Abstract

The sensory and affective impact of a photograph in a news story may mitigate the message of the headline and even the content of the story as a whole, with the potential to lead the reader to countless parallel stories. These stories can be imbricated to the theme explored by the media, but can also expand to several other issues, memories, events, authors unveiling to the reader other situational layers that transcend the sphere of simple reading leading to reflexivity. This text has, therefore, the intention to reflect at length about the inequities in health, especially in relation to the distribution of vaccines against Covid-19 on the planet, from an image published by France Presse in a story about a day with record application of doses of the vaccine against Covid-19 in India.

Photograph; Health inequity; Health care; Covid-19; Syndemic

When she looked at the pandemic: one photograph, countless movies

The Covid-19 pandemic is likely the largest event of the 21st century - it is perhaps too early to predict, given that the first quarter of the century has not yet been reached. There is no precedent for a health event (also environmental, social, economic, to say the least) of such widespread, devastating, and unpredictable behavior (viruses, variants, speed of transmission, etc.) in humanity’s post-industrial era.

In this second decade of the 21st century, a time when the planet is home to some eight billion people, everything leads one to believe that the world has shrunk. That borders are becoming more fluid every day and distances are economic rather than geographical. That, in fact, a butterfly flapping its wings in Kochi, Kerala, India can influence the weather in Xique-Xique, Bahia, Brazil. Nature, of which we are all a component and inseparable part, without primacy, superiority or title of ownership - we must understand this and share it - passes through us with events, news, happenings at every beat of any heart. We are an integrated and chaotically ordered whole. But some humans insist in believing that they are the animate species able to dominate, subjugate and program this already given (if not disturbed by the human) chaotic order.

An emblematic, delicate and subtle message of this nature was given on August 28, 2021, in an article by France Presse, echoed by the G1 portal, about the mass vaccination in India, which informed that about ten million people had been vaccinated in just one day in the country - a figure that seems grandiose, but which corresponds to less than 1% of the approximately 1.38 billion inhabitants of the land of the divine river Ganges. But the main message and motto of this article is the magnetic photo printed in the news, which depicts a lady being vaccinated in Amritsar, in the state of Punjab, India, a city recognized as the center of the Sikh religion. It is there where she lies, surrounded by a large artificial lake (a Sarovar) or the AmritSar (Lake of Holy Water or Immortal Nectar) itself, the Golden Temple of this devotion that has about 27 million followers. The photo ^bbOut of respect for the copyrights on reproduction of images, I indicate here only the link where the photo can be viewed: https://g1.globo.com/mundo/noticia/2021/08/28/india-vacina-10-milhoes-de-pessoas-contra-a-covid-19-em-apenas-um-dia.ghtml is undoubtedly a work of rare beauty by photographer Narinder Nanu, of AFP - Agence France-Presse¹1. France Presse. Índia vacina 10 milhões de pessoas contra a Covid-19 em apenas um dia [Internet]. Rio de Janeiro: Globo; 2021 [citado 1 Nov 2021]. Disponível em: https://g1.globo.com/mundo/noticia/2021/08/28/india-vacina-10-milhoes-de-pessoas-contra-a-covid-19-em-apenas-um-dia.ghtml
https://g1.globo.com/mundo/noticia/2021/... .

The experienced, captivating, and magnetized eyes of the lady illustrating the story are the highlight and source of all the symbolism that only an image can reveal. In them dwells a lake of holy water, an immortal nectar - a universe in a walnut shell (the old lady’s tired eyelids) whose core are the infinite experiences of an entire life. Her expression conveys hope, despair, past, future, doubt, certainty, skepticism, faith, desire for survival, certainty of finitude. Feelings read so clearly and familiarly that they push us to clash with themselves in us. The Indian lady’s eyes are the eyes of ordered chaos informing us that they themselves - these eyes - are in many faces of other humans (or not), symbolizing our pandemic period.

