Two new books have placed the pandemic in perspective as the crisis unfolded. Richard Horton’s The Covid-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again, and Debora Mackenzie’s Covid-19: The Pandemic That Never Should Have Happened contextualise why it is taking place and proposals on how to stop the world from going through a similar experience again. Both authors realise that preventing another such catastrophe requires changes which address social and economic conditions such as inequality and poverty. But they stop short of envisioning a post-capitalist world. Richard Horton, editor of medical journal The Lancet, examines how the Sars-Cov-2 virus spread from Wuhan in China to the rest of the world. He critiques the unjustifiable level of unpreparedness, the role of science policymaking and the political failure of governments, and offers ideas about how to avoid such severe shocks in future.
Communist Party officials in Wuhan stifled the alert raised by doctors such as Li Wenliang in December 2019 (see review of Wuhan Diary). But, as Horton points out, the excuse of poor handling of the initial phase by China and World Health Organisation (WHO) is stretching the truth. He commends the self-sacrificing efforts of Chinese doctors and scientists, and notes that the WHO declared a ‘public health emergency of international concern’ (PHEIC) within just 30 days. The response of most governments was lacklustre. Early indications showed the need for national health systems to expand intensive care facilities, build stocks of personal protective equipment and prepare capacity for a surge of patients. But they failed to do any of this. “It took the UK government seven weeks to recognise the seriousness of Covid-19,” Horton writes.
The US government’s response was “predictably unpredictable” in dismissing the “Chinese virus” as inconsequential. And Italy continued with business as usual until it had a surge in infections. Horton argues that “deficiencies in decision-making” on the pandemic reflect “inherent failures in the mechanics of Western democracies that threaten their very existence”. He also points to more palpable reasons. Despite the experience of Sars, Mers and Ebola epidemics, as well as lessons from several pandemic scenario-planning exercises, governments underestimated the danger. And they feared the economic consequences of lockdown.
But, Horton notes, the deeper roots of unpreparedness lie in the gross underfunding of health and social care “compounded by a decade of austerity”. Public health departments in the US are chronically underfunded, while NHS funding in Britain declined just as patient demand increased, suffering £1 billion of cuts since 2015. These cuts translate to wage losses for health workers — who are now celebrated by governments — and gross understaffing of public health. In Britain for example, a one percent cap on pay increases in 2010 meant nurses lost 14 percent in real wages. A 2015 survey of NHS trusts in England revealed that 93 percent suffered shortages in nursing staff. But the book fails to say a word about privatisation which, much more than the immediate failure of government decision-making, set the stage for the lack of preparedness.
Another failing is that of the scientific policymaking. On the one hand, quality research churned out evidence at a faster rate than ever. On the other, scientific advisers stuck to “the political scripts they had been given in support of government policy”. Horton presents this as “the greatest science policy failure for a generation”. However, as Alex Callinicos observed in Socialist Worker, “science advice is shaped by politics”. And as Horton himself earlier said in an interview, “the idea you can strip out politics from medicine or health is historically ignorant”. So, government claims of “following the science” were part of the politics of Covid-19. Drawing conclusions from its impact “so far on human society”, Horton urges “a social and political critique”.
The poor, black people and other ethnic minorities have been disproportionately affected. Noting that the number of deaths in the most deprived areas in Britain was more than double those in the least deprived, Horton stresses the fact that inequality exacerbates Covid-19 and the pandemic in turn amplifies “long-standing inequalities”. What this makes clear to him is that “risk was not evenly distributed across societies”. He envisions a “post-Covid-19 age” based on “a new era of social and political relations”. This will be informed by a change of attitude that helps us avoid overestimating “the likelihood that good things will happen in life”. At the heart of this post-Covid-19 order is the “vigilant state and society” where government and the public work to make sure that never again does society go through this valley of the shadow of death, while also protecting “our most cherished political and social rights”.
Meanwhile, in her book Covid-19: The Pandemic That Never Should Have Happened, Debora Mackenzie, a science journalist, takes a historical look at the increasing spread of zoonotic (animal-to-human) diseases over the past few decades, questions why and how the new coronavirus disease became a global health and social-economic emergency, examines steps taken (and not taken) by governments. She concludes with a look at how to stop the next pandemic.
