Abstract: Throughout history, international politics and policies have influenced medical advancement. From its religious and spiritual origins to its expansion to global practice, the field has evolved through nationalistic ideologies, often to the detriment of equitable access to care and technology. For example, the prolonged use of chloroform anesthesia in Europe over the less harmful nitrous oxide demonstrated how partisan pride can overshadow safety. Likewise, the COVID-19 pandemic revealed how rhetoric and national and international politics led to unjust vaccine distribution. Using case studies of the United States, Brazil, and Chile, this paper will illustrate the impacts of nationalism on global health. While the US and Brazil both encountered vaccine hesitancy, Chile’s pragmatic and inclusive approach to vaccine allocation led to it having the most vaccinated population in Latin America at the time. Efforts to combat vaccine nationalism, like the COVAX program, delivered less than 50% of its original target to provide vaccines to lower-middle and lower-income countries, showing how difficult it is to create global health partnerships in a market-driven world. Using historical and modern examples, this essay aims to show how nationalism continues to impede the progress of medical advancement and public health and safety.

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Medicine does not operate in a vacuum. Its practice is influenced by politics, sociology, and even language. Initially, one may struggle to see the connection between something so analytical and quantitative as science and medicine and the qualitative (maybe even erroneous) nature of human activity. Historically, medicine is precisely rooted in uniquely human qualities: religion and spirituality. From tribal beginnings, medicine grew to international proportions. As medical historian Henry E. Sigerist points out, the first instance of international medicine was the Grecian practice. It remained the standard for international medicine in the Mediterranean for over 1,000 years. Today, all hospitals and medical centers worldwide commemorate common ancestors of the practice like Hippocrates, Galen, Pasteur, and the like. Even so, linguistic, political, and educational rivalries overturned the international origins of medicine, and the world was left with a medical history “poisoned with nationalistic prejudices, every country claiming priority for discoveries, hunting for ‘firsts’ and ‘fathers’ of medical intervention.” [1] The WHO was newly founded when Sigerist delivered these words at Johns Hopkins University. He claimed that medicine could “get away with” its nationalistic tendencies, but public health cannot. He cites examples from the Black Death to cholera, where all countries united in a fight against one common pathogenic enemy. However, in recent years, it has become apparent that Sigerist’s hope for public health never came to fruition. 

     Dr. Paul Offit, immunologist and infectious disease specialist, writes on the history of various medical technologies like vaccines and anesthesia. Early anesthetics like ether and nitrous oxide had their pitfalls, but neither outweighed the danger of chloroform which, in many cases, caused heart issues and sudden death. [2] As a result, chloroform was discontinued or banned in the United States. In Europe, even after the dangers of chloroform were widely understood, it was used in 80-90 percent of all surgeries, causing hundreds of preventable deaths. 

     So, why did Europeans use chloroform for decades when it was clearly the riskier choice? The most likely explanation is nationalistic pride; chloroform had debuted in Europe, whereas nitrous oxide and ether had debuted in America. Also, the births of Prince Leopold and Princess Beatrice under chloroform anesthesia had been highly and proudly publicized, influencing a nation. [2] Nationalism continues to affect medicine and public health today. The most recent and impactful instance occurred during the development of the COVID-19 vaccine.

     Vaccine nationalism is a term that describes high-income countries (HICs) that push for early access, hoarding the first vaccines and leaving little for the rest of the world. [3] To illustrate, over half of the world's vaccines produced in 2021 had been purchased in advance by HICs, which only represent 13% of the world’s population. [4] The US hoarded millions of vaccines under the guise of providing a dose for every American adult. However, by 2024, the surplus created by the hoarding vaccines caused about 15.1 million COVID-19 vaccines to be discarded as they passed their expiration dates. 

     The US was not the only world power facing vaccine nationalism. At the beginning of vaccine rollouts, Brazil was offered CoronaVac, a vaccine made by a Chinese biotech company. Strangely enough, Brazil’s initial vaccine hesitancy began with a Chinese telecommunications company. Before the pandemic, Donald Trump denounced Huawei as an extension of dangerous Chinese surveillance. [5] President of Brazil, Jair Bolsonaro, followed suit. As COVID-19 ravaged the population, Brazil’s communications minister quickly made amends with Huawei and used the opportunity to ask for vaccines. Nevertheless, the anti-vaccine and anti-China rhetoric persisted, leading to Brazilians claiming to reject any China-made vaccine. [6] China was quick to send vaccines to other Latin American countries, a sharp contrast to the United States’ approach.5 Despite China’s willingness to export vaccines, it is not blameless in its nationalistic agenda. In promoting its own vaccine, China’s state media-initiated misinformation campaigns against Pfizer and Moderna.7 Some of these videos also influenced American anti-vax groups. During this time, Chile vaccinated more people than all of Latin America using the same CoronaVac vaccine. [8]

     The success in Chile was multifaceted. COVID-19 took such a toll that Chile’s approach was pragmatic; they were willing to accept any vaccine regardless of its country of origin.9 Academic institutions paired with laboratories to conduct clinical trials and the government diversified the pool of potential distributors. For example, Chile recognized agreements with Sinovac, Pfizer-BioNTech, Oxford-AstraZeneca, Janssen, and pre-agreements with many others. There was no single option for the Chilean government, and they weren’t swayed by one country’s politics or power over another. The government also ran positive media campaigns and minor incentives such as a “mobility pass” allowing vaccinated individuals to move around in locked-down areas. Finally, the vaccine distribution created a sense of pride and patriotism as opposed to ignorance and nationalism. 

     Considering the great awareness of the existing inequalities in the country, the strategy defined priority groups that started with people at higher risk—health personnel, older people—generating a sense of justice and a common goal, since people who were more in need were the first receiving the vaccine, while the rest waited for their turn. [9]

      Interestingly, vaccine nationalism was anticipated. In an attempt to combat it, several global health organizations co-led an endeavor for equity in vaccine distribution in the COVAX program. [10] Their goal was to deliver 2 billion doses by the end of 2021; unfortunately, under 50% of that objective was reached with many criticizing the initiative for being a middle-ground approach. [11] The barrier? Vaccine nationalism. High-income countries overcrowded the market and undermined COVAX’s buying power. This factor, coupled with poor funding and export bans, meant COVAX was ultimately a failure.

     The recent pandemic was a string of instances where public health has been nationalized to benefit the wealthiest countries’ citizens. Even in 1947, Sigerist understood that the world may never overcome these tendencies:

 

“Nationalism has been the great curse of humanity. In no other shape has the Demon of Ignorance assumed more hideous proportions; to no other obsession do we yield ourselves more readily... it rages today as of yore in spite of the precepts of religion and the practice of democracy. Nor is there any hope of change; the pulpit is dumb, the press fans the flames, literature panders to it and the people love to have it so." [1]