Why did the pandemic spiral out of control, and what are the obstacles that continue to prolong it? Capitalism and racism have been key culprits, diverting healthcare resources away from those who need them most and interfering with anti-pandemic measures.
by Brian Crawford
The ebb and flow of this pandemic is thoroughly predictable, as the numbers of individuals contracting the virus and the number of deaths rise or fall in response to safety measures being relaxed or reimposed. Predictable as it was, it was also preventable, in a country with the wealth, resources and potential for productive capacity of the United States, management of a public health crisis should have been the model, instead it’s been an unmitigated disaster.
Mirroring public reaction to the Pandemic of 1918, many people wanted to resume their daily routines, and businesses wanted to restart the economy. Their wishes were granted during that pandemic of a century ago and deadly third and fourth waves were the consequences. One hundred years ago knowledge of virology and epidemiology were primitive in comparison to today’s scientific advances. Flu vaccines were unavailable until decades after the 1918 pandemic. Yet despite all of its technology the U.S. COVID-19 death toll is nearing the total number of deaths resulting from the last “once in a lifetime” pandemic.
Despite the pandemics which emerged like warning shots over the past two decades, from SARS (severe acute respiratory syndrome), Ebola, Zika, and H1N1, the U.S. was completely unprepared for the COVID-19 onslaught.
Structural inadequacies, lack of basic material needs, combined with an incoherent federal response left states to fend for themselves and left the country just this side of a catastrophe. COVID-19 rampages through the country but is surely only a foretaste of what is to come and the wealthiest country on the planet has failed miserably in raising its defenses. The next pandemic is unlikely to wait a century and could be monumentally more devastating.
As ineffectual and indifferent as the previous administration was, the farce could not obscure deeply rooted structural problems which are a constant in American health care. The triumvirate of large hospital groups, the pharmaceutical industry, and health insurers will continue to maintain their hegemony. Patients are at the mercy of these powerful corporate entities. Medieval medicine prescribed bleeding as a remedy for a variety of illnesses, modern medicine exposes the patient to a financial bloodletting for the privilege of receiving medical attention. Extraordinary circumstances such as crisis exposes the inequities manifest in the racial and class character of society. In medicine the crisis shines a light on inequality of treatment and access.
Crisis begets crisis as the pandemic hastened economic decline. An economic contraction was inevitable under these conditions. Capitalism rides one bubble after another all bound to burst. “In a crisis ( . . .) the over-accumulation of means of production (factories,machines, buildings, and so on) is amplified by a massive over-accumulation of fictitious capitals of paper claims,to future profits in the form of stocks, bonds, collateral debt obligations, and more which are sure to be savaged during a crisis. (“GLOBAL SLUMP” David McNally P.82) In an economic world based on fictitious wealth, reality eventually sets in; the crash was coming, COVID quickened the pace.
As the virus spread quickly across the United States markets declined and the economic “prosperity” of the first quarter dissipated. Massive unemployment plunged millions into poverty with the prospect of employment dim. Given the link between employment and health care, the loss of the former meant the loss of the latter. Many workers experienced wage reductions which increased anxiety, compounding concerns of personal and familial health. For the many millions experiencing long term unemployment, rent, mortgage, and utilities became an even greater burden and the weight became crushing one over time. At the peak, unemployment rose to 18 million in April 2020.
On the other hand wealth has its privileges as the monopolists accumulate astounding fortunes on top of their already astounding fortunes.The top fraction of a percent added one trillion dollars of wealth to their vaults.
As the spoils go to the few, the many who engage in productive labor find their cupboards bare. Shelter in place orders, though necessary in these conditions, do not apply to many low wage workers who cannot afford not to work, and cannot work from home. They risk health and safety in order to continue to earn the wages that allow them to live.
