Yet this is exactly what happened when the Covid-19 crisis struck. The United States held the lives of people hostage — in Iran, in Cuba, in Venezuela, or indeed, any of the other 30 countries in the global south that face US sanctions — “relent or die” was the mandate.

Right at the beginning, testing kits dispatched to Iran by the World Health Organization were held up. US sanctions regimes obstructed most shipments and financial channels, delaying early control of the pandemic.

Medical items are technically exempt from sanctions, but institutions and companies are threatened by Washington for doing business with Iran. This made it nearly impossible for Iran to buy items like testing kits and protective gear to save the lives of patients and healthcare workers early in the pandemic. Cuba, similarly, could not buy ventilators for its Intensive Care Units (ICUs) or even spare parts for existing machines because the supplier had been bought out by a US company.

This is no accident. Consider how Phyllis Bennis of the Institute for Policy Studies in Washington DC describes economic sanctions: “[They] are designed to make people’s lives unbearable. The goal of US sanctions – in Iran, in Venezuela, and beyond – is precisely to destroy the lives of ordinary people, in the hope that they will rise up in favour of whatever regime change Washington is looking for.”

Sanctions contract economies, much like the coronavirus does. Iran’s economy was curbed by sanctions even before the country was exposed to the virus. Prolonging a lockdown was made nearly impossible as the government had to balance lives against livelihoods, the latter to the determinant of the former and under attack by sanctions. Not only had Iranians lost access to their country’s sovereign sources of income and foreign assets, but no assistance was provided either. Iran’s first-ever request for an emergency loan from the IMF has yet to be ratified, obstructed due to US pressure.

At the end of last year, Alena Douhan, the United Nation’s Special Rapporteur, referred to unilateral sanctions as the “main obstacle to the delivery of aid, including medicine, medical equipment, protective kits, food and other essential goods.” In the summer of 2020, arguably the peak of the pandemic in Iran, the United States doubled down on its sanctions.

It is undeniable that sanctions are an act of war — wielded by rich and powerful countries, that leverage human life elsewhere as a bargaining chip for political gains at home. And they do so with complete impunity.

Indeed, well before the pandemic, economic sanctions had decimated health systems and economies around the world. The US blockade is calculated to have cost Cuba nearly US$144 billion dollars over six decades. From April 2019 to March 2020 alone, the US introduced 90 new economic actions and measures against Cuba calculated at a cost of US$5 billion in 12 months — US$1 billion more than in the previous year.

This led to drastic shortages in food, fuels, and medicines; exhausting queues have become part of life’s daily grind for the Cuban population. All this came to a head when the pandemic began. Close to fifty new actions, measures and sanctions were imposed to cut off Cuba from the world. Like most countries, the lockdown which kept Cubans safe sent their economy into a nosedive, but unlike most countries, Cuba has no lender of last resort and no emergency funding to assist it through crises. Their access to international financial institutions is blocked by the United States.

This alarming story repeats itself in Venezuela where US sanctions are estimated to have cost the country US$120 billion since 2014 and the lives of over 100,000 Venezuelans, as imports of key medicines and healthcare equipment had already been blocked before 2020. During the pandemic, the IMF refused an emergency loan to Venezuela, while the Bank of England confiscated Venezuela’s gold.

Yet, what happens to Iran, Cuba, and Venezuela is not about these countries alone. First, these sanctions are imposed through extraterritorial application which violates countless international norms and treaties. Second, we are all hurt by the US blockade of Cuba, which prevents the world from accessing some of their world-leading, and affordable drugs for cancer, diabetic foot ulcers, meningitis B, psoriasis and now for Covid-19.

How can we end this war on health?

To end the war on health is to end the war on information. Throughout the pandemic we bitterly learned that even scientific information is not immune to politicisation, harming the health of global populations, but especially those that are resisting the global order. This campaign of disinformation demonises non-Western scientific progress and conceals Western attempts at monopolising science itself.

During the pandemic, Cuba’s biotech sector adapted and developed promising treatments for patients with the new coronavirus and is currently trialling five vaccines specifically for Covid-19. Even in this area, US sanctions see Cuba struggling to access reagents for their medicines and to access basic medical equipment, like the syringes required for mass vaccination.

