, pharmaceutical executives met Nelson Mandela and Kofi Annan to seek a compromise. The fundamental question was either South Africa’s production of HIV drugs was prepared to lose some of its profits but gain in terms of image, or ten million HIV-positive patients were sentenced to death. In that situation, the pharmaceutical companies succumbed.
Today, there is not even a request from an African leadership for a patent suspension. If patents remain, the production of vaccines is blocked. Therefore, the recent vaccine production hub in South Africa, thanks to the financing of France, Germany, and Norway, is entirely useless if no one will intervene, forcing companies to give the possibility to the hubs to produce vaccines through the compulsory license. Consequently, the production of vaccines could reach 60% in the next three years. Big companies made huge profits with a weak and fragmented policy that led to misinformation on vaccines exaggerated by social media spreading false news. Moreover, public institutions are plastered with bureaucratic communication tools that are not adequate for the speed and professionalism of disinformation.
Patents are important because increased life expectancy through drugs and technologies, but in the presence of a pandemic, it is necessary to give priority to global health. For example, in Sierra Leone, in a short time, the arrival of Covid-19 frightened health professionals resulting in restrictive policies on the hospital admission of patients. Lockdowns were made for three days, causing significant problems because it was impossible to access life-saving therapies for fear of Covid-19. At the same time, when vaccines arrived, doctors and nurses were suspicious. The problem with access to treatments is the low density of doctors (less than three doctors per 100 inhabitants) and constant oxygen deficiency. In December 2021, only 6% were vaccinated. Today more than 26% of people are immunized in Sierra Leone.
Additionally, in less than twenty-four hours, Emergency created a Covid-19 Department and transported oxygen machinery because of the lack of treatment centers. The population often asks NGOs for help, so the priority is to define an approach that allows everyone to benefit from universal and accessible healthcare. To do this, the Italian Development Cooperation works with local governments and raises awareness among the authorities of the partner countries on these aspects. The local health systems reinforcement requires political stability and direct dialogues with the institutions. Concrete interventions involve the renovation, expansion, or building of health facilities such as laboratories, clinics, and hospitals; medical and technical staff training.
As long as pandemics will be addressed frequently, there’s an urgent need to prevent zoonosis, which is responsible for transmitting diseases from animals to humans.
Health must be able to reach the most vulnerable people, such as migrants, and promote inclusion. Without politics, inequalities will accelerate. Reducing poverty is not enough to reduce inequalities. Enabling functions that generate income and social inclusion is deemed necessary. Within this framework, education is a crucial social aspect. Millions of children will not return to school in Italy, and gender inequalities are affecting the quality of development. An impressive democratic recession has marked the last decade. The virus of inequality is an internal threat to democracy that is eroding the social foundations of democracy.
The pandemic has also provided a window of opportunity for progressive thinking based on a turning point in European policies resulting in a change of common sense towards the school, the not guaranteed everywhere national health service, and the importance of the caregivers.
How to move toward a model that can work for everyone? And can a model ensure real value to all professional figures? Indeed, the pandemic has opened our eyes in terms of topics to focus on, and this is the time to rethink our economy, not to start production again as or more than before, but women, children, and developing countries must be the core of the new policies, as an inclusive and sustainable development requires and demands.
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