Sections of the working class were discovered to be “essential”. This discovery was a product of a combined economic and public health crisis. Grocery store clerks, meatpackers, and other low wage workers assumed their place alongside health care as essential to society. Now exalted, these workers sought compensation and protection that fit their new status. Wages and protocols to address health and safety were essential demands made by workers. Striking at the point of production, some workers engaged in work stoppages to demand employers address the risks involved in the act of working their shifts. Amazon had over 20,000 COVID-19 cases confirmed (their estimate) as of October 2020. Epitomizing the callousness of monopoly capitalism, employees were harassed, berated, threatened and in some cases terminated in response to expressing their concerns to management, even though CEO Jeff Bezos,the world’s richest man, could pay each of Amazon’s employees $105,000 and still find himself extraordinarily wealthy. For sellers of online products, Amazon is the massive troll at the gate that must be paid; to decline is to wither and die. Amazon’s retail dominance is assured as the company controls a third of the online market. Only Apple compares in net worth, an inconceivable one trillion U.S. dollars. Any reasonable observer would assume that one of the most profitable firms on earth could accommodate its employees, particularly considering current conditions. The reasonable observer would be wrong. Work actions and a union organizing campaign were launched in the heart of right-to-work country (Alabama). This is an illustration of the confrontation of labor and monopoly capitalism. All measures were employed by Amazon in its attempt to prevent the unionization of even one worksite, as a successful union drive could be contagious. Amazon considered this contagion more lethal than COVID-19. Rather than address workforce concerns and demands, the firm spent $7 billion on anti-union advertising.
Medical staff were engaged on two fronts: first COVID-19, second, the profit-motivated U.S. healthcare system. Many hospitals, especially in the first few months of the pandemic, lacked basics such as personal protective equipment (PPE). Essential but taken for granted, gowns, gloves, and masks are ubiquitous in hospital settings. Yet in a time of emergency which could last years, hospitals around the country were without these necessities. Lacking resources, some resorted to reusing what was on hand. Nurses at Kaiser and elsewhere protested conditions in hospitals around the country. Low nurse to patient ratios (always a concern) became even more of a problem with increased numbers of COVID patients, many of whom arrived critically ill. Strike actions were undertaken nationally including an action at HCA Healthcare the largest hospital chain in the country. Concessions are being demanded by HCA including wage freezes and an end to 401K contributions, while the corporation profits totaled $7 billion added to the $5 billion in government funding.
The government provided for corporations with a disproportionate share of stimulus spending in excess of half a trillion dollars. Assistance for the working class, millions of whom were unemployed, amounted to a six hundred dollar check and that was opposed by a significant number of legislators in both chambers of Congress. Subsidies for corporations passed unanimously, but addressing the virus was another matter. Abdicating its role of leadership, the Federal government refused to create a national anti-pandemic policy.
Institutions tasked with combating the virus were no real counter to the cynicism of the president in the early days. There was a delayed reaction in recommendations for the appropriate measures to be taken and both the Centers for Disease Control and Prevention and the Surgeon General advised against wearing masks. The World Health Organization declared that masks were designed for medical personnel. This deception was a cover for lack of supply.
Any legitimate debate on the efficacy of masks stems from whether COVID-19 is spread through droplets or aerosols. Droplets are prone to gravity and do not linger in the atmosphere. Aerosols evaporate but leave nuclei in the air which can remain for hours. COVID-19, like influenza, seems to be transmittable via aerosols, and poor ventilation is a key factor in prolonging its presence indoors. Prior to the measures taken to mitigate the spread of the virus, the transmission rate was 2.5, in other words, each infected person infecting 2-3 persons.This rate of infection is similar to influenza but much less than measles, which has an infection rate of 18 and is known to spread via aerosols.“Either the amount of SARS-CoV-2 [the virus that causes COVID-19] required to cause infection is much larger than measles or aerosols are not the dominant mode of transmission.” Infection rates from close contact are dependent on duration and intensity of contact. Individuals infected with SARS-COV-2 seem to produce droplets and aerosols, but the rate of infection is more consistent with droplets as the primary source. Given this evidence, masks would be effective against the spread of the virus combined with social distancing.