Mackenzie identifies economic activity pushing into a “wilderness that harbours new infections” while “intensifying food production in ways that can breed disease” as major reasons of how “we found ourselves in this situation”. These and “our ever-increasing global connectedness” and “persistent poverty in so many places” show that many more pandemics lurk around the corner. In this context, it might have been impossible to prevent the Covid-19 pandemic. But, as Mackenzie points out, its impact would have been far less lethal if governments acted before its spread became “a big deal”. With her focus on stopping the next pandemic, Mackenzie probes beyond such inaction after Sars-Cov-2 left Pandora’s box, putting the shocking level of unpreparedness into context. Like Horton she points to the years of neglect and underfunding of public health, but also goes further and unmasks the ruthless hand of privatisation over the last four decades.
For-profit interests which put wealth before health do not only undermine crisis preparedness, they pose problems to the global response which might not be easily surmounted. “Vaccines used to be made by government agencies as a public good, not for profit,” she points out. “But since the 1980s, pharmaceutical development is all done by private companies that are required to turn a profit.” Unfortunately, despite verbal commitments by governments at the World Health Assembly in May to ensure universal and equitable access to a Covid-19 vaccine when ready, pharmaceutical companies racing to produce vaccines are working for profits. There is, however, a campaign of civil society organisations and trade unions for a ‘people’s vaccine’ which puts people before profit. While Mackenzie appreciates how privatisation undermines public healthcare, she seems not to recognise the same animal when it wears the veil of public-private partnerships (PPP), which she sees as a “coming back” of emphasis on the common good. These PPPs, she believes, will address the “problems of capitalism” which have “stymied” our “defences against viruses”.
To buttress this faulty view, Mackenzie presents as a good example the Coalition for Epidemic Preparedness Innovations (CEPI), “launched just in time for this pandemic”. What she fails to point out is the influence of big pharma on CEPI which was actually launched at the 2017 World Economic Forum — an event where politicians and billionaires make deals. Two years ago pharmaceutical companies such as Pfizer, Johnson & Johnson and Takeda made CEPI’s scientific committee go back on an earlier policy, pushed by Doctors Without Borders, for prices of the goods they produce to be set. These companies insisted on substantial profits on intellectual property rights to their vaccines’ development funded by CEPI. Like privatisation in general, PPPs, including during the pandemic, amount to subsidising private profits with public funds.
Mackenzie, however, shows the culpability of governments and corporations who put politics and economics before the health of people, reminding us that Europe, Japan and the US begged the WHO not to consider the swine flu outbreak as a pandemic in 2009 because it would cause a panic. “Yet, while governments were complaining that the pandemic virus was too mild to make a fuss over, vaccine makers had actually been counting on a mild first wave” so they would have “time to make a vaccine in time for an autumn wave”, Mackenzie writes. Economic considerations were also central to the grossly inadequate stockpiling of medical equipment needed for the Covid-19 response. Like Horton, Mackenzie believes we should “hold governments accountable for their promises” on one hand, while on the other establish “a high-level authoritative system which brings countries and international agencies together to collaborate on diseases”.
The crisis might be an opportunity for change. But any optimism for this is doused by the book’s turn to the pseudo-scientific “behavioural immune system” theory. Mackenzie claims “there is evidence the behavioural immune system underlines tribalism and xenophobia”. This immune system is activated by a “real disease outbreak” and apparently shifts people “in an authoritarian direction”. This anti-climactic endnote of the book, and its often-repeated catchphrase “we are all in this together”, leads to the same conclusion as Horton’s wish for “vigilant state and society”. Thus despite their brilliant analyses of the inexcusable level of government’s unpreparedness, and how social inequality contributed significantly to the loss of well over a million lives, the crux of these authors’ seemingly optimistic proposals for a postCovid-19 world is actually dark.
The reason is not far-fetched. It stems from trying to square the circle. The pandemic, thus, does not reflect a failure of capitalism or, to use Horton’s euphemism, “Western democracies”. This is akin to the view of economic crises as “market failures”. Capitalism, with its logic of accumulation, will throw the lives and livelihoods of the many under the bus in defence of expanding profits. Crisis unpreparedness does not emerge from some problems of capitalism. Capitalism itself is the problem. We cannot solve the existential challenges humankind faces (pandemics, social inequality, climate crisis) within the system which is at the heart of these. We must work towards a world which safeguards human health and the planet’s health.
Baba Aye is an officer with Public Services International (PSI), the global union federation for workers in public services, representing some 30 million workers from 154 countries.
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