Assassinations or class struggle? (2025)

Street art in San Francisco

From the February 2025 issue of the Socialist Standard

Luigi Mangione allegedly assassinated the capitalist Brian Thompson, CEO of a health insurance company, after seeing his own mother’s prolonged suffering after being denied health insurance coverage in North America, where healthcare is unsocialised by design. The shot was heard around the world and ignited the long dormant class consciousness of North America. The outpouring of support for Mangione’s alleged act has been politically surprising for many of the lapdogs of capital. The media especially has been caught on the back foot, seeing political pundits booed by their own audience as the public celebrate the alleged act.

Capitalism and political violence go hand in hand. As Malcolm X said, ‘violence is American as cherry pie.’ It’s just not usually cutting in this direction. We will see this same political opera play out again and again as capitalism tumbles from one crisis to the next, economic and environmental, and as society becomes more individualistic and fragmented from both wings of the political spectrum, as well as an increase in violence inspired by conspiracy theorists. Examples abound from ‘pizzagate’ or the ‘MAGA bomber’ Cesar Sayoc.

Western society’s morals advocate for people to only use peaceful means of achieving social change, but capitalism is anything but peaceful. The inherent tensions between classes in a capitalist society lead to situations where violence is inevitable when the oppressed are spoken to everyday in the language of violence by capital.

The state, as argued by Max Weber, is defined by its monopoly on the legitimate use of physical force. In this regard, the 1 percent wields power through the apparatus of the state, enforcing laws and maintaining order to protect its property. So, when the working class resorts to violence, it is typically a reaction to an unyielding system that allows no channels and permits no voice.

Consider the words of Marxist revolutionary Rosa Luxemburg, who once stated, ‘Freedom is always and exclusively freedom for the one who thinks differently.’ Where the state fails to provide avenues for dissent, the working class feels compelled to take matters into their own hands, an act not of frivolity but of desperation. To condemn such an act will serve the oppressive structure of the status quo that continues to render peaceful protests ineffectual.

The job of a socialist party in this context is not to support the wild actions of rugged individualists but to provide paths of mass action with a coherent philosophy, uniting disparate efforts into a collective strategy. Antonio Gramsci emphasised the importance of a ‘war of position’ in establishing hegemony, advocating for a broad ideological struggle that counters individualistic acts of defiance with systemic solutions. The party must provide structure to the movement, demonstrating that the fight against oppression is not one of isolated and ultimately futile gestures but part of a large revolutionary struggle.

The late historian Eric Hobsbawm pointed out the ‘social bursts’ of violence that erupt during times of severe inequity. The working class mobilisation amidst such strife, far from being vilified, should be understood within the broader narrative of class conflict.

The state’s response to dissent is a reflection of its inherent class interests. The role of a socialist party is not only to channel individual acts into a collective aim but also to recognise and respond to the realities of revolutionary action, acknowledging that, while peaceful revolution is its aim, understanding the circumstances that lead to violence is crucial in the pursuit of a free society. It is through this synthesis of theory and practice that the socialist movement can articulate its vision for the future, one where productive resources are held in common, and where the state, and its monopoly of violence, will be a thing of the past.

A. T.

Cooking the Books: Bottom line building (2008)

The Cooking the Books column from the January 2008 issue of the Socialist Standard

Like everyone else with an email address we get loads of spam. Most go straight into the trash can, but the subject of one – “Crack Patient Paying Problems with these Helpful Hints” – caught our eye. It turned out to be a plug for an audio-conference in America on “Tried-and-True Ways To Get Chiropractic Patients to Hand Over Their Dues”. The message began:

“Getting patients to pay their bills at your chiropractic office isn’t always the most successful part of the visit. And even a handful of patients who don’t pay their bills can start adding up – and hurting your practice’s bottom line. But you can learn less-stressful way to collect pays, deductibles and co-insurance in this 1-hour session. Your expert speaker, Marty Kotlar, DC, CHCC, CBCS, will provide strategic advice on everything from gathering patient information to forming an office policy explaining the patients’ financial obligations. Don’t miss this bottom-line-building session . . .”

Chiropractics is an “alternative medicine” that is regarded by most conventional doctors as quackery (it is based on the idea that by manipulating the spine you can deal with ailments in other parts of the body, a bit like reflexology claims for manipulating your toes). But that’s not the point since no doubt teleconferences also take place in America about how conventional doctors can boost their bottom lines too – except that it does not fit in with the caring image that “alternative medicines” seek to cultivate as a way of attracting paying customers.

In Britain NHS doctors – and patients – are freed from this stress since the doctor’s fees are paid to them directly by the government. Not a solution, we imagine, that Marty Kotlar will be proposing in his teleconference, even though chiropractors in Britain would dearly like to get in on the act and even though doctors’ practices in Britain are, with government encouragement, going the American way and converting themselves into profit-seeking businesses. Of course to the extent that they take on private patients these medical businesses do face the problem of getting patients to pay up, as do unrecognised “alternative” practitioners and NHS dentists. So perhaps, after all, they could learn something from listening in to Marty Kotlar’s “bottom-line-building session”.

Most people, in Britain at least, find it abhorrent that people should have to pay for medical treatment and health care. And they’re right; if you are ill, you should get treatment whether or not you can afford to pay for it. Socialists go further. We say the same as-of-right access to what you need should apply across the board, to housing, heating, electricity, food, clothes, transport, entertainment.

But this will only be possible once the means for producing these things have become the common property of the community as a whole instead of being, as at present, provided by profit-seeking businesses owned by rich individuals, corporations or states.

Concerning “A National Health Service” (1944)

From the June 1944 issue of the Socialist Standard

The White Paper issued in February 1944 dilates on proposals for a National Health Service. This is the result of discussions with various bodies including the British Medical Association (which may be termed the doctors’ trade union), the Royal Colleges, Voluntary and Municipal Hospital representatives. In the words of the report:-

The Government . . . want to ensure that in future every man and woman and child can rely on getting all the advice and treatment and care which they may need in matters of personal health; that what they get shall be the best medical and other facilities available; that their getting these shall not depend on whether they can pay for them, or on any other factor irrelevant to the real need—the  real need being to bring the country’s full resources to bear upon reducing ill-health and promoting good health in all its citizens.

As Socialists we are not impressed by this show of good-will; we give due regard to the capitalist need for healthy workers, and to the date of publication – viz., during a period of something very like war weariness, when accounts of Jap atrocities are needed to pep up morale.

We will digress for a moment to examine the state of medicine at this time in relation to the working class.

Ideas regarding a State medical service for all, not just for insured workers as prevails at the present time, are by no means new, but in their previous forms they have met with opposition from both the British and American Medical Associations. In their organ, the British Medical Journal, the BMA have expressed fear that the present “free” choice of doctor will cease. That freedom of the present choice will be apparent to most workers, but should any retain illusions, they may be quickly dispelled. A worker may not choose a Harley Street specialist, but most have a general practitioner engaged in panel practice, unless he is prepared to spend his meagre earnings on doctor’s fees. The doctor chosen is usually the nearest, in order to save time. Frequently nothing is known of his or her qualifications, letters after the name conveying no more than would hieroglyphics. When the choice is made, unless the worker is extremely ill, he attends an overcrowded surgery, perhaps being allowed five minutes of the doctor’s time. He may, however, not get this, for it has long been the custom for doctors with large panel practices to employ assistants – e.g., newly qualified doctors. The assistant sees the panel patients whilst the doctor attends his fee-paying patients. (This practice is in abeyance during war time, due to the calling up of young doctors, so the poor panel patient gets less time than ever.)

