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 catastrophe like the COVID-19 pandemic requires making changes that address key underlining social and economic conditions like inequality and poverty. But they stop short of envisioning a post-capitalist world
Richard Horton, editor of the medical journal The Lancet, examines how the SARS-COV-2 virus spread from Wuhan to 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 like Li Wenliang in December (see review of Wuhan Diary). But, as Horton points out, the excuse of poor handling of the initial phase by the Chinese and World Health Organization (WHO) is stretching the truth. He commended the self-sacrificing efforts of Chinese doctors and scientists and notes that the World Health Organization declared a Public Health Emergency of International Concern (PHIEC) alarm within just 30 days.
Most governments initial response was lacklustre. Early Indications indicated the need for national health systems to scale up intensive care facilities, build up stocks of personal protective equipment and build capacity for surge of patients. But they failed to do these. Even well-resourced countries, as Horton puts it, failed to prioritise taking the needed measures immediately, which could have prevented the loss of many lives.
“It took the UK government seven weeks to recognise the seriousness of COVID-19”. The United States government’s response was “predictably unpredictable” in dismissing the “Chinese virus” as inconsequential. And Italy continued with business as usual until it faced a surge.
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 however also points at some more palpable reasons.
Governments underestimated the danger. And they feared “the economic consequences of lockdowns”. But the deeper roots of unpreparedness despite the experience of SARS, MERS and Ebola, as well as lessons from several pandemic scenario planning exercises is the legacy of gross underfunding of health and social care “compounded by a decade of austerity measures”.
Public health departments in the US “have been chronically underfunded”. Funding of the NHS in Britain declined at the same time patients demand was rising and suffered £1bn of cuts since 2015. Horton adds that “this reduction in growth of health spending was felt across most of Europe.”
These cuts translate into wage cuts for health workers who are now celebrated by governments and gross understaffing of public health. In Britain for example, a 1% cap in pay increases in 2010 meant nurses lost 14% in real wages. A 2015 survey of NHS trusts in England revealed that 93% suffered shortages of nursing staff.
But the book fails to say a word about privatisation alongside cuts. The Guardian’s 31 May “How a decade of privatisation and cuts exposed England to coronavirus” shows these are two hands of the same rotten body of neoliberalism. The profit motive behind privatisation, much more than governments’ failing at decision-making set the stage for lack of crisis preparedness.
Another failing in Horton’s view is that of the scientific policymaking. On one hand quality research churned out evidence at a faster rate than ever before. On the other, scientific advisors stuck to “the political scripts they had were given”, “in support of government policy”. The book presents this situation as “the greatest science policy failure for a generation”.
However, as Alex Callinicos observes in Socialist Worker “science advise is shaped by politics”. And Horton himself had earlier said in an interview that “The idea you can strip out politics from medicine or health is historically ignorant.” So, government’s claims of “following the science” was part of the politics of COVID-19. Horton’s demand of politicians to “probe, to analyse and to question” the science thus loses sight of the wood, despite earlier seeing the trees of a cheerleading scientific community.
The pandemic is not only a health crisis it is “about life itself”. Drawing conclusions from its impact “so far on human society”, Horton urges revisiting of the risk society as a central element of “a social and political critique”.
The poor, blacks and other ethnic minorities have been disproportionately affected. Noting that the number of deaths in the most deprived areas in Britain were more than double those in the least deprived in Britain, Horton stresses the fact that inequality exacerbated COVID-19 and the pandemic in turn has amplified “long-standing inequalities”. What this makes clear to him is that “risk was not evenly distributed across societies”.
Reform policies could smoothen the edges of this distribution. But for as long as production is driven by the profit motive, such uneven development between the deprived and the propertied will continue. And those who benefit from the primacy of profit will not fail to have the determinant influence on decisions of governments.
Horton envisions a “post-COVID-19 age” based on “a new era of social and political relations”. These will be informed by a change of attitude with optimism tempered by pessimism that helps us avoid overestimation of “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, whilst also protecting “our most cherished political and social rights”.
It is utopian to assume that this idyllic state and society can be established without supplanting the profit-driven capitalist economic relations with those based on solidarity and production based on need instead of accumulation of wealth.
The response of governments to COVID-19 which Horton sees as the greatest failure of Western democracies since the Second World War” actually reflects the reality of capitalism in its naked form. The animal spirits of capitalism and with it the crazed goose-steeping towards wars and pandemics can be caged to a limited extent for a while. But they cannot be tamed. That is a major reason to learn from the collapse of the post-World War II order and the spirit of ’45 as Ken Loach put the social compromise of that order.
Mackenzie’s interesting book takes an historical look at the increasing spread of zoonotic diseases in 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 and ends with a look at how o stop the next pandemic.
