A/HRC/45/44 4. Impact of systemic racism on therapy and vaccine development 45. Equal protection requires States to consider who is disregarded as well as who is protected. Interventions that appear neutral may actually license or facilitate racial bias and stereotypes if specific efforts are not made to counter them. In the COVID-19 pandemic, all front-end planning and protection efforts have failed to address public health issues specific to people of African descent. Dramatic racial disparities have ensued. 46. The above-described situation raises a parallel concern that research and knowledge production in response to the crisis may fail to investigate racialized barriers to care or to recognize the racially discriminatory intent or impact of policy. In the United States, some early vaccine research lacks meaningful representation of people of African descent despite the stark racial disparities that have emerged during the pandemic and the siting of the trials in Atlanta, a city with a largely Black population.36 47. In many States, high-level decision-making relating to the crisis lacks the representation, expertise and understanding necessary to responsibly plan on behalf of communities of African descent. Navigating the COVID-19 pandemic requires understanding rather than denying diversity. For example, in a submission to the Working Group, representatives of civil society questioned the propriety of all-white leadership teams at hospitals in London. States have the opportunity to leverage existing civil society expertise to define key concerns and to implement policy effectively. In the United States, the first vaccine set for phase III trials was developed by a woman doctor of African descent. An authentic understanding of Afrodescendent communities, with the participation of the persons affected and diverse voices at every level, should help to inform and drive innovation. 48. Without targeted efforts to contain systemic racism, States may instrumentalize people of African descent for scientific innovation by default. In 2019, in the United States, major commercial health-care algorithms recommended less treatment, intervention and care for people of African descent than for identically situated white people (on the basis of different risk scores).37 In scientific research, factors including “study design” and “logistics” operate to exclude people of African descent. In Brazil, hydroxychloroquine, a drug promoted by the United States, was provided to indigenous populations and advertised as curative before and after being discovered to be ineffective against COVID-19. 49. The use of people of African descent as “lab rats” for research on COVID-19 was publicly discussed in April 2020 during a televised broadcast by the head of intensive care at a large public university hospital in Paris and the director of research at the French National Institute of Health and Medical Research (INSERM). One doctor offered Africans for vaccine testing, referring to their lack of access to masks, treatment and resuscitation. The other doctor discussed plans to conduct just such studies. Amid public uproar, the latter subsequent apologized but failed to take responsibility for any misconduct or to acknowledge the substantive racism or the colonialist tropes invoked, instead apologizing for any “hurt feelings” from his remarks. The Director General of the World Health Organization condemned the original statements, unequivocally stating that “Africa cannot and will not be a testing ground for any vaccine. The hangover from colonial mentality has to stop.” 50. The above-mentioned “hangover from colonial mentality” has created barriers to the human rights of people of African descent. For example, in Haiti, the rationale for policies denying access to expensive HIV medications originated from bias, not cost considerations. In 2001, the Government of the United States opposed timed HIV medications for Haitians, stating they did not wear watches. Some United Nations officials stated that babies should drink HIV-tainted breast milk because supplying formula was “creating dependencies” that were not “cost-effective” or “efficient”.38 Researchers had to prove that Haitians could follow 36 37 38 See for example Lisa A. Jackson et al., “An mRNA Vaccine against SARS-CoV-2 – Preliminary Report”, New England Journal of Medicine, 14 July 2020. See Ziad Obermeyer et al., “Dissecting racial bias in an algorithm used to manage the health of populations”, Science, vol. 366, No. 6464 (25 October 2019). David A. Walton et al., “Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti”, Journal of Public Health Policy, vol. 25, No. 2 (28 April 2004). 11