In these days of specialisation, the general practitioner cannot completely attend to all his patients’ requirements. Equipment and the services of dispensers and secretaries are costly. The White Paper recognises this fact and proposes Health Centres in which a group of doctors could practise with staff and equipment provided. The private patients also suffer under the present system. Their own doctor may administer palliatives instead of sending them to the appropriate specialist for radical treatment.

The BMA have also feared they may find their members working in the guise of civil servants subject to control, which they state would stifle initiative and responsibility towards those sacred trusts, their patients. The American counterpart went so far as to remove from membership any doctor taking part in salaried practice, until prevented from so doing by an order of the Supreme Court in 1942.

Much of the opposition to a National Health Service arises from the inability of doctors to regard themselves as members of the working class. They are, in their own opinion, a class apart, members of the highest profession, rendering selfless service to mankind. No doubt many start with the highest ideals, but few keep them. This is not intended to portray doctors as battening ghoulishly on the lay public, but like all others, they are caught in the cleft stick of capitalism. The doctor is an expensive product; he must keep up certain appearances, and bring up his children in like manner. To be successful he cannot escape the sordid struggle for life under capitalism. He must sell his labour power in order to live, as does his meanest panel patient. These facts are not readily appreciated by the BMA, who, however, by their resistance to salaried schemes, have compelled the doctor to sell in the open market.

Nevertheless, the views of the BMA have not been wholly representative of opinion here or in America. In  a leading article, The Lancet (January 22nd, 1944), anticipating the proposals in the White Paper, commented on the advantages to the patient of co-operation between local authorities, hospitals and the doctor, now inadequate, and states that hitherto most attention has been paid to the convenience of the doctors concerned. Unpopularity of central control may be the reason for this outburst. “Enough of this bureaucratic planning; give me my own show and let me get on with it”. The article continues: “The answer to him has already been given. ‘The needs of the sick are endlessly variable; the resources of medicine are multifarious; and only a large adaptable, sensitive, smooth running organisation will fit one to the other in the largest number of cases.'”

Similarly the attitude in the USA, where there is no National Health Insurance, is changing. Reviewing Kaiser Wakes the Doctors, by Paul De Kruif, New York (a work demonstrating the success of shipbuilder Kaiser’s medical scheme for workers in the mushroom ship yards of the Pacific coast, employing 60 salaried doctors), The Lancet of February 19th, 1944, quotes De Kruif’s confession. Hitherto, he had “remained content with official medical explanations that this prepaid medicine was unethical; 100,000 doctors could not be wrong.” It now appears that they could. At the present state of development it is uneconomic for the doctors to sell their labour power in the open market, as the worker cannot afford to buy it, and his health suffers in consequence. The needs of war-time industry here and in the States require workers to receive expert medical attention in every sphere, in order to return to work rapidly and make the wheels of capitalism spin. Note the recent accent on “rehabilitation”. In times of slump the breakdown of a few workers is immaterial when others can be drawn from the reserve army of the unemployed. The present arrangements, in which the general practitioner works alone, are not conducive to the production of efficient, healthy workers. “Accident proneness” is inevitable in sub-healthy states. Also the fact that the worker’s wife has no panel doctor has come to be realised as an anomaly overdue for remedy. As she must be a fee-paying patient, she often fails to seek necessary advice, and comes to accept ill-health as part of her life.

The widespread influence of the BMA compelled the Government to accept its offices in the recent discussions. The White Paper is throughout a sop to the BMA, reiterating again and again that “the patient should choose his own doctor”. The suggested arrangements for the entire population to be covered by insurance has the advantage of simplicity, but not so the arrangement of general practitioners. The Health Centres proposed will be used by a group of doctors who will see their patients there instead of at their surgeries. A salary or equivalent will be paid to them but – and what a large “but” it is – the doctor may still have private fee-paying patients. The report states, however, that no one must be given “reason to believe that he can obtain more skilled treatment by obtaining it privately than by seeking it within the new source”.

Socialists may suppress a smile at so naive a hope. What reason is there to suppose that a doctor now giving greater attention to his private patients than his panel will not continue to do so under the new scheme? It is not hard to visualise a doctor seeing his erstwhile panel patients at the Health Centre, receiving his salary for so doing, and then rushing off to see his private patients. True, the better equipment provided at the Health Centre may even be an inducement to persons of means to attend, so that private practice declines and the doctor ceases to sell his labour power in the open market, but what then?

Will the doctor’s salaried position enable him to see his true place in society? Time will show, but under neither this proposed scheme nor any other will the worker get the requisite attention. Under any scheme in capitalist society expenditure is resisted at every step, as has been the case with housing for the workers (not their masters), sanitation, education and the like. Even the Beverage scheme for health insurance requires that large scale unemployment shall not obtain; such statements serve to demonstrate the hollowness of capitalistic schemes, for it is powerless to prevent unemployment, which is inherent in its constitution. Only under Socialism, where the wages system  will no longer exist, and where the workers will enjoy the fruits of their labour under ideal conditions without exploitation, can doctors truly serve their fellow-workers, and a real health service for all be established.

W. P.

The cost of lives (1985)

From the May 1985 issue of the Socialist Standard

The relentless pursuit of profit under capitalism produces a wealth of contradictions: coal mines are closed while old people die of cold, food production is curtailed despite widespread starvation, hospitals are closed and ill health in the general population increases in spite of advances in high technology medicine. The provision of health care is distorted by the competing forces within capitalism as social needs are, if catered for at all, secondary and coincidental to the overriding requirement of profitability.

The interests within the health care system are: the workers trying to obtain improved medical services "free at the point of use"; the government trying to "privatise" medicine and reduce state provision of health care, the insurance companies who are gaining increasing numbers of subscribers to private insurance schemes as the National Health Service deteriorates; the companies who supply drugs, equipment, provisions. construction and services and are parasitical on the health service; private medicine with fees for consultation and surgery.

Although bringing health care under state provision with the development of the National Health Service appeared to represent a gain for the working class it is, in fact, a victory for ruling class expediency and has developed, and continues to be shaped, according to the needs of capital. There is no doubt that new discoveries, technological improvements and modern drugs have eased the misery of many serious diseases. However, it would be wrong to assume that the use of sophisticated techniques automatically confers benefits on patients. Illich (Limits to Medicine, 1976) claims that coronary care units are no more effective than normal medical wards but require three times as much equipment and five times the number of staff to run them. Garner (The NHS: Your Money or Your Life, 1979) cites research which supports this claim and points out that patients nursed in coronary care units have a higher mortality rate than those nursed at home.

Ineffective or even harmful treatments may continue to be used because they are profitable or allow control, prestige and power by vested professional interests. The misleading publicity (or advertising) which accompanies technological medicine and discouragement of information and knowledge outside professional circles may lead to a "demand" for dubious medical treatments by the general public who mistakenly believe that miracle cures have been found without being aware of potentially dangerous complications or side-effects. The damage that commercialised medicine can cause has been pointed out by Eyer:

  . . . when doctors went on strike in Los Angeles County in 1976. limiting elective surgery for the most part, the death rate fell by about 15 per cent and rose well above its previous level when the doctors resumed practice. before returning to normal. This means at least one out of every six deaths in Los Angeles is due to the overdevelopment of medicine.