The photo seems to have been taken in an improvised vaccination station (or even in a home care service) where objects of daily life rest on a table - among them many seem to be medicines - that we do not know if it is for work or for meals, but whatever. The lady is flanked by female faces and hands that appear to be those of health care workers. A smartphone in the hand of someone who may be one of these workers, to the lady’s right, is the counterpoint to the hand with the syringe and needle that instilled the vaccine in the lady’s left arm. As if to perform a counterbalance, another hand supports (or rests on) the lady’s right arm. Still composing the set of women in the scene, in the background, to the right of the lady with the eyes of the world, sits another woman (the only one who appears wearing a face mask) who, with her gaze low, induces the spectator to her view of a smartphone or even a line of sight that is alien to the scene¹1. France Presse. Índia vacina 10 milhões de pessoas contra a Covid-19 em apenas um dia [Internet]. Rio de Janeiro: Globo; 2021 [citado 1 Nov 2021]. Disponível em: https://g1.globo.com/mundo/noticia/2021/08/28/india-vacina-10-milhoes-de-pessoas-contra-a-covid-19-em-apenas-um-dia.ghtml
https://g1.globo.com/mundo/noticia/2021/... .

And I, here as a spectator, remember Adriana Calcanhotto’s song and ask: “Why does she [the lady with the eyes of the world] have the eyes of a wave?”²2. Calcanhotto A. Olhos de onda [CD-ROM]. Nova York: Sony Music Entertainment; c2014. 1 CD-ROM: 4 3/4 in. Yes, she has those wave eyes; of infinite waves. Eyes that make me think of how many waves and tides have already come and said goodbye through the eyes of this lady. How many of these waves were babies born in the houses of the poor or of maharajas in urban centers, in the fields or in Indian, African, Brazilian, Colombian, Mexican, and other slums? How many of these waves soaked the bodies of people who were bidding farewell to life for cremation or burial? How many of them celebrated life and its cycles (childhood, adolescence, adulthood, old age)? How many mourned their dead? How many were thrilled by births? How many of them said welcome or farewells to their loved ones, saying goodbye or getting closer? Or how many waves rejoiced and were happy with the return of their lovers, their beloved? It is the wave eyes, the hangover eyes that bring everything into themselves ^ccThe expression “Wave Eyes” is an allusion by Calcanhotto to Machado de Assis’ “Dom Casmurro”, in which the eyes of Capitu, the protagonist of the novel “carried I know not what mysterious and energetic fluid, a force that swept inward, like the wave that retreats from the beach on days of hangover”. .

Ten million doses of vaccines applied in one day. That was the headline... Nothing in the article referred to the eyes of the old lady illustrating the text. Maybe because deep inside, where the terror of the pandemic resides, we all knew in waves that we were drunkenly balancing between the supposed (bet?) salvation through immunization and contamination due to lack of soap for a minimum hygiene. Actually, we wobbled in fact between borders that squandered vaccines and others that didn’t even have them. The iniquities of the whole world stamped in this lady’s eyes. Rich countries that attributed the act of getting vaccinated against the complications of SarsCOV-2 to volition and the right to choose, while others were unable to access vaccines, medicines, or basic supplies that would minimize the ravages of Covid-19.

About one year and ten months after the pandemic began, the first day of November 2021, also known to be the eve of the day of the dead in Brazil, and in some countries that keep this day to honor those who have died, counted more than five million deaths from Covid-19 that needed to be revered around the globe. In the eyes of the lady in the photo, in the sky of her glow and in the cloud of her pain, all the deaths show themselves⁵5. Google Notícias. Coronavirus (Covid-19) [Internet]. São Paulo: Google; 2021 [citado 1 Nov 2021]. Disponível em: https://news.google.com/covid19/map?hl=pt-BR&gl=BR&ceid=BR%3Apt-419&state=4
https://news.google.com/covid19/map?hl=p... .

On a planet with about 7.9 billion people, according to information from the website Our World in Data, the month of December 2021 also began with about 8.2 billion doses of the vaccine against Covid-19 administered around the world. This figure means that 55.2% of the world’s population had received at least one dose of the vaccine, so there were about 33.9 million doses given each day. But the health inequity is revealed when, among low-income countries, only 6.3% of people had received at least one dose. In particular, in African countries, only 11.1% of people had received vaccinations, of these approximately 7.3% were fully vaccinated. Table 1 shows the percentage of the population in each continent who had received a dose of vaccine or were fully vaccinated as of November 2021⁶6. Our World in Data. Coronavirus (Covid-19) Vaccinations [Internet]. Oxford: Our World in Data; 2021 [citado 1 Dez 2021]. Disponível em: https://ourworldindata.org/covid-vaccinations
https://ourworldindata.org/covid-vaccina... . These figures for the African continent are, to say the least, an incontrovertible indictment of the inequity faced by its population.

