When suspicion replaces evidence in public health

The UK Government's decision not to recognise people as vaccinated if they received COVID-19 vaccines in most of Latin America, Africa, and south Asia received widespread condemnation.¹ Many commentators have rightly called out this discriminatory policy, which unfairly targets people from low-income countries. However, as a group of scholars from the medical humanities and social sciences, we are particularly concerned that the way in which the government makes decisions about which countries are exempt from quarantine once fully vaccinated dispenses with evidence-based policy making.²

The policy recalls an earlier moment in global public health. At the height of the British Empire, quarantine effectively served to prevent citizens from low-income and middle-income countries entering high-income countries on the basis of the assumption that people from these countries were vectors of contagion. Both then, with quarantine islands, and now, with quarantine hotels, these policies rely on and exacerbate the role of suspicion in policing public health, especially regarding vaccines that are manufactured in countries other than the UK.³

The consequences of suspicion, and not evidence, driving policy are serious. This UK policy is irrational because many of these low-income and middle-income countries administered the same vaccines that the UK Government distributed to its own population. In some instances, the UK Government donated these vaccines.

Although efforts to vaccinate the world against COVID-19 are picking up pace, there is still a lot of vaccine hesitancy. As the head of Africa Centres for Disease Control and Prevention noted, policies that exclude some vaccinated people could increase vaccine hesitancy from people who believe that vaccines are useless.⁴ ChAdOx1 nCoV-19 (AZD1222), which more than 50% of the UK population has been vaccinated with, accounts for most of the vaccines the UK have now labelled as unacceptable for travellers from some other countries. The rationale for not accepting the vaccine is unclear and speaks to a long history of suspicion-based public health policing in global health, as emphasised by the What's at Stake in the Fake research project. It took WHO and other global health leaders decades to recover from undermining public confidence in low-cost generic drugs, which enabled low-income populations to access basic medicines. Do we want to repeat this cycle with vaccines, at what might be the start of an increase in pandemics due to increased urbanisation, globalisation, and climate change?

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We declare no competing interests.