Editorial: Manpower and the Crisis (1947)

Editorial from the March 1947 issue of the Socialist Standard

Remedy the Labour Government Cannot Use

Capitalism breeds war, waste and want as a jungle swamp breeds pestilence. Practically every minister in the Labour Government has acknowledged the truth of this some time or other and has pointed the obvious moral that if you want to remove the pestilential effects you must remove the capitalist cause, and introduce Socialism in the place of Capitalism. They said this, but did any of them understand what they were saying? Probably not. If by chance some of them did then by taking office in the Labour Government they were acting a deliberate lie for they were promising something it was not in their power to do. There can be no Socialism until there are a majority of convinced Socialists in the electorate and even the most deluded of Labour leaders would surely not claim that the 12 million Labour voters were Socialists. A government cannot impose Socialism on an unwilling electorate. This should be obvious, but it took the recent crisis to jolt the “Daily Herald” into even a partial recognition of the facts. The “Herald’s” admission, a veritable masterpiece of understatement, was framed as a warning to Ministers not to entertain the “treacherous delusion” that would “regard the whole electorate as enthusiastic converts to Socialism” (February 8th, 1947). The same Editorial goes on to claim that “a peaceful revolution is being wrought in this land which will bring solid benefits within our lifetime, and will confer blessings untold on posterity.” We can leave posterity to speak for itself and content ourselves with foretelling a time when the electorate will count it an immediate blessing to be rid of the Labour Government.

The reader is of course entitled to ask us why we are sure that Labourism cannot succeed. The answer is to be found in the opening paragraph of this article. Capitalism we know; Socialism the workers can have when they are ready to grasp it; and there is no other choice. The root fallacy of Labourism is the belief that a Labour Government can administer capitalism in a non-capitalist way. With all the good intentions in the world it cannot be done” Labour Ministers may make election promises with perfect sincerity, but in office they learn day by day what it really means to keep this exploiting, profit-making system .going, in competition with the rest of the capitalist Powers. It means resisting wage claims so that the capitalists can go on making profit. It means perpetuating the vast gulf between rich and poor. It means maintaining the armed forces and struggling with rival Powers for trade, raw materials and colonies.

It is hardly necessary to say that it also involves swallowing past declarations of what ought to be done, such, for example, as Sir Stafford Cripps’ complete reversal of his views on trade rivalry. Now he is chief director of the export drive. Five years ago he declared, “If, after the coming of peace, we were to start once again the vicious circle of international trade competition, we should be lost, and in a few years would be confronting another war” (interview with a Brazilian newspaper—”Sunday Express” November 8th, 1942).

The recent crisis, forerunner of others, took on the appearance of a problem of fuel and manpower, brought to an acute phase by an “Act of God,” the British weather. It was, however, not a crisis of coal or of cold, but of capitalism. Let us examine this and see how capitalism, which caused the problem, prevents the Labour Government from solving it. The second World War (itself a product of capitalism) destroyed vast amounts of wealth and left a legacy of shortages of housing, food, fuel, clothing, transport, etc. Not that want was a new experience for the working class, but the war aggravated the problem by the immensity of the destruction it wrought all over-Europe and Asia. What would a sanely organised human society have done about this, assuming that such a form of society had to tackle the problem? It would have stopped all waste of labour and materials, halted the production of armaments, and of luxuries for the rich, and would have concentrated on producing the necessities of life in the quantities urgently needed by the population of the world. How did the Labour Government (and all the governments in all the countries) tackle it? They spoke the right words, but proceeded to apply fiddling half-measures. The British Labour Government said they needed man-power in production, but they found that British capitalism had a still more pressing need to keep 1,500,000 men in the armed forces and other hundreds of thousands supplying the needs of the forces and preparing for future wars. They said they needed more workers producing coal, food, houses, etc., for the millions who lacked bare necessities, but they left intact the class structure of capitalism, with its hundreds of thousands. of wealthy idlers consuming without producing, and its hundreds of thousands of workers engaged in banking, financial and other operations that only arise because of capitalism. There are over 700,000 non-industrial civil servants, about 350,000 of whom are Post Office workers. The great bulk of the remaining 350,000 are doing work rendered necessary only by capitalism, as is also much of the work of the Post Office. We are told that many civil servants are employed on insurance and similar work which the Labour Government regards as socially useful; but it is only the mind habituated to capitalism that cannot see what this work really is. Staffs handling unemployed and health. insurance are not there to see that the needy (needy because of capitalism) receive enough to satisfy their needs, but to protect capitalism against the needy receiving more than the niggardly amount allotted to keep them quiet.

The same contradiction between proclaimed aims and practical activities can be found in every sphere. The luxury needs of the wealthy have not been sacrificed to speed up the provision of necessities. On the contrary, the Government has encouraged the planning of luxury liners, luxury air travel, and luxury goods for export. These schemes are defended with the plea that luxury exports make it possible to import necessities unobtainable in other ways. The curious thing is that the governments of other war-damaged countries (France, for example) are doing the same and on the same plea, so that some luxury goods are being imported by all the countries which declare their inability to supply enough necessities for their populations. What it shows is that, despite Labour Party talk about a “new world,” the British and other Labour Governments are basing their plans for the future on the continuance of the same old capitalism, with its extremes of wealth and poverty. They are all catering for the needs of the wealthy.