Masking is only one of the measures required to combat the spread of COVID-19.The emergence of a novel virus dictates protocols that are dependent on a collective response to contain the spread. One person is infected, that person infects another, that person interacts with others, one or more of them travel, including internationally, and you have the beginnings of a pandemic. The fewer contacts (preferably none during the period of infection), the greater chance of containment. Restricting public gatherings and major events is necessary. Testing the population is vital in understanding the breadth of the spread of an infectious disease. These strategies are well established, and thus it becomes a matter of rational implementation.
The irrational is the real
It is apparent that wealth does not guarantee rationality, as the U.S., the wealthiest nation with the most resources has produced the most incoherent response. Scientific and economic studies confirm the vital need for non-pharmaceutical intervention, measures such as social distancing, masking, closure of non essential businesses and restricting large gatherings. Testing, one of the most obvious measures to be taken has been lacking throughout the pandemic. Confirmed cases are over 30 million (April 2021) with nearly 600 thousand dead but due to lack of testing it is most likely that the real figures for both categories are much higher.
For the previous administration, the irrational was the real. Suppress the information and initially deny the existence of a pandemic. When that is no longer an option, resort to minimizing the severity of the infectious disease that is killing people by the hundreds of thousands. The policy of the Trump administration was a calculation constructed on fantasy. No matter how many times he would say the virus would disappear, it would only become worse.
A national plan devoid of federal guidance left fifty states to devise their own policies. Fifty states issued fifty differing mandates, or in some cases no mandates at all. California was the first state to issue a shelter in place order. After two months this order was lifted and partial reopening proceeded. By June a new wave of infections and deaths plagued the state, culminating in a particularly deadly August. This precipitated another lockdown. In January the governor announced that the state would relax restrictions on outdoor dining even though cases and fatalities were higher than in December.
States with fewer restrictions, such as Texas, Georgia, Florida and the Dakotas called the prescribed measures an infringement on liberties, but in actual fact their primary concerns were economic. As the Lieutenant Governor of Texas said: ”there are more important things than living”. Georgia ,Texas, and Florida eventually approved some restrictions, while the Dakotas at most made some measures voluntary. These states at various points during the pandemic had the highest rates of infections in the country. In the cases of Texas, Florida and Georgia they are in the top five in highest numbers of cases and fatalities in the country.
By executive order, meatpacking became a critical infrastructure under the Defense Production Act; meat processing was forced to continue despite health and safety concerns for employees of these plants. The industry accounted for 8% of cases and 4% of deaths as of December 2020. Punitive actions were taken against employees who missed work, up to and including termination. This included employees with COVID-19 symptoms. Tyson increased its fourth quarter earnings to $695 million with a fifty percent rise in stock price due to increased production. JBS, the Brazilian multinational, increased third quarter profits to $595 million.
In the Tyson Waterloo Iowa plant 1000 employees were infected and five succumbed to the virus. In Greenley, Colorado 6 workers died after contracting COVID-19. Lawsuits were filed by families of the deceased charging companies with forcing employees to work in close quarters without proper COVID-19 safety measures. It became evident that the industry “would rather risk their employees’ health and keep their production going.” Governments around the world (in service of capital) in effect placed concerns for economic contraction ahead of the widespread contraction of COVID-19. Brazil, India and the U.S. refused and/or delayed their country’s responses and became the nations with highest rates of cases and deaths.
The virus does not die, it multiplies
SARS-CoV-2, as with any virus, mutates as it continues to spread. Countries around the world have not responded with the urgency needed to limit the spread. This is particularly true in the early stages, which are critical in preventing an infectious disease progressing into an epidemic and later developing into a pandemic. Strict lockdowns by countries limited or slowed the spread of COVID. This was a response to massive outbreaks. In a few countries lockdowns were mandated to avert widespread infection. Every country, regardless of the stringency of their policies, eventually relaxed mandates in response to falling rates of infections and deaths by opening businesses and relaxing other restrictions. Invariably rates in both categories rose again requiring another lockdown. This cycle has been repeated throughout the pandemic up to this moment.