Similarly, Iran’s active biopharmaceutical industry produces drugs that are considered state of the art by international standards, and is currently trialling six vaccine candidates. The diminution of medical and pharmaceutical trade doesn’t just jeopardise the health security of Iranians, it also weakens neighbouring populations in Central and Western Asia that could benefit from regional capacities in Iran, rather than relying on Western imports.

A notable achievement of Iran’s public health, particularly relevant for the current pandemic, is its century long expertise in vaccine production and vaccination coverage. Iran’s most recent success was the elimination of measles. This is something not yet achieved in many parts of the world, with outbreaks occurring as recently as 2019 in Europe – the very same year that Iran managed to eliminate it entirely. Cuba developed the world’s first vaccination for Meningitis B back in 1988, but it took 30 years for Britain’s National Health Service to introduce a similar vaccine into its public health childhood immunisation programme.

In this pandemic Iran is not looking exclusively westward: it’s importing from Russia, collaborating with Cuba, securing vaccines through COVAX, and producing them domestically. In fact, the Supreme Leader has reacted by banning the import of vaccinations produced by its geopolitical opponents, such as the US and UK. This decision has provoked an outburst of condemnation across the globe. It is not a crime to say no to Western jabs, but the West’s hoarding of vaccines and blocking the WTO from removing intellectual property rights for scaling up generic productions (as requested by India and South Africa) are indeed global health crimes. The virus has made one thing clear: no one is safe until everyone is safe.

One only has to look at Cuba to learn what the international community must demand in response to a global health crisis. Whilst dealing with the scarcity of resource and the huge mobilisation to control Covid-19 at home, Cuba has sent 57 brigades of medical specialists in disease control and disaster response to treat 1.26 million Covid-19 patients in 40 countries around the world, including in Europe. Their first destination back in March 2020 was Lombardy in Italy when it was the epicentre of the pandemic. This act of solidarity was entirely consistent with Cuba’s astonishing record of medical internationalism. Prior to 2020, 400,000 Cuban medical professionals had already served overseas in 164 countries since 1960, providing healthcare that is free at the point of delivery.

Almost nothing has been said about them by politicians and the mainstream media despite the incredible impact they have had throughout the global south. Literally, millions of lives have been saved and hundreds of millions of lives improved. By 2014, Cuban medical professionals had performed 1.2 billion consultations overseas, attended 2.2 million births and performed over 8 million surgeries. Over six decades, Cuba has also provided free medical training to tens of thousands of students from the global south. Since 1990, 30,000 foreign students have graduated as medics from Havana’s Latin American School of Medicine; the vast majority of them studied for free. This is the fruit of a welfare-based development model which promotes collaboration over competition and in which international solidarity is upheld as the highest expression of humanity. These principles are imbued in Cuba’s education and healthcare systems.

Now the global south looks to Cuba’s Covid-19 vaccine progress with hope. They know from experience that Cuba will share its life-saving breakthroughs and that Cuban medicines will be affordable and will be made available without the imposition of conditions, such as big pharma is reported to be imposing on developing countries. The Cubans will collaborate internationally, as indeed they are with Iran (100,000 doses of Cuba’s Covid-19 vaccine Soberana 2 have already been delivered to Iran which is participating in the island’s phase III clinical trials), with the objective of saving lives. That is a lesson that the rest of the world must learn from and uphold.

Sanctions — where the health and lives of peoples in certain parts of the world are treated as dispensable by the imperialist countries — are murder. They are an assault on the very foundations of any world where we seek to live, care, and love together. Sanctions should be removed, not only to save lives of targeted populations, but also to strengthen global health through capacities of targeted countries.

This essay is part of our ‘Manifesto for Human Life’ series published on the anniversary of the Covid-19 pandemic. Sign the manifesto here.

Helen Yaffe is a Lecturer in Economic and Social History in the University of Glasgow and a Visiting Fellow at the Latin America and Caribbean Centre in the London School of Economics. She is the author of ‘We Are Cuba! How a Revolutionary People Have Survived in a Post-Soviet World’ published last year by Yale University Press.

Vira Ameli is a DPhil student at the University of Oxford. Her research lies at the intersection of medical and social sciences, and she is currently focusing on the context of HIV in Iran and the larger Middle East and North Africa.