And everything indicated that this appalling situation would continue. The WHO - World Health Organization estimated that by the end of 2021 only five of the 54 African countries would reach the goal of 40% of their inhabitants with complete vaccination against Covid-19. The vaccine deficit on this continent was about 275 million doses, and only three countries (Seychelles, Mauritius, and Morocco) would reach the 40% target of fully vaccinated people (these countries have about 36.5 million people). But that’s not all, supplies are also scarce and the perfect storm could also bring a significant syringe shortage that would have to be addressed. On the other hand, as was unfortunately to be expected, more than 70% of the high-income countries had 40% or more of their population fully vaccinated⁷7. G1. Só 5 países africanos devem conseguir vacinar 40% de suas populações contra a Covid-19 até o fim do ano, prevê OMS [Internet]. Rio de Janeiro: Globo; 2021 [citado 1 Nov 2021]. Disponível em: https://g1.globo.com/saude/coronavirus/vacinas/noticia/2021/10/28/so-5-paises-africanos-devem-conseguir-vacinar-40percent-de-suas-populacoes-contra-a-covid-19-ate-o-fim-do-ano-preve-oms.ghtml
https://g1.globo.com/saude/coronavirus/v... .

In Brazil, a study by the Oswaldo Cruz Foundation⁸8. Fiocruz. MonitoraCovid-19. Nota técnica 23 - desigualdades na vacinação contra Covid-19 [Internet]. Rio de Janeiro: ICICT/Fiocruz; 2021 [citado 23 Dez 2021]. Disponível em: https://bigdata-covid19.icict.fiocruz.br/nota_tecnica_23.pdf
https://bigdata-covid19.icict.fiocruz.br... also denounced the regional inequalities in the vaccination against Covid-19, despite the data showing that, on December 8, 2021, 74.95% of the Brazilian population had received the first dose of the Covid-19 vaccine and that 64.78% of Brazilians had completed the vaccination schedule, and 9.04% had already received a booster dose of the vaccine, according to the interchangeability criteria of the immunization ( Table 2 ).

This Fiocruz study added that of the 5,570 Brazilian municipalities, less than 900 (about 16%) reached more than 80% of their population with complete vaccination coverage, and that cities with low HDI - Human Development Index - had the lowest rates of vaccination coverage. From the states’ point of view, Acre, Amazonas, Amapá, Maranhão, Pará, Roraima, and Tocantins had only about 7% of their municipalities with vaccination coverage above 80%, for the first dose. Moreover, no municipality in these states reached a percentage above 80% for the second dose of the vaccine against Covid-19⁸8. Fiocruz. MonitoraCovid-19. Nota técnica 23 - desigualdades na vacinação contra Covid-19 [Internet]. Rio de Janeiro: ICICT/Fiocruz; 2021 [citado 23 Dez 2021]. Disponível em: https://bigdata-covid19.icict.fiocruz.br/nota_tecnica_23.pdf
https://bigdata-covid19.icict.fiocruz.br... .

Therefore, the inequities are revealed in the most varied contexts and in a world that has shrunk, being an indictment that those with higher incomes forget that there are no borders for viruses and that pandemic (as the word itself indicates) refers to the entire planet.

During the 76th General Assembly of the UN - United Nations Organization, held in September 2021, the Prime Minister of Barbados, Mia Amor Mottley, made the following statement, recalling the lyrics of a song written by Bob Marley, Who will get up and stand up?

It is worth remembering that the fact that South Africa was the first country to sequence and inform the WHO of the existence of a new variant of SarsCOV-2, currently known as the Omicron variant, instead of promoting recognition and gratitude to the country and its health authorities, fostered an even greater isolation of the country by closing its borders to South African countries and immediately recommending the establishment of sanitary barriers, even before there were indications that the new variant had, in fact, appeared in South Africa¹⁰10. Charleaux JP. Como a reação à variante ômicron impacta a África do Sul [Internet]. São Paulo: Nexo Jornal; 2021 [citado 7 Dez 2021]. Disponível em: https://www.nexojornal.com.br/expresso/2021/11/29/Como-a-rea%C3%A7%C3%A3o-%C3%A0-variante-%C3%B4micron-impacta-a-%C3%81frica-do-Sul
https://www.nexojornal.com.br/expresso/2... .