Variants that have appeared as a result of the unabated spread of the virus have become a concern. According to the CDC there are five variants classified as Variants of Concern (VoC). One variant was initially discovered in Brazil, one in South Africa, one in the United Kingdom and two in California. Now emerging from the ongoing catastrophe in India is a new variant referred to as “double mutant”, which has characteristics of both the South African and Brazilian variants; more concerning is a characteristic known as the “escape mutation” which could make this variant resistant to vaccines or at least render them less effective. The U.S. population is not safe; traits found in the variants in California are also found in Brazilian and South African variants. This is a consequence of the lack of early containment.
Models from early in the pandemic demonstrate that China’s lockdown was largely effective even when unreported cases are taken into consideration. After two months, cases decreased from a thousand per day to a dozen. Rates of infection per person reduced from 2 or more to one and a half within a two-week period in mid January 2020. If these drastic measures had not been taken it is estimated that 500 million would have been infected. Studies demonstrate that early detection and containment are the most important steps to limiting the spread. This could have averted long term lockdowns.
A flaw in the Chinese response was repeated in every other country. Significant delays in reporting cases and implementation of containment strategies hampered the country’s efforts in the early stages of the outbreak. China could have cut its infections by 67% if it had acted a week earlier and possibly reduced infections to 5% by responding three weeks earlier.
China increased its production of masks and other personal protective equipment in response to global need and an opportunity to leverage more access to other markets particularly Europe. Low inventory in the U.S. affected hospitals across the country. China stepped into this void since the U.S. could not fill its own need and in effect gained advantage over its global competitor.
Maximizing profit
Capitalism’s pursuit of profit tends to be at the expense of urgent social needs. The links in the supply chain are essential in everyday production but they are critical in a public health emergency. China’s supply chain was instrumental in its ability to not only build a hospital in less than two weeks but to increase production of needed medical supplies for export as well as its own needs. The U.S. broke its chain decades ago in a massive outflow of capital overseas.
Outsourcing of production directly impacts the working class, resulting in job loss and subsequent long-term unemployment or non union low wage employment. Over the last forty years the U.S. has offshored 8 million jobs. Offshoring cost the U.S. in its ability to produce critical supplies. Capitalism’s drive for maximum profit was at the root of outsourcing. Dependency on foreign suppliers however, exposes vulnerabilities that are a direct result of the decades of offshoring of production. Productive capacity is reduced and urgent needs go unmet.
Maximizing profit is the main objective. This maximization is achieved through “efficiency” and “efficiency” is achieved by removing slack from the system as Naomi Klein explains. “So when it comes to something like health care or eldercare, that means you don’t want to have a single empty hospital bed or a single empty bed in an eldercare facility, because that’s inefficiency.” An excess of hospital beds which could be used in case of a disaster or pandemic would not be utilized unless these circumstances arose. They are not available because that would be inefficient. The pandemic is here and we don’t have enough beds because of the drive to implement capitalist efficiency.
Consolidation in all sectors, from hospital groups to medical equipment suppliers, insurance and pharmaceutical companies have led to less competition. Consolidation does not reduce costs, especially for patients. Widespread consolidation eliminates competition and leads to monopoly. Horizontal integration, mergers of companies that produce the same products or services and vertical integration which involves mergers of firms that produce different products and services in the supply chain, create conglomerates. This reduces competitions in multiple industries. Some of the largest vertical consolidations recently have been health insurers and pharmacy and pharmacy benefits companies. Greater concentration and the corollary lack of competition have driven price increases as the firms charge what the market will bear. Market based healthcare in the United States “produce suboptimal public health outcomes when products and services are developed and sold by entities such as corporations that focus primarily on profit maximization.”