(J. B. McKinlay (Ed.): Issues in the Political Economy of Health Care, 1984.) 

Although excessive medical and surgical intervention is a feature of private health care, under-provision of facilities is common when its supply is less profitable. Professor Stewart Cameron of Guy's Hospital. London claims that 2,000 sufferers from renal failure may be dying unnecessarily each year in Britain because of insufficient renal dialysis machines (Medicine in Society, 1984).

The considerable variation in the provision of health care facilities has been summed up by Julian Tudor Hart (Lancet, 1, 405. 1971) as the Inverse Care Law. in which he states: ". . . the availability of good medical care tends to vary inversely with the need of the population served. This operates more completely where medical care is most exposed to market forces and less so where it is reduced." Wales typifies the Inverse Care Law with some 10.000 deaths from coronary artery disease each year and 25,000 men of working age suffering from angina, but with a dearth of cardiologists compared with regions in England (Medicine in Society, 1982). This contrasts markedly with private medicine as the fashionable London clinics accepted patients from the continent for coronary by-pass surgery until it was realised that patients receiving drug treatments made similar progress. It is true that a minority of people with coronary heart disease benefit from by-pass surgery providing they are properly assessed and identified. Also the much simpler and safer procedure of supplying cardiac pacemakers could save lives in Wales if they had the resources.

Heart transplants make dramatic news but there is little evidence that, on average, they prolong life expectancy. The deaths of heart transplant patients get very little reporting by the media, distorting the benefits, or lack of them, of technological changes. Nevertheless, in spite of all the evidence that technological advances need to be approached much more cautiously and with considerably more evaluation, there seems to be more specialisation and technological expansion than ever before. Garner has pointed out that doctors in the United States carried out twice as many operations on a group of Federal employees when paid a fee-for-service than doctors paid a flat salary by another insurance scheme. Similarly, the number of hysterectomies performed in Saskatchewan increased by 72 per cent after the introduction of national health insurance which reimbursed the doctor. Apart from the obvious profit motive, the restriction of skills to a professional elite concentrates power, prestige and more money into fewer hands. Mitchell (What is to be Done About Illness and Health?, 1984) claims: "We tend to assume that historically paid physicians opposed the herbalists and lay healers because their methods were ineffective or dangerous. Yet there is considerable evidence that it was because these methods did work that they were threatened".

Widgery (Health in Danger, 1979) has questioned the "medical prestige mongering" of advanced medicine: "In Buenos Aires doctors are playing about with cardiac surgical units costing tens of thousands of dollars while new-born babies die in the precincts of the hospital for lack of decent milk". He also questioned some of the cardiac resuscitation procedures:

 . . . while every effort can and should be devoted to monitoring and reviving patients in units equipped for intensive care, the kind of indiscriminate, ineffective invasion we carried out, which we wholeheartedly conceived as solely for the patient's good, was in fact depriving the dying of the last shred of dignity in order to give us a little practice and a little false prestige. None of this is to argue that we should abandon or relent our development of medical science, but we need to sharpen its focus, take more seriously its implications and applications. We need to ask honestly, every time whether its net result enhances the doctor's prestige or the patient's well-being, for these are by no means the same thing.

Under capitalism medical care assumes its most profitable form and there is usually more money to be made from curing a complaint than preventing it. In under-developed countries the resources consumed by curative medicine in the prestige hospitals of the major cities have been at the expense of preventive services in the rural areas. ("The Politics of Health in Tanzania", Development and Change 4 (1) 39. 1972) has put the contradiction of high technology medicine co-existing with poor primary services in Tanzania in perspective:

  . . . a man has hookworm anaemia (common in Tanzania). He has been ill for years; eventually he has to stop work altogether. He is admitted to hospital. He needs laboratory tests, skilled medical and nursing attention, drug treatment and a blood transfusion. After a time he improves, and he eventually goes back to work. At home, he catches hookworm again; the whole process is repeated. If his village had used pit latrines none of this would have happened.

Poverty remains the main cause of a considerable amount of ill health. Millions of children die each year from malnutrition and infection in the Third World. Even in the more affluent countries workers have higher mortality rates than the rich as a result of working in stressful, polluted, alienating environments and living in poor housing conditions. And within countries such as Britain relative poverty is still quite widespread. Thus a socially deprived area such as Rochdale has an infant mortality rate 2½ times greater than the national average.

In advanced, industrialised countries preventive services also have a low priority because they are less profitable. Yet governments are anxious to shift the burden of costs away from the state and back to the consumer. As Crawford states:

  The emphasis on individual responsibility for health mystifies the social production of disease and undermines demands for rights and entitlements to medical care. Beneath the rhetoric about the costs of medical care and the obligation of the individual to remain healthy lies a political programme to shift the burden of costs back to labour and consumers and to paralyse regulatory efforts undertaken to control environmental and occupational hazards. (J. B. McKinlay. op. cit.)

As it is uneconomical to safeguard workers' health during unemployment because a reserve army of labour is available, drastic cuts have been made in the health and social services. But substantial increases in military expenditure, aid to private industry, the police force, and tax advantages for the wealthy reflect capitalism's priorities.

Carl Pinel

Economics of hospitals (1981)

From the April 1981 issue of the Socialist Standard

  "The durability of public mental hospitals (in America) was based on solid economic and social factors. A hospital is a great source of employment, often in an isolated area, and is also a reliable market for local goods and services."

Saul Feldman (USA)

Nurses refuse to work unprotected (2020)

From the WSPUS website

The pandemic is over and that’s official. Everyone back to work, folks! Enough loafing around already!

According to a document leaked from the Centers for Disease Control, the daily number of new cases, currently 30,000, is projected to rise to 200,000 by the end of the month. 

Fake news, I guess. 

Meanwhile it is reported that ten nurses have been suspended at Providence St. John’s Health Center in Santa Monica, California for refusing to work without the protection of tight-fitting N95 respirator masks. A co-worker had tested positive for Covid-19 and several doctors had advised them not to care for severely affected patients without wearing a respirator. However, the hospital administration ordered them to do exactly that. They were warned that failure to comply would be reported to the state licensing board as patient abandonment and negligence.   

The nurses suspect that the respirators are not really in short supply, as the administration claims. ‘The hospital group is a multi-billion-dollar corporation,’ noted one nurse. ‘It can definitely afford to buy them.’ 

The nurses are scared not only of catching Covid-19 but also of contaminating their families. Over 9,000 healthcare workers have tested positive so far.

In public rhetoric nurses are celebrated as ‘frontline’ heroes and heroines in the fight against the pandemic. But inside the hospitals their fate depends on administrators who totally lack respect for such lowly creatures and ignore their complaints. Administrative personnel may even outnumber healthcare workers. It is their duty to ensure that paperwork is completed correctly. The main concern of high-level administrators is to earn their annual bonus. According to Healthcare Finance News, the bonus of a hospital CEO is on average about a third of base salary and is determined by revenue size and other ‘standard performance metrics.’ 

That is why the administrators do not want to buy ‘too much’ protective equipment. That is why they are always on the lookout for ways to cut personnel and other costs. 

‘There is no shortage of nurses,’ explains one inside observer. ‘There is a shortage of properly paid nursing positions.’ So nurses are forced to put in long hours of overtime. After a time they can no longer take the pressure and ‘burn out’ (here). Many quit. An increasing number commit suicide. 

