Global health prioritizes the needs of the global north at the expense of the global south, which racializes disease treatment and upholds a legacy of oppressive healthcare.

How does anti-Blackness manifest itself? No continent has been more impacted by the ravages of colonialism and racism than the African continent. Sadly, even today, Africans are at the receiving end of discrimination, from vaccine apartheid to visa apartheid. The Covid-19 pandemic offers a stunning recent example of anti-Blackness. No continent is less vaccinated and boosted than the African continent [3]. While wealthy nations rushed to clean up the shelves, hoard vaccines, and even throw away millions of expired vaccines, the African region was left last in the line. Despite the efforts of activists and the support of most countries, a few rich countries blocked the TRIPS waiver that could have significantly expanded vaccine manufacturing in the Global South. Two years after vaccination began in wealthy nations, and even as second and third booster shots are being offered in the Global North, barely one in four people in the African region are vaccinated with two doses (as of January 2023) [3]. The African region has also had the lowest Covid-19 testing rate, and access to anti-viral medications such as Paxlovid is practically non-existent. This pattern of discrimination is not new. More than 30 years ago, when anti-retrovirals (ARV) became available, they were considered too expensive to roll-out in the African region. As late as 2001, some experts maintained that ARV treatment in Sub-Saharan Africa was impossible. It took incredible activism, legal action, and community effort before they started becoming available, by which time millions of Africans got infected and died. When the Ebola outbreak ravaged West Africa during 2014–16, it killed more than 11,000 people in Guinea, Liberia, and Sierra Leone. Even intravenous hydration was seen as being too challenging during this crisis. While an overwhelming majority of the mostly White American and European healthcare workers who contracted Ebola survived, the infection killed two-thirds of West Africans with Ebola. Investments in R&D dramatically increased only after Ebola infections began to be reported outside Africa; in fact, investment for new product development increased more than 900-fold after the outbreak in 2014 [4]. Africa is the only continent where mpox has been endemic for decades. And yet, when the global outbreak occurred, the west was prioritized for vaccine rollout. A giant share of the mpox vaccines is still held by the US, UK, Canada and France–some of the richest nations in the world, while the African region was once again left behind [5]. In the same vein, although sub-Saharan Africa carries the highest burden of cervical cancer cases and deaths globally, access to human papillomavirus vaccines remains very low in most African countries. When the same patterns echo across diseases and across decades, it is hard to call it anything but anti-Blackness. Anti-Blackness is structural and dangerous The de-prioritization of African lives by the rest of the world has harmful and deadly consequences. For example, in the sub-Saharan African countries most affected, HIV/AIDS lowered life expectancy among adults by about twenty years. Earlier access to ARVs could have prevented this devastating impact. Given the low vaccine and booster coverage in Africa against Covid-19, and emerging, highly immune-evasive subvariants, the African continent is poorly prepared to face any new, deadly variant of SARS-CoV2 as well as the consequences of long Covid. Why is anti-Blackness so widespread? Historically, and even today, every aspect of global health is dominated by rich nations in the Global North. The health of Black people in Africa was never a priority for countries that colonized and exploited the continent; rather global health and its precursors grew out of the need to protect colonialists from diseases prevalent in colonised regions of the world. In fact, the act of colonial conquest was so violently disruptive that it radically altered lives and habitats leading to what was referred to in the early 1900s as the “pathological revolution” [6]. Hence, historically, decisions about the health of Black people were made in countries far away and not always in their best interests. Are things better today? Sadly, data show we have a very long way to go. In 2020, less than 10% of the largest global health organizations were head-quartered in the African region, and very few of the global health organizations are led by African nationals [7]. A survey of over 2000 Board seats of global health organizations shows that less than 3% of the seats are held by nationals of low-income countries [8].