Healthcare availability was at a premium before the pandemic and is at a critical stage for many, particularly those who are poor in urban or rural settings. Hundreds of hospitals have closed over the last four decades and new facilities prioritize the affluent suburbs. “Between 1990 and 2010, 148 non-profit hospitals closed in the largest cities”. Pharmacies are also scarce in poor communities and are becoming more so as these closures continue. Combine these factors with lack of health insurance and COVID arrives to pour salt into the open wounds.
Race and medicine
Racial bias compounds the problem. Bias within the medical profession historically has led to a divergence in healthcare outcomes that are part and parcel of broader societal and institutional racism. In medicine, its manifestations endure in pseudoscience originally meant to rationalize and confirm racial hierarchy combined with structural negligence. These factors are compounded by market-based medicine which leaves many without access to quality care. Race continues to be a factor in treatment and outcomes.
Susan Reverby argues that despite vaccine refusal, access is the more prominent issue for minority communities. Reverby acknowledges that historically medicine as an institution served as an instrument of exploitation, but the horrors of experimentation must be measured within the context of structural racism. The Tuskegee experiment which left syphilis untreated in Black men, or physicians operating on Blacks without anesthesia and other such experiments are historical facts that stain the memories and are the seeds of mistrust.
History is the present, as Black patients encounter a lack of diligence on the part of physicians and medical staff which results in differing outcomes from that of white patients. Dr. Susan Moore streamed commentary on the internet as a testament to the dismissive and negligent treatment she received. The attending physician refused her pain relief and implied that she was a drug abuser. As a physician, Dr. Moore was aware of the severity of her condition, as well as the proper course of treatment. Dr. Moore was able to be her own medical advocate. Despite finally receiving medication and a discharge she was readmitted and died three weeks later. As an experienced internist Dr. Moore could legitimately self-diagnose and understand the inadequacies of her treatment. Consider a physician with years of experience, who is now a patient, and is refused the collegial compliment of the benefit of the doubt, an understanding that perhaps knowledge and profession would account for something. Dr. Susan Moore was denied this courtesy.
Kevin Shulman M.D. in an article in the New England Journal of Medicine found that Blacks are less likely to receive treatment and procedures appropriate for cases of cardiac events when being admitted to the hospital. Racial disparities are consistent with that of the rest of the institutions and society. Pseudoscience of the past based race on biology and from there it became a sociological phenomenon, the notion of racial hierarchy ingrained in society since the country’s founding to satisfy an economic need for labor.
Gynecology as a specialty owes its founding to the experimentation performed on Black female slaves. The nature of being an enslaved person consists of being another person’s property and in the master/slave relationship the slave owner is conferred the right to consent on behalf of the slave. Through these experiments the slave owner’s interests are satisfied by ensuring the female slave can continue to labor on the plantation and reproduce more slaves. The doctor for his purposes was provided with a subject for experimentation. Rationalizing these experiments based on the subsequent advances in medicine minimizes the barbarism involved; women were not given anesthesia during surgery because it was believed that Black people possessed a greater tolerance for pain.
Racial hierarchy received scientific support in 19th century medicine which promoted theories that Blacks possessed thicker skulls and less nerve sensitivity. As racial bias follows us into the 21st century, it is grounded within institutions including medicine. Half of medical students believe there are biological differences between Blacks and whites. A quarter of these students believe Blacks have thicker skin. Significantly, physicians who subscribe to these stereotypes tend to exhibit biases in their treatment which affects patient outcomes. Public awareness of the Tuskegee experiment or the taking of Henrietta Lack’s cells and subsequent experimentation on her family, all without consent, are part of centuries of using the poor and African Americans as subjects for medical research without their consent. Racist assumptions by medical professionals become lived realities for patients in the recorded history of medical science and present day encounters. Medicine is not a world apart, it shares the disease of racism which infects all other institutions.