Such are a few of the delights of healthcare for profit. 

Stefan

Markets are trash (2020)

From the WSPUS website

I’ve never wanted to restart a year so bad in my life. We lost Kobe Bryant, Trump almost started World War Three with Iran, and now we’re living in a real-life version of Contagion that’s got us on a trajectory rivaling The Great Depression – and we’ve barely entered the second quarter. 2020 so far has been absolute garbage. On the bright side, at least this pandemic is waking people up to the fact that markets are garbage too.  

I know that many people reading this may already understand what a market is. However, watching a YouTube video of Sam Seder debating a Libertarian before writing this made me realize that I need to clarify the meaning of markets before I demonstrate precisely why they are trash. 

The almighty Google sources their meanings from the Oxford Dictionary’s website Lexico.com, which defines a market as an area or arena in which commercial dealings are conducted. 

For example, someone voluntarily calling into a radio show for free doesn’t constitute a commercial dealing since no money or commodities have been or will be exchanged. However, the host monetizing the call later does constitute a commercial dealing with the entity that distributes it, assuming that entity is different. In other words, a market only exists when a commodity is directly exchanged for another commodity, whatever happens later. The commodity most commonly exchanged is money. Markets suck for a lot of reasons, but right now I’ll focus on the contradictions between effective and notional demand and supply, as well as on profit.  

Lexico.com defines effective demand as 

 the level of demand that represents a real intention to purchase a good by people with the means to pay.

In contrast, notional demand is the demand of people who want a commodity but are unable to buy it for some reason, like not having enough money or a ban. Effective supply is the amount of a commodity furnished on the market, as opposed to notional supply, which is the amount of a commodity that would be furnished on a market if there were no market constraints, such as below-average profit margins for the commodity or a ban. 

Another critical concept is derived demand, which Lexico.com defines as 

 a demand for a commodity or service which is a consequence of the demand for something else.

A good example is Nevada governor Stephen Sisolak ordering temporary closure of all non-essential businesses in the state to curb the spread of Covid-19. The order led to lower derived demand for public transportation since fewer people are traveling to work, drink at the bar, get a haircut, and so on.  

The Covid-19 outbreak itself is an excellent example of how effective demand and supply can lead to negative results. It’s widely believed that the Covid-19 pandemic started in November of 2019 as a result of consumption of bats or pangolins sold at the Huanan Seafood Wholesale Market – a live animal and seafood market in Wuhan, China that also sold the flesh and organs of various exotic wild animals, referred to as yewei or bushmeat. The other two major coronavirus outbreaks of the past decade, MERS and SARS – of which Covid-19 is a variant – are believed to have originated in bats as well. Although no one has found evidence of anyone selling bats or pangolins at the market, Covid-19’s genetic similarity to another coronavirus found in bats (see here) suggests that it did originate with them and was most likely transmitted to humans through an intermediate animal – widely believed to be a pangolin (see here). Considering that two thirds of the first 41 people hospitalized for Covid-19 had direct exposure to the market (see here), pangolins could have been sold there — under the table, since they are a protected species. Assuming that was the case, the effective demand for yewei, which is known to have already caused two significant outbreaks this decade, met with the effective supply of yewei. Markets can incentivize the supply of dangerous goods – for instance, bombs, the only use of which is murder, or infected meat, leading to a global pandemic like the one we’re dealing with right now.  

Another excellent example of the negative results of effective demand is the impact of Covid-19 on my hometown, Las Vegas. The town’s economy revolves around the Strip, which caters mainly to tourists’ and locals’ leisure activities. The effective demand for goods and services was drastically lowered on the Strip after stay-at-home orders were issued to curb the spread of the virus, causing a domino effect. The lower effective demand for goods and services on the Strip led to lower effective demand for labor on the Strip, causing many workers employed on the Strip to be laid-off. With their derived demand for healthcare coverage and housing coming from their employment, these workers being laid-off led, in economic terms, to them losing effective demand for healthcare coverage and shelter during the pandemic. 

I give kudos to Wynn Resorts for committing to pay all their employees through mid-May, even though it may only be because it would be too expensive and time-consuming to bring all their employees back if they lay them off. Still, I haven’t heard of any other companies committing to that. 

Thank god, also, that Governor Sisolak issued a moratorium on all evictions during the pandemic. Still, he did make it clear that any unpaid rents or mortgages would have to be paid after the pandemic, essentially postponing the homelessness of many Las Vegans to a later date.  

The absurdity doesn’t end there. A resident at St. Vincent’s – the town’s homeless shelter for men, where I happened to live for about a month – was diagnosed with Covid-19. As a result, they shut the shelter down until further notice as a “safety precaution” — meaning that they wanted to avoid legal liability if other residents got sick. Now they have as many as 500 residents sleeping outside in the parking lot of Cashman Center, sectioned off into “social distancing” boxes. And this is on the same street as hotels with thousands of empty rooms, which are now only a notional supply due to the ban on non-essential business. Even if that were not the case, these homeless men would have only notional demand for these rooms that could help curb the spread of the disease among them, because they can’t afford them anyway. They are basically leaving these residents out to die, since a vaccine may not be available until at least early 2021 – a vaccine for which they may anyway have only notional demand.  

Vaccines usually take 2—5 years to be ready for market, but the urgency of the pandemic has experts hoping optimistically that it can be done in 12—18 months. The long timespan is due partly to the complexity of the vaccine development process, but in large part also to the need for funding. Over 60% of vaccine research and development funding comes from for-profit companies (see here), which was a major stumbling block in the development of vaccines for SARS and MERS. For-profit companies tend to be hesitant to invest in vaccine development since it’s much more lucrative to invest in other medications. Even if they do invest, a pandemic may pass before they can get a vaccine to market – an outcome that they see as a waste of money. Publicly funded research would be subject to the same sort of prioritization, so the only way to guarantee that we develop vaccines promptly is to remove market forces entirely.  

In a socialist society there would be no markets, because there would be no money. Since production would be for use rather than for profit, vaccine research and development would not be dependent on securing investment. It would depend only on having the necessary resources at hand. We would not stop developing a vaccine just because a pandemic has passed; we would continue to develop it, so that we would have a head start in case a future pathogen arises with a similar genetic makeup, as with SARS and Covid-19. Since there would be universal free access to all products, we would have an incentive to stockpile a buffer of supplies so we can isolate ourselves for long periods if that is necessary in order to fight a pandemic. Since healthcare would be free, anyone could get tested, use a vaccine, or get a ventilator without impediment or significant delay. Our decisions would no longer be subject to the anarchy of the market, because we would finally have achieved coordinated cooperative control over production and distribution. 

Jordan Levi

Why the shortage of medical supplies? (2020)

From the WSPUS website

Introduction

One key feature of the coronavirus crisis is the grave shortages of medical supplies. Respiratory and surgical masks, gloves, gowns, and other personal protective equipment (PPE); ventilators, X-ray machines, and other medical devices; the various components of testing kits; even sedatives. The list goes on and on. And many things not yet in short supply will be soon. 

Anyone at all familiar with capitalist dogma regarding the wonders of the ‘free market’ must surely find these shortages surprising. After all, it is a much-celebrated virtue of this market that it balances supply and demand and satisfies consumer demand (true, only within the limits of what consumers can afford). Shortages are associated not with capitalism but with the sole recognized alternative of the pseudo-socialist Soviet-type ‘command economy.’