It identifies economic activities which entail pushing into “wilderness that harbours new infections and intensifying food production in ways that can breed disease” as a major reason of how “we” found “ourselves in this situation”. This and “our ever-increasing global connectedness” and “persistent poverty in so many places” are also the very reasons why many more pandemics could be lurking around the corner soon.
She thus echoes the argument in Rob Wallace’s Big Farms Make Big Flu which shows the interconnectedness of agribusiness, political-economy, science and increasing spread of infectious diseases. In this context, it might have been impossible to prevent the COVID-19 pandemic. But, as Mackenzie points out, its impact could have been far less lethal if governments had acted before its spread became “a big deal”.
With her focus on stopping the next pandemic in its track, Mackenzie probed deeper beyond such inaction after the SARS-Cov-2 virus left pandora’s box in putting the shocking level of unpreparedness into context. Like Horton she reveals years of neglect and underfunding of public health. And she goes further, unmasking the ruthless hand of privatisation, over the last four decades.
But for-profit interests which put wealth before health did 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”as she later added, “pharmaceutical development is all done by private companies that are required to turn a profit.”
And unfortunately, despite verbal commitments made by government at the World Health Assembly in May, to ensure universal and equitable access to a COVID-19 vaccine when ready, pharmaceutical companies in the race to get out vaccines are working on a for-profit basis. There is however an ongoing campaign of civil society organisations and trade unions for a People’s Vaccine, which puts people before profit.
While Mackenzie appreciates how unmasked privatisation undermined public healthcare, she seems not to recognise the same animal when it puts on the veil of public-private partnerships, which she sees as a “coming back” of emphasis on the common good. And these PPPs, she believes, will address the “problems of capitalism” which have “stymied” our “defenses against viruses.
To buttress this faulty view, she presents the Coalition for Epidemic Preparedness Innovations (CEPI) “which was launched just in time for this pandemic” as a good example. What she fails to point out is the influence of big pharma CEPI, which was actually launched at the World Economic Forum in Davos in 2017. Two years ago, pharmaceutical companies like Pfizer, Johnson & Johnson, Pfizer, and Takeda made the CEPI scientific committee to go back on an earlier policy pushed by Medicins sans Frontiers (Doctors without Borders), for prices of the goods they produce to be set, for equitable access.
These companies insisted on substantial profits or intellectual property rights to their vaccines’ development funded by CEPI. Like privatisation in general, PPPs, including during the pandemic amount to subsidizing private profits with public funds.
Mackenzie however shows the culpability of both governments and corporations over the years in putting politics and economics before the health of people. Her book reveals that Europe, Japan and the United States begged the WHO not to consider the swine flu (H1N1) 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 that they could have “time to make a vaccine in time for an autumn wave”.
Economic considerations also played a key role in the grossly inadequate stockpiling of medical equipment that was need for the COVID-19 response. And Mackenzie hopes that subsequently “countries will stockpile the things we have desperately needed during this pandemic”. But it is utopian that this will suddenly become the norm whilst the capitalist logic driving such considerations subsists.
Like Horton and the world at large, Mackenzie also points out the critical role of health workers and “low-income people” who are key workers, on the frontline of the pandemic response. She also stresses the need for protection of health workers in a pandemic, as one of the “big lessons” that “nations clearly haven’t learnt” from the SARS outbreak at the turn of the century.
Since governments do not always heed such important lessons as we all can see, Mackenzie believes that some of the main points we should take away from this moment to avoid a worse one is “to hold governments accountable for their promises” on one hand and establishing “a high-level authoritative system “which brings countries and international agencies together to collaborate on diseases” on the other.
The crisis might be an opportunity for change. But the optimism that this realisation might come with is doused with the book’s turn to the pseudo-scientific “behavioural immune system” theory. This is According to McKenzie “there is evidence the behavioural immune system underlines tribalism and xenophobia”. This “immune system” is activated by a “real disease outbreak” and shifts “people’s political direction in an authoritarian direction”.
This anti-climatic endnote of the book and its often-repeated catchphrase “we are all in this together” leads to the same highway of a need for Horton’s “vigilant state and society”. Thus despite brilliant analyses of the inexcusable level of government’s crisis unpreparedness, and how social inequality contributed significantly to the avoidable loss of well over a million lives, the crux of their seemingly optimistic proposals for a post-COVID-19 world is actually dark.
The reason for that is not far-fetched. It stems from trying to square the circle. The pandemic 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 lives and livelihoods of the many under the bus in defence of profit expansion.
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, and the 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.
by Baba AYE
Note: first published in Socialist Review, December 2020, pp: 22-23