Collaboration between the medical establishment and the state resulted in coerced sterilization. Eugenics-inspired laws were on the books in most states by 1935, instituting this forced medical procedure as a means of social control. In the South, forced hysterectomies were termed “Mississippi apendectomies’, and the procedure targeted the Black population of the region. Native American women experienced sterilization without consent at exceptionally high rates. Meanwhile, Puerto Rico is estimated to have the highest rates in the world.
North Carolina’s eugenics program resulted in a third of sterilizations being performed on females below the age of eighteen; the youngest on record was nine years old. “Many sterilization advocates viewed reproductive surgery as a necessary public health intervention that would protect society from deleterious genes and the social and economic costs of managing their ‘degenerate stock’.” This means of social control became the law of the land, with California performing one third of all the procedures in the country in a seventy year period beginning in the first decade of the 20th century. Recently, Califormia sterilized 150 women in the states prison system; the women have charged the prison system with coercing them into the procedure. Doctors working at ICE detention facilities have also been accused of performing unwanted hysterectomies on women detained there. Medical science betrays patient trust and attempts to give a scientific foundation for theories of racial superiority and inferiority which permeate other institutions.
Black and Brown suspicion of law enforcement is well earned, the judicial process is only a thoroughfare to the penitentiary and the medical profession provides no antidote for what ails. Vaccines are a necessity, the only means of achieving herd immunity; the doubt and suspicion which racial minorities have toward medicine as an institution is directly related to the empirical knowledge of every iteration of racial bias. It’s not a figment of the imagination but manifests itself in the material conditions in which Black and Brown people find themselves. Racial minorities’ mortality rates are higher than whites for reasons other than skepticism.
The consequences of not receiving access or receiving inadequate medical care, combined with America’s history of perpetrating racist abuses in the name of healthcare, contributes to the reluctance to accept the word of public health officials and lack of trust in medical science, including the efficacy and safety of the vaccines. This mistrust could be a contributing factor in prolonging the pandemic. Demographically vaccination rates for Blacks and Latinos are at 5% and 11% respectively according to the CDC.
The real drug lords
While the situation in the U.S. may not be ideal, in most of the world there are no vaccines available at all. Wealthy nations are able to pay more for vaccines and therefore vaccines are available exclusively in these richer countries. Less than half a dozen firms stand to reap tremendous profits as their stock prices soar. The National Institute of Health provided public funding for these pharmaceutical companies research and development. Socialization of the costs of development and the enormous profit gained by private industry is capitalism’s bread and butter, particularly in crisis. During the mortgage based crisis of 2008 the government bought the debt of financial institutions which allowed finance capital to return to profitability while homeowners drowned in their debt. In the case of the current public health emergency, millions waited months for the vaccine, while globally the wait may be years. New variants emerge more contagious and deadlier than the original.
Pharmaceutical industry’s legal defense for its refusal to fill the global demand is rooted in patent law and intellectual property rights codified by the World Trade Organization. Protections guarantee exclusive rights to a firm and a return for investors. Exclusivity incentivizes investment. Vaccines have immense use value, as they are a social necessity during a public health emergency. Yet, its negative impact on potential profits makes equitable distribution less desirable for investors and the pharmaceutical industry. Monetizing vaccines as a commodity is limited, many only require one dose to effectively achieve long-term immunity. This differs from other products which require continuous consumption and replacement by consumers, guaranteeing long-term demand. Market size “conditions the investment appeal of most vaccines.” If the ill is confined to a demographic, or an impoverished region, the cure may not arrive. “Currently only 1% of COVID-19 vaccines are going to low-income countries and projections show much of the world’s population may not be vaccinated until 2023 or 2024.”