The shortages of medical supplies have many causes. Some are intrinsic to the capitalist system. Others are not. Examples of causes that do not flow from the nature of capitalism as a system are the corruption and/or ignorance of specific politicians such as US president Donald Trump and British prime minister Boris Johnson. A country may have honest and well-informed public officials while still being part of world capitalism. This investigation focuses mainly on causes that are closely connected with the nature of capitalism.

Admittedly, it is sometimes difficult to draw a firm line between what is intrinsic to capitalism and what is not. For instance, whether governments maintain and replenish national and subnational stockpiles of medical goods for use in emergencies is a matter of policy. As such it is not fully predetermined by the nature of capitalism. However, spending lots of money for a purpose as unprofitable as preparing for future contingencies does go against the spirit of capitalism, so neglect of stockpiling requirements does have some connection with the nature of capitalism. This helps explain why the federal government of the United States has failed to replenish the national stockpile while the State of California abandoned its own stockpile.  

I begin with a discussion of the main systemic causes that underlie shortages of existing medical goods or impede the creation and wide use of new products to assist in the fight against COVID-19 (Section 1). Then I present three case studies, focusing on specific products as follows:

Section 2.  Respiratory face masks (respirators) – the single most essential item of PPE
Section 3.  Ventilators – ‘breathing machines’ to intubate patients at risk of suffocation
Section 4.  Vaccines 

Section 1.  Systemic causes

In organizing future output of a product, the capitalist faces a degree of uncertainty. He has some knowledge of current demand for the product, but cannot be sure how much demand there will be for it at the time when it reaches the market. He may find himself saddled with a surplus that he cannot sell at a profit. In deciding whether to fund development of a new product, he faces even more uncertainty: he does not know when it will be ready for sale or even whether a usable product will emerge at all.

During the initial stage of a newly emerging epidemic (not yet a pandemic) uncertainty about future demand for medical supplies is especially great. Perhaps the epidemic will remain localized and gradually fizzle out. Perhaps it will spread rapidly, only to dissipate equally rapidly with the arrival of spring. Then demand will rise sharply but disappear before he can produce, distribute, and sell the products to satisfy it.  

Besides fear of ending up with a surplus that cannot be sold at a profit, the capitalist may have other reasons to be concerned about possible costs of trying to satisfy rising demand. As we shall see in the next section, a company that specializes in the production of face masks for use by workers in industry and construction may fear that it will be sued by new medical customers who are dissatisfied with its product. It may be willing to sell to such customers only if it is freed from legal liability.    

Note that the capitalist does not consider how he can best contribute to the treatment of patients or to the fight against the epidemic. As a capitalist he has to operate by the rules of the capitalist system. He cannot behave as a socially responsible human being. However devastating the epidemic may become, it cannot alter that. What he cares about is his ‘bottom line.’    

That said, there is still the matter of the capitalist’s attitude toward risk. Is he more concerned about capturing possible gains if higher demand is sustained or about avoiding possible losses if higher demand proves short-lived? Recent decades have seen a shift in business practice toward giving priority to the avoidance of possible losses. This shift has been associated with adoption of the so-called ‘just-in-time’ principle.

Just-in-time

The shift toward more cautious decision making began in Japan in the 1970s, when the Toyota company adopted at its manufacturing plants the practice that came to be known as ‘just-in-time’ or ‘lean’ manufacturing or the Toyota Production System. Since then this practice has spread throughout the world. The basic idea is to save on space, labor, and other costs associated with storage by producing only to satisfy demand definitely known to exist, or even only to meet orders already in hand. Maintaining production capacity or inventory to cope with possible rises in demand above this level is considered wasteful.  

Charles Johnson, president of the International Safety Equipment Association, has been quoted as saying: 

Manufacturers don’t carry inventory. If you do, you are less competitive. They produce what they need to satisfy orders. That’s what has happened to global manufacturing.

‘Just in time’ now prevails at all links of the supply chain. Retail outlets place orders with their suppliers ‘just in time.’ So do hospitals. As a result, reserves no longer exist anywhere in the system. 

When demand suddenly leaps upward, as it does for medical supplies during a pandemic, ‘just-in-time’ ensures that there will be no spare production capacity or inventory to help satisfy the increased demand. With sufficient investment it is still possible greatly to expand output, but this inevitably takes time – and in an emergency, by definition, time is short. 

A rational system of production for use would enable society to maintain reserve production capacity and inventory of essential goods adequate for foreseeable contingencies. Of course, not everything that can happen is foreseeable and mistakes of judgement will always be possible. 

Globalization

Globalization is a significant cause of the current shortages. It has led to extreme geographical concentration in the production of many goods. Specialized products especially are often available only from a single producer in a single country – and that country is rarely the United States. Thus the coronavirus test initially recommended by the Centers for Disease Control required the use of a genetic analysis kit available only from the diagnostic firm Qiagen in Germany and nasopharyngeal swabs (inserted into a nasal passage to get a sample for testing) available only from Copan, a company whose manufacturing plant is in northern Italy – a region itself hard hit by the pandemic. Unsurprisingly, clinics in the United States have been able to obtain supplies from these companies only after long delay, if at all.

However, the United States is dependent for medical supplies mainly on imports from China. Factories in China, even if owned by American corporations, suspended exports in order to meet rising domestic demand as the epidemic spread within the country. Later exports of some goods resumed, though at much higher prices. A commentator in the congressional magazine The Hill writes:

  Right now, only China has the potential production scale to meet the soaring demand in the United States and elsewhere for such vital products as medical-protective equipment, pharmaceuticals, electronics, and household essentials. It is imperative for our country and the world that we encourage the rapid recovery of Chinese production capacity. Particularly, we need China to ramp up output quickly in areas of most-critical need, such as sophisticated protective gear for doctors and nurses and pharmaceuticals/medicines for patients and households. 

Stockpiles

The Strategic National Stockpile (SNS), originally called the National Pharmaceutical Stockpile, was established in 1998 on the initiative of President Clinton. Its contents are stored at 12 secret locations in different parts of the country. A stock of protective equipment was added to the stockpile in 2006 but it was depleted during the influenza epidemic of 2009 and has not been replenished to any significant extent. Much of the equipment released from the stockpile during the current pandemic was found to be in disrepair.

The SNS has been exhausted since about April 8. Its contents were not distributed with a view to maximizing their impact. States with relatively mild outbreaks received disproportionately large amounts at the expense of ‘hotspots’ like New York and Chicago (here). Requests from states with Republican governors – Florida, for instance – were met more fully and more promptly than requests from states with Democratic governors. 

Some states had stockpiles of their own. They too are now exhausted. California used to have a very substantial stockpile, established in 2006 under Governor Arnold Schwarzenegger at a cost of $200 million and containing 51 million N95 respirators, 2,400 portable ventilators, 3,700,000 courses of anti-viral medications, and three 200-bed well-equipped mobile hospitals. It was scrapped in 2011 by Governor Jerry Brown as part of cuts to reduce the state’s deficit (here). 

Patents

Especially important are new products, like an effective drug or vaccine, that might radically change the situation for the better, but only if made widely available as soon as technically possible. Unfortunately, this is not in the interest of the producing company. The way for it to maximize its profit is to take out a patent on any new product and exploit to the full the monopoly position that the patent gives it for a certain number of years. That means delaying the start of large-scale production and then charging an exorbitant price. [1] 

As we shall see in Section 4, considerations of likely profitability have a negative impact even at the stage of research and development of a new drug or vaccine, especially when funds are sought for the conduct of clinical trials. 