All this brings me to necropolitics, a concept coined by Achile Mbembe¹¹11. Mbembe A. Necropolítica. Art Ens [Internet]. 2016 [citado 1 Nov 2021]; (32):122-51. Disponível em: https://revistas.ufrj.br/index.php/ae/article/view/8993/7169
https://revistas.ufrj.br/index.php/ae/ar... , which rages like an endless cloud of lead over Africa. And the wave eyes of the lady in the photo observe the fallen bodies of her black brothers overseas. The peaked Horn of Africa does not pierce the transoceanic gaze of the lady from Punjab. Humans recognize each other in the distance, in the extra sea, in the supra sea, the wave eyes of this lady wander in the Pacific waves in solidarity with her forgotten neighbors on earth. And, unfortunately, it is not only in Africa that necropolitics impale the lives considered disposable by unbridled capitalism. This is the martyrdom of countless countries classified as lower-middle income economies.

It should not be forgotten that Mbembe¹¹11. Mbembe A. Necropolítica. Art Ens [Internet]. 2016 [citado 1 Nov 2021]; (32):122-51. Disponível em: https://revistas.ufrj.br/index.php/ae/article/view/8993/7169
https://revistas.ufrj.br/index.php/ae/ar... in his essay on necropolitics:

Therefore, I do not think it is a mistake to agree with Mbembe’s argument¹¹11. Mbembe A. Necropolítica. Art Ens [Internet]. 2016 [citado 1 Nov 2021]; (32):122-51. Disponível em: https://revistas.ufrj.br/index.php/ae/article/view/8993/7169
https://revistas.ufrj.br/index.php/ae/ar... :

In this sense, the concept of syndemic proposed by Singer comes to the fore, which some authors have embraced and WHO has supported as a term that can provide some important facets for thinking about issues and interventions to confront Covid-19. Codeço and Coelho¹²12. 12. Codeço CT, Coelho FC. Redes: um olhar sistêmico para a epidemiologia de doenças transmissíveis. Cienc Saude Colet. 2008; 13(6):1767-74. doi: 10.1590/S1413-81232008000600011.
https://doi.org/10.1590/S1413-8123200800... , in an attempt to clarify the term, state that:

In other words, a syndemic in the pandemic of Covid-19 can be detected when there is an interweaving of several concomitant factors such as the absence of (or negligence in) public policies, scarcity of basic inputs such as hygiene and cleaning items and/or personal protection equipment, food insecurity, unemployment, difficulty of access to health services, medicines, and vaccines.

This concept is useful, therefore, to address the set of factors that promotes deleterious effects and not just the disease or health problem in isolation. As stated by Singer et al .¹³13. Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet. 2017; 389(10072):941-50. doi: 10.1016/S0140-6736(17)30003-X.
https://doi.org/10.1016/S0140-6736(17)30... :

Or again, as Bottallo¹⁴14. Bottallo A. Combinação de Covid-19 e doenças crônicas cria “sindemia global”, sugere estudo [Internet]. São Paulo: Folha de São Paulo; 2020 [citado 2 Nov 2021]. Disponível em: https://www1.folha.uol.com.br/equilibrioesaude/2020/10/combinacao-de-covid-19-e-doencas-cronicas-cria-sindemia-global-sugere-estudo.shtml
https://www1.folha.uol.com.br/equilibrio... says:

All this is drawn in the lady’s gaze with the eyes of the world. The inequities, the multitude of socially vulnerable people, the ruthless money lords of the world, the injustices of the rulers, the selfishness of the owners of unmatched navels, owners of the blinkered certainty that they are the only ones deserving of the planet’s blessings. There is a lack of otherness, a lack of hospitality, a lack of welcoming the foreigner and speaking his or her language. Yes... it is the welcoming eyes of the lady from Punjab that led me to close this text with the notion of hospitality described by Derrida¹⁵15. Derrida J, Dufourmantelle A. Anne Dufourmantelle convida Jacques Derrida a falar da hospitalidade. São Paulo: Escuta; 2003.:

It is necessary, therefore, to go beyond the borders of encapsulated languages and welcome the foreigner. It is necessary to face the paradox of respecting idiosyncrasies, culture, ethnicities, listening to the foreigner’s language and, in the exercise of otherness, exercising unconditional hospitality. We have reached a planetary limit. No country, state or nation; no city, neighborhood, residence, or person is a capsule shielded from danger or surrounded by security. The tired and message-filled eyes of the lady with the eyes of the world teach me the similarity of difference while denouncing the indifference of those who don’t recognize themselves as similar.

Thank you, lady with the eyes of the world. Thank you, Narinder Nanu.

Acknowledgements

I especially thank the sensitivity of those who photograph souls. My many thanks to Narinder Nanu and all the direct and indirect victims of Covid-19 for providing me with this reflection.

References

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