A coalition of countries led by South Africa and India are petitioning the WTO to suspend intellectual property rights under the Trade Related Aspect to Intellectual Property Rights, the waiver would allow countries to engage in the production of vaccines without the prospect of legal action from the patent holding firms. Those opposed to the waiver include the U.S.Chamber of Commerce, the Business Roundtable, lobbyist for the industry, members of both chambers of congress as well as countries such as the U.K., Norway, Canada, Brazil, Japan and Australia, countries that are home to dominant firms in the pharmaceutical industry. These countries are vastly outnumbered by the 100 countries that support a waiver of TRIPS. While the European Commission admonishes countries for not encouraging innovation, the sequestration of technology hampers that innovation and prevents productive use of each nations spare capacity.
Countries without productive capabilities or whose production is hampered by lack of access to vaccines due to IP restriction risk the current rampant spread of the virus turning into a vaccine resistant strain. Despite the rapidity of vaccine development, market forces are at work; wealthy nations are not just home countries to pharmaceutical companies, they are also their major markets. “Market-driven mechanisms alone are insufficient to achieve the goal of stopping the pandemic by achieving herd immunity with vaccines.” Not only are market-driven mechanisms insufficient, they are a steel barrier to herd immunity as the pharmaceutical companies and their national governments block billions of the world’s population from access to vaccines. Protecting intellectual property is one and the same as protecting future profitability.
Healthcare markets are based on conflicting interests, with the industry and the dominant firms which rule on the one hand and that of the public interest on the other. In classic market-based economics, price is based on consumer demand and willingness to pay, cost of production and competition. Market based healthcare in the U.S. does not conform to the classic theory. Capitalism in practice rarely resembles the idealized version in textbooks but is consistent with the interest of the butcher, baker, and candlestick maker’s interests and their drive for market share and profitability. More concentration in the industry significantly reduces competition. Consolidation continues with large firms among the pharmaceutical industry, health insurers and medical supply companies. Lack of competition leaves the choice of what to produce and its pricing up to the discretion of the firms which dominate the market. Crisis affords the industry the prospect of greater profit with their ability to raise prices amid the desperation of a pandemic. Markets are no antidote for infectious disease, they are the prescription for making the pandemic endemic.
Soaring stock prices are what firms desire. Social benefit is an afterthought if it is a thought at all. Wealthy nations are the targeted market due to their ability to pay. Presently, there is no lack of demand in the rest of the world for vaccines during a pandemic. Willingness is not the issue; the inability to pay and the recalcitrance of both the pharmaceutical industry and their home countries are barriers to inoculating the world against an infectious disease which has caused the death of more than three million people to date. Intellectual property rights endowed by the Trade Related Intellectual Property Rights (TRIPS) can be waived and the U.S. can take measures to force the distribution of vaccines. The industry exerts pressure through lobbyists and lawyers to maintain their advantage. They are protected by their home countries to the detriment of global health. Even though the U.S. president seems to have relented and supported a waiver this process could take time as opposition remains.
Though the handful of companies producing vaccines have protected their intellectual property, their prioritization of the wealth of the U.S. and Europe leaves most of the nearly eight billion people on Earth at the mercy of a killer. Science understands through the study of virology and epidemiology the potential of viruses to become the next global health crisis. Science seeks to understand zoonotic disease in animals which might crossover to humans. Science in the service of capitalism develops products which enhance corporate stock prices and their quarterly earnings. Karl Marx wrote that for the capitalist “his commodity possesses no direct use-value. Otherwise, he would not bring it to market. It has use-value for others; but for himself it’s only direct use-value is as bearer of exchange value, and consequently a means of exchange.” (Capital Vol. I P.179) It stands to reason that barring the prospect of making profit, a firm will not produce a particular commodity. It will produce a commodity in the anticipation of a lucrative market. That market will be served and those that cannot pay the price demanded face neglect.