Patents also impede independent attempts to replicate or repair ventilators and other medical equipment.

Section 2.  Respiratory face masks

Here is how two hospital workers describe the current shortage of the protective face masks known as ‘N95 respirators’ (so called because they supposedly filter at least 95% of airborne particles):

Dr. Michael Pappas, resident physician at a hospital in New York City:

  Under normal circumstances you could be fired for re-using a single N95 mask throughout the day. You are supposed to dispose of your mask after dealing with one patient and use another for the next patient, to ensure that you do not contaminate that patient or yourself. But currently our hospital is asking healthcare workers to use only one N95 mask each day. And that’s actually a better situation than in most New York City hospitals, which give staff one N95 mask that they’re supposed to carry around in a paper bag and use for an entire week. [2] 

Maria Louviaux, RN, of the California Nurses Association:

  At our hospital nurses and all frontline staff are not allowed to wear our N95 respirators. Respirators are actually under lock and key. In some cases, security needs to be called up to release our personal protective equipment. In other cases, a respirator needs to be signed out. But we do not have easy access to N95 respirators or to surgical masks. We’re not allowed to wear masks of any kind unless certain criteria are met throughout the hospital.  

  Once we are finally issued an N95 respirator, it has to be used continuously as we go from one patient to another. We have to re-use it repeatedly until it is compromised by soiling, wetting, or loss of integrity. And that violates the rules set by the FDA for its use. [3]

In South Korea, by contrast, even ordinary citizens walk about wearing KF94 masks, which are almost the same as the N95 respirators that are in such short supply even for hospital staff in the United States. [4]  

The April 2 issue of The Washington Post featured an investigation of why production of protective respiratory masks has not increased early enough and fast enough to meet the need generated by the pandemic. The main manufacturer of such masks in the United States is 3M, a company with headquarters in Minnesota and factories in South Dakota and Nebraska. 

Under normal circumstances, however, the bulk of the face masks produced by 3M are of a type intended for use by workers in industry and construction, not by medical personnel. Most production of masks for medical use had been relocated to China in order to reduce costs, but in mid-February China stopped exporting the masks, reserving them for domestic use. So globalization has played an important part in creating the shortage.  

Industrial and medical masks are designed differently. Medical masks contain more material, providing added protection against splashes. Industrial masks are not tested for fluid penetration. The two types are also subject to different regulations set by different agencies. 3M has been reluctant to switch its production line from industrial to medical masks, as this would require retooling – and then a second retooling to switch back again after the pandemic. But the company was also reluctant to supply its industrial masks to medical customers, fearing that it might be sued. 

What to do? It was at this point that Arthur Caplan, Professor of Bioethics at New York University School of Medicine, offered 3M and other manufacturers of medical supplies some unsolicited advice:

  Don’t talk to your lawyers if you’re making masks or gowns or ventilators. See where the need is and get moving as fast as you can.

But 3M paid the good professor no heed. Why hire lawyers if you can’t consult them? Not until March 22, after the FDA had approved medical use of industrial masks and legislation had passed waiving legal liability, did 3M finally conclude that its continued profitability was no longer in doubt and announce a rapid expansion of output. 

Will socialism be any better than capitalism in this respect? Will people in a socialist society be able to ‘see where the need is and get moving as fast as they can’? True, they won’t have to worry about lawsuits, but they will face other obstacles to prompt action if they have saddled themselves with a complicated, unwieldy, and overcentralized decision-making system. That is why it is so important not just to abolish capitalism but to design a flexible and sufficiently decentralized system of democratic decision-making for socialism.           

Another major factor underlying the dire shortage of face masks is the ‘just in time’ principle, followed not only by manufacturers producing only to satisfy orders but also by hospitals with a policy of not buying supplies in advance. To quote Dr. Pappas again:

  Instead of buying supplies in advance, many hospitals … waited to see if the pandemic actually hit or not, because buying supplies in advance would be an extra cost for hospitals if the pandemic never hit. So they didn’t buy supplies, they didn’t prepare, and now we’re seeing what we’re seeing.

Finally, what of the Strategic National Stockpile? 

This emergency stock of masks was depleted during the influenza epidemic of 2009, when 85 million N95 respirators were distributed. It was never replenished to any significant extent despite repeated warnings and requests from healthcare groups. 

Section 3.  Ventilators

Over the coming months, hundreds of thousands of people in the United States are going to come down with severe forms of COVID-19 infection. How many will pull through and how many will die of ‘respiratory failure’ – that is, suffocation – will depend crucially on the availability of ventilators in the intensive care units of hospitals. There are only 62,000 ventilators in service across the country, many of which are being used for non-coronavirus patients. A recent survey found that even acute-care hospitals have on average only eleven ‘full-feature’ ventilators. Unless they very soon acquire many tens of thousands more of the machines, hospitals will be overwhelmed as the pandemic spreads. By the time you read this article, some may already be overwhelmed.

In a desperate attempt to mitigate the disaster, hospital staff are preparing to link up each of their ventilators to four patients. A video posted on YouTube shows them how to do it. As the instructor admits, this is an ‘off-label use’ of machines designed to serve one patient at a time. I cannot help wondering how well it will work. 

Go for it auto execs!

Initially Trump took the orthodox ‘neo-liberal’ view that there was no reason for government to get involved. ‘Unfettered free enterprise’ could be trusted to rise to the occasion. However, he ended up brokering a deal for a joint venture between General Motors and Ventec Life Systems. General Motors would retool a car parts plant in Kokomo, Indiana as a ventilator production facility using Ventec’s technology. A government order for 80,000 ventilators was to be fulfilled in just two months. Trump’s enthusiasm was unbounded. ‘Go for it auto execs,’ he tweeted excitedly on March 22, ‘let’s see how good you are?’ 

Then suddenly it was announced that the deal was off. Officials in the Administration were unhappy about the cost – over a billion dollars, a large part of which had to be paid upfront to cover the cost of retooling. True, it worked out at only $13,000 per ventilator, which would seem good value for money, considering that these machines usually sell within the range $25–50,000. ‘But for Chrissake’, lamented officials at the Federal Emergency Management Agency, ‘for that money we could buy eighteen F-35 fighter jets!’ And if you think I made that up for ironic effect then you are wrong. They really find it distasteful to spend large sums of government money for the benefit of ordinary people. 

An interdepartmental working group was set up to investigate the matter under the wise guidance of Clown Prince Jared Kushner (who was admitted to college only after his dad paid a hefty bribe – I mean ‘donation’). The GM-Ventec project remains on the table, but another dozen or so other proposals are also under consideration. The target of 80,000 ventilators was whittled down to 20,000 and then to 7,500 – so a plan to more than double the number of machines was transformed into a scheme to increase that number by just 12%. 

You see, some officials are worried that too many ventilators may be ordered. What are they to do with the surplus? 

Exclamation points

Give the guy credit where it is due. Trump must have started to get impatient, because on March 27 he issued the following statement:

  Today, I signed a Presidential Memorandum directing the Secretary of Health and Human Services to use any and all authority available under the Defense Production Act to require General Motors to accept, perform, and prioritize Federal contracts for ventilators. Our negotiations with General Motors regarding its ability to supply ventilators have been productive, but our fight against the virus is too urgent to allow the give-and-take of the contracting process to continue to run its normal course. General Motors was wasting time. Today’s action will help ensure the quick production of ventilators that will save American lives.