That neglect can only come back to haunt the world as cases continue to rise reaching a record 850,000 on April 26th. As with all of the statistics during this pandemic the count of cases and deaths are underestimated. India, which manufactures vaccines for export, finds itself with the worst outbreak in the world and has to address its own needs. While some countries turn to China and Russia for vaccines, the U.S. and Europe’s obstinance condemns perhaps billions to be exposed to COVID-19 and its variants. Viruses mutate and variants are spreading rapidly with the potential to create a strain resistant to current vaccines, jeopardizing even the safety of people living in the rich countries that have abundant access to the current batch of vaccines.
Pharmaceutical companies are reported to have used extortion tactics in negotiating with countries in Latin America. Pfizer has been accused of demanding countries put up sovereign assets such as federal reserve banks and embassy buildings in case of legal action. This would shield the company from liability, that burden would fall on the government.
Capitalism as the plague
Privatization of health care is exemplified in the convoluted U.S. system. Together with commercialization and financialization it limits access, reduces production, increases prices. Quality health care is available if a patient can pay for expensive insurance, and then it is subject to the discretion of the firm as to what will be covered or not, regardless of a physician’s recommendations. Patients must pay for services with copays to insurance companies or out of pocket. Instead of government negotiated prices corporations set costs. What is left of public health is on a starvation diet, its services are cut or outsourced, staffs are reduced and austerity deprives poor communities of fundamental needs. Public hospitals were compelled to embrace the market and commercialization to survive. Poverty, a symptom of capitalism, finds no place in the market. By definition, the impoverished can’t bear the costs. “Commercialization [ . . .] saw public hospitals descend into marketplaces, where patients had to supply their own services and equipment–everything from food to nursing to drugs and surgical sutures, all purchased on the commercial market at prices vastly inflated from what public hospitals could normally negotiate.”
Meredith Thurshen and Annie Thebaud-Mony argue that “over the past four decades [. . . ] government health policies have reduced health services to commodities and objects of speculative investment.” Public/Private partnerships are instrumental in the emergence of financialization of health care. “It leverages private sources of capital and turns exchanges of goods and services into financial instruments.” Thus health care is transformed “into a salable and tradeable asset for global investors.” The World Health Organization agreed to embrace public-private partnerships by financial institutions to promote “efficiency” and “innovation”. In actual fact these partnerships provided prey for the rapacious investment banks like Goldman Sachs, Merrill Lynch, Credit Suisse each have health investment departments to manage these financial instruments. Financialization has come to dominate the world economy as opposed to the exchange of tangible objects as commodities. “Thanks in part to new technology (for example computerized trading) global financial assets (as opposed to assets in land and property or commodities) grew from $12 trillion in 1980 to $379 trillion in 2018.” Financialization is a detriment in multiple sectors, yet it finds advocacy in international institutions such as the United Nations.
The context in which the pandemic arrives is a moment of constant economic fragility for the working class and struggling profitability for capitalism. The latter will intensify exploitation of the former as proven during this global health crisis. The crisis itself provides corporations within health care as well as financial institutions with opportunities for enormous profits. The state and international institutions will continue to defend corporations. This is the root of the problem. As long as most of the world has not received a single dose of vaccine the pandemic will continue; for the pharmaceutical industry releasing vaccines (their intellectual property) is not in their interest. If the timeframe for vaccinating the world is a matter of two or three years, it means there is enough time for a vaccine resistant strain to emerge and become dominant. The bourgeoisie’s first instinct is to save capitalism and on this altar the masses must be sacrificed by the millions. Brought into stark relief over the last year and a half is the extent to which capitalism has brought us to the brink. Efforts to salvage the profits of national and multinational corporations prove to be more important to the capitalists than life itself.
A critical moment has arrived with a pandemic and economic crisis converging to exacerbate the ongoing displacement and dispossession of the masses. People are disoriented by all the phenomena hurled at them daily. Sights and sounds originating from all directions. Empirically the people experience their oppression but without historical context and theory the phenomena will be treated as a series of isolated incidents or problems to be solved by the same system and its institution that created them. Capitalism’s internal logic is incompatible with human need, even with the profit motive it falls short.