The Defense Production Act of 1950 authorizes the President to require businesses to sign contracts and fulfill orders deemed necessary for defense, but it has also been invoked occasionally in non-military emergencies. Democrats in Congress were urging him to invoke it in the current crisis. Trump was under pressure from corporate CEOs and the Chamber of Commerce not to do so.  

Trump then fired off tweets to General Motors and Ford, which was working on its own plan to adapt car parts for ventilators, declaring that they ‘MUST START MAKING VENTILATORS NOW!!!!!!’ (yes, in capital letters and followed by six exclamation points).  

It seems that this ‘very stable genius’ – as Trump has described himself – momentarily forgot how capitalism works, even though most of the time he understands this very well. How else could he fondly imagine that a few presidential exclamation points might induce a corporation to set aside considerations of profitability in order to satisfy a human need, however urgent? 

As of this writing (April 10), no new facility for the production of ventilators is yet in operation in the United States. 

An even harsher light

But there is another aspect to this problem – one that casts the functioning of capitalism in an even harsher light.

While American hospitals have only 62,000 ventilators in service, they have in storage a very large number – estimates run as high as 100,000 – of ventilators that might be brought back into use if repaired. It is true that older models may not be reliable, but repairs could bring enough machines back into use to save many people. Hospitals, however, are unable to have ventilators repaired due to restrictions imposed by the manufacturers (Siemens, Philips, General Electric Healthcare, Medtronic, Ventec Life Systems, Hamilton Medical), who also fight legislative challenges to their repair monopoly. [5] 

First of all, purchasers of ventilators and independent technicians are denied access to the documentation and software required for repairs. Second, unauthorized attempts to repair a ventilator are blocked by special ‘anti-repair software.’ Third, a hospital that hires a technician who manages to overcome these obstacles and repair a ventilator may be sued by the manufacturer. 

In Brescia, a city in the north Italian region of Lombardy, a technical expert used a 3D printer to produce 110 special valves needed to repair ventilators at a local hospital. It cost him just 1 euro for each valve, as compared with the price of 10,000 euros charged by the manufacturer of the ventilators, Intersurgical. He gave his valves to the hospital for free, thereby saving at least ten lives. However, he faced a threat of legal action for infringing Intersurgical’s patent and therefore decided not to provide the same service to other hospitals (here). 

Of course, it is not only medical equipment manufacturers who deliberately try to prevent repair of their products. Manufacturers of computers, tractors, and many other devices do exactly the same thing. It is one of the ways by which they artificially shorten the service life of their products with a view to ‘persuading’ consumers to buy new ones. The phenomenon is known as built-in obsolescence. It is a normal feature of capitalism and a major source of the enormous waste generated by that system.

A waste of labor, a waste of resources, and – as in this case – a waste of human life.

Oases and hotspots

The prospects of the pandemic in the United States vary widely from one place to another, depending on the timing and strength of the response from city and state governments. At one extreme are places like Seattle and the San Francisco – Bay Area where strong measures were adopted at an early stage and have shown good results, comparable with those achieved by South Korea and Hong Kong. Here the pandemic is already on the wane; numbers infected are relatively low; hospitals have coped well. 

However, such ‘oases’ are few and far between. More typical are the many areas where measures, though in effect by late March, began only after significant delay. These include such cities as New York, Chicago, Detroit, Atlanta, Miami, and New Orleans. In quite a few of these ‘hotspots’ hospitals are already in crisis. 

Even worse are likely outcomes in areas where adequate measures had still not been taken in early April. Most but not all such areas are in the Southern ‘bible belt.’ Here, for instance, religious services are still being held – sometimes for the explicit purpose of vanquishing the virus by prayer or exorcism. 

For the time being, however, media attention has focused on the plight of New York City. 

New York appeals for help

At a press conference on March 28, Andrew M. Cuomo, governor of New York State, stated that according to projections New York State was going to need 30,000–40,000 more ventilators by May  1. The Clown Prince responded that according to his projections New York did not need so many, though Dr. Anthony S. Fauci, MD, the immunologist who serves on the White House Coronavirus Task Force, said that he saw no reason to doubt Cuomo’s estimate. The Clown Prince urged Trump to ‘push back’ against Cuomo. 

Where were the additional ventilators to come from?

Can they be purchased? The trouble is that high demand and short supply have created a seller’s market with sky-high prices. The situation is exacerbated by the lack of coordination at the national level, which forces state governments to bid against one another and against the Federal Emergency Management Agency (here).

The Strategic National Stockpile is supposed to supplement local medical supplies during a public health emergency. And federal authorities have sent New York State 400 ventilators from this source – 200 earmarked for New York City and 200 for the rest of the state. ‘What am I going to do with 400 ventilators when I need 30,000?’ asked Cuomo. Not to mention that many have parts missing and do not work. It is unfortunate that New York State has a Democratic governor, as only Republican governors like Florida’s Ron DeSantis get their requests met quickly and in full by the Trump Administration (here). 

At a press conference on April 4, Governor Cuomo announced that 1,000 ventilators would be arriving by air later that day – a donation ‘facilitated’ by the Chinese government. The State of Oregon, now itself over the hump of the pandemic, is giving New York another 140 ventilators. [6]

China, Oregon, and the federal authorities, taken together, are sending New York 1,540 ventilators, just 4—5% of the number needed. 

According to recent reports, New York was going to run out of ventilators on April 8 (and Louisiana on April 9).         

Who will be left to die?

So it seems that hospitals in New York – and other places – are going to be overwhelmed – meaning, in particular, that they are going to run out of ventilators. What happens then? Who will be hooked up to a ventilator? Who will be left to die? 

According to a TV talk show broadcast from New York on April 3, these life-and-death decisions will be based on ratings that combine three factors:

• age of the patient (younger people have priority)
• the patient’s state of health prior to infection (people otherwise in good health have priority)
• health insurance status (people with ‘good’ insurance or able to pay for themselves; people with less ‘good’ insurance; people who are uninsured)

Those with the highest ratings get a ventilator all to themselves; those with the lowest ratings are left to die; those in the middle share a ventilator with other patients. 

In other words, a class system has been devised – as befits a class society.

In production at last?

Meanwhile, what progress is there with new production projects like those described above?

On April 5 Tesla posted the first YouTube video about their ventilator prototype, made using electric car parts – a project reportedly initiated at the request of New York City mayor Bill de Blasio. [7] However, the design is new and untested.

Parallel to the General Motors—Ventec project, Ford is working with General Electric and plans to start production on April 20 at its Rawsonville Assembly Plant in Ypsilanti, Michigan. Ford promises to deliver 50,000 ventilators within three months. I don’t know how realistic this timetable is. Time will tell. But even if the promise is fulfilled these ventilators will arrive too late for many. With a prompter response to the start of the pandemic, many if not all of them would already be saving lives.                                                                 

Section 4.  Vaccines

There would seem to be good prospects for a safe and effective vaccine against the SARS-CoV-2 coronavirus.

First, numerous teams of scientists are working in parallel, applying diverse approaches to the problem. According to an interview on March 21 with Dr. Stanley Plotkin, inventor of the rubella vaccine, at least forty possible vaccines were already under development at that date (here). By April 8 the number had risen to 115 (surveyed here). Besides European and North American biotech companies, Chinese, Indian, and Japanese companies are now in the race. China alone is developing nine potential vaccines.

In addition, the Oslo-based Coalition for Epidemic Preparedness Innovations is funding several research efforts by non-commercial organizations. [8] Non-commercial projects are of special value, because they are not bound by the commercial secrecy that impedes cooperation among scientists working for different companies.

The Boston-based company Moderna has already begun a first-phase clinical trial of an RNA vaccine – a new type – on human subjects (here).

Second, the evidence so far indicates that the virus is slow to mutate. Genetic differences among the strains that have emerged in different countries are slight. This greatly simplifies the task. Any vaccines developed to protect against the virus in its current forms will probably remain potent for a considerable period.  

Third, the SARS-CoV-2 virus is new but by no means completely new. It bears some similarity to other coronaviruses and especially – as the label given it indicates – to the SARS-CoV-1 coronavirus of 2002—2003, and also to the MERS coronavirus of 2012—2014. This family resemblance to viruses that have already been studied facilitates the search for a vaccine. [9]  

Squandered advantage

However, much of the advantage that this family resemblance could have given was squandered when research into SARS-CoV-1 and MERS was discontinued after the corresponding epidemics ended. In particular, Dr. Maria Elena Bottazzi and her team at Baylor College of Medicine and Texas Children’s Hospital Center for Vaccine Development developed early vaccines against SARS-CoV-1 and MERS but in 2016 were unable to obtain funding to conduct clinical trials. Such trials that would have given a head start to current work on a SARS-CoV-2 vaccine. Researchers would already have some idea of how humans react to one class of possible vaccines against members of the SARS family of coronaviruses. [10]

Why then was ‘no one interested’ in funding trials of these vaccines? Here is what virologist Dr. Hakim Djaballah, head of the Pasteur Institute Korea, has to say about it:

  There is no more threat, so everybody forgets about it… The best comparison is with the Ebola virus in Africa. The only reason we got a vaccine for Ebola is because Ebola decided to leave the continent of Africa and started infecting people in Europe and America. So those people started getting worried about the spread of Ebola on their own soil. And that was the push for government funding to get those vaccines made. Companies will not make vaccines if there is no one to buy them. They make them only when governments are in crisis. So those governments write and sign the checks and hand over the money. But those governments have not seen a vaccine for SARS-CoV-1 yet. And there hasn’t been a push for it. Now perhaps they will try something, but I’m not holding my breath. [11]

No money for research to guard against future contingencies like reappearance of an old pathogen or emergence of a new one belonging to the same family as an old one. No money to fight even a current epidemic so long as only poor countries are affected. No money to preserve and strengthen research capacities in order to be in the best possible position to meet future challenges. There is no commercial justification for any of these things. 

This is the narrow focus of capitalist society. Profit-oriented decision makers see no palpable advantage in contributing to a broadly conceived and future-oriented research program, although it is precisely such a program that humanity needs in its present predicament. To quote another scientist:   

  We need coordinated research, worldwide, on virus illnesses, to be prepared for the next mutation. It will be impossible to cover all possible variants, but we would be much closer to a new mutation than we are now. [12]

This makes good sense. A socialist world community would surely do it that way. But is such a high degree of global coordination feasible in a world of competing producers and rival nation-states?

Delay, delay

The time needed from the start of research on a new vaccine until it is marketed is commonly estimated as 12—18 months, although many commentators say that it could easily take two years and some give an upper limit of three years or even longer. Dr. Plotkin recalls that ‘it took at least five years before a vaccine [for rubella] was on the market’ and adds: ‘We cannot afford to have that kind of delay in an emergency like this one.’ He urges companies to ‘go into superaction’ immediately, with a view to having a vaccine available in the event of a second wave of the pandemic next winter – that is, within about 8 months. 

One major reason why the process takes so long is the number and duration of the clinical trials required to get a vaccine licensed by regulatory agencies like the US Food and Drug Administration. The official purpose of licensing is to ensure the safety and efficacy of drugs and vaccines. In practice, the FDA was long ago ‘captured’ by the companies it is supposed to regulate, with most of the scientists who sit on its advisory committees dependent on those companies. [13] FDA decisions therefore tend to reflect the interests of the companies that have the most political clout at the time.  

Monopolization and extortion

Another recommendation made by Dr. Plotkin is that the FDA should license not one but several vaccines against SARS-CoV-2, ‘because if we need millions of doses a single manufacturer will not be able to make enough for the world.’ This too makes good sense. Or at least it would if production were carried on to satisfy human needs. However, we live under a global system in which production is for profit. 

How then does a company that develops and produces vaccines act in order to maximize its profit? It seeks to monopolize the market for a vaccine against a specific disease by ensuring that its vaccine – and its vaccine alone! – is licensed. Then it applies for a patent on its vaccine – another significant cause of delay. Monopolization sets the scene for extortion. The company sells its vaccine at an exorbitant price that makes it unaffordable to most of those who need it.  

How many times this has happened in the past! A few years ago, for instance, the Joint Committee on Vaccination and Immunization, one of the committees that advises the British National Health Service, recommended that a new vaccine against Meningitis B manufactured by Novartis NOT be made available to all children in the UK, even though this terrible disease afflicts 1,870 people per year. It was ‘highly unlikely to be cost effective’ – in other words, it was too expensive. [14] And this in a country that for over seven decades now has had what “progressive” Americans politicians call ‘Medicare for All’! Vaccines against the scourge of viral hepatitis are likewise too expensive for large-scale use. [15] 

Indeed, there has already been an attempt to monopolize a future SARS-CoV-2 vaccine – one that does not yet even exist. In mid-March, the German press reported that the Trump Administration was trying to secure exclusive rights to any vaccine created by the German pharmaceutical company CureVac. Research and development would then be moved to the United States and the vaccine made available only in the United States (here).

Stephen Shenfield

Notes

[1] For a discussion of patents, with other examples of the harm done by them in the medical field, see here.

[2] Interviewed on April 7 by The Real News.

[3] Interviewed on April 6 by The Real News.

[4] Professor Kim Woo-joo of Korea University Guro Hospital, interviewed on March 27 by The Korea Times. 

[5] They do this both directly and through their lobbying group, AdvaMed. See Jason Koebler, ‘Hospitals Need to Repair Ventilators. Manufacturers Are Making That Impossible,’ Vice, March 18. 

[6] See here. It is not clear who in China is actually footing the bill. 

[7] See here. There were soon several videos on YouTube about Tesla’s ventilator.

[8] Seven projects as of April 10. See here.

[9] See the article by researchers at La Jolla Institute for Immunology in the March 16 online issue of Cell, Host and Microbe. 

[10] See here. For a detailed assessment and references to articles by members of the Bottazzi team, see comments by pharmaceutical engineer Christopher C. VanLang on the question-and-answer website quora.com.  

[11] In an interview with The Korea Times.

[12] Physicist Cees J.M. Lanting on the question-and-answer website quora.com.

[13] This includes scientists directly employed by companies, scientists working for them on contract, and the many university scientists who depend on corporate money to fund their research. In fact, there are so few genuinely independent scientists that the FDA would be unable to rely mainly on them even if its leading officials wished to do so. 

[14] 10% of victims die, while many survivors become deaf or blind or have to have limbs amputated (The Independent, July 24, 2013; Daily Mail, August 24, 2013). 

[15] Vaccines exist for types A and B of this disease: see here. For a discussion of the availability of vaccines in underdeveloped countries, see here.