Here then is the simple problem and the simple solution. On a conservative estimate the production of useful goods could easily be doubled in short time if the armed forces and propertied idlers and the workers doing work necessitated only by capitalism, were brought into production. Why doesn’t the Labour Government even attempt to do it? They don’t do it because even if they wanted to they dare not. They were put into power by an electorate that does not understand or want Socialism and which therefore gave the Labour Government nothing more than a man¬ date to go on administering capitalism.

The recent crisis arose because the capitalist state needs to have millions of people taken from production for the armed forces and other non-productive activities and therefore cannot take simple straightforward measures to make good the destruction of war. It led to great suffering and to the increase of unemployed to about 2,500,000 at the peak. In due course another and more usual type of capitalist crisis will blow up. Goods will be produced in excess of what can be sold at a profit, then unemployment will soar again. Then the Labour Government will be looking for other excuses than the cold weather to explain the failure of its plans. The “New Statesman,” which shared all of the foolish Labour Party beliefs in the possibility of applying so-called Socialist policies to capitalism, has in anticipation already coined the appropriate face-saving formula for the next crisis: “… the Government is confronted with the certainty, now that the illusions about a liberalisation of America’s trade policy have finally been dispelled, that a Socialist experiment confined only to this country is bound to fail” (February 8th, 1947). So the “New Statesman,” shedding one illusion, grasps at another equally absurd. It proposes that Britain cut adrift from trade and financial ties with U.S.A. and collaborate instead “with other countries which are experimenting with planned economies.” If it is a fallacy, as it certainly is, that a Labour Government can apply Socialist plans to capitalism, common sense should make it clear that you do not escape from the dilemma by linking up with other countries in which similar governments are trying to perform the same impossible feat. Capitalist crises know no frontiers, and Labour Governments here and elsewhere will no more escape the next crisis than they did the “economic blizzard” that blew down the British Labour Government in 1931 and simultaneously toppled over the Labour Government in Australia.

For the world’s workers there is no escape from the problems and crises caused by capitalism except by introducing Socialism.

What if there’s a shortage? (2025)

From the November 2025 issue of the Socialist Standard

For a socialist post-capitalist society to come about presupposes two basic things. In the absence of either of these (and, even more so, both), this society would not be realisable.

Firstly, you have to have a majority of people who want it, understand what it entails and are committed to seeing it flourish and succeed. It cannot be imposed from above by a minority, however enlightened or well-meaning.

Secondly, you have to have in place an advanced technological infrastructure that has at least the potential to enable us to adequately meet the reasonable needs of the population. In other words, to more or less ensure ‘plenty’. The more output were to fall below the level required to meet these needs, the greater the strain that would be imposed upon the particular kind of social arrangement that defines a post-capitalist society – a society characterised by the free distribution of goods and services provided by the voluntary work of its members.

What is plenty?

Of course, what is meant by ‘plenty’ is something relative; it depends not just on physical output but, also, on our values. When we talk of ‘plenty’ the question always arises – ‘in relation to what’?

If what you deem to be minimally acceptable as a standard is something so extravagant as a sprawling multi-bedroomed mansion set in its own spacious grounds along with a fleet of luxury cars parked in the garage and outbuildings for the servants then, very clearly, in per capita terms, we are not going to achieve ‘plenty’ by this yardstick, in a post-capitalist society.

You can therefore forget about achieving such a society in that case. However, by the same token, you can also forget about ever extricating yourselves from the circumstances you find yourself in today which for a great many people are grim and precarious. In short, you will be lumbered with capitalism for the foreseeable future.

To achieve ‘plenty,’ then, will require us to lower the bar to something rather more realistic. This is precisely why the first of these preconditions of a post-capitalist society cannot be separated or considered in isolation from the second: to some extent they mesh together.

In principle, achieving and maintaining a state of ‘plenty’ would eliminate the need for any form of rationing – money, of course, being the means by which goods are rationed today under capitalism. However, we cannot entirely rule out the possibility of some shortages arising in a post-capitalist society, whether in the early days or from a natural disaster. That being the case, we cannot rule out some form of rationing in the sense of restrictions on the consumption of some goods.

Prior to the 20th century it probably would not have been feasible to establish such a society given that the means of production would not yet have been sufficiently developed to materially support it. This is no longer the case. Indeed, it has not been the case for quite a long time now. As a generalisation, one can say that it is fairly indisputable that the technological potential to satisfy most, if not all, of the needs of the population, globally speaking, exists today.

Not erased overnight

The legacy of capitalism’s self-inflicted shortcomings would not be able to be erased overnight. We cannot expect universal ‘plenty’ to suddenly materialise the ‘day after the revolution,’ so to speak. The apparatus of capitalist production is geared to creating and maintaining artificial scarcity. It will take some time, however short, to restructure and reorganise industry to fully meet human needs as well as ensure it is effectively managed in an environmentally sustainable fashion.

This means that at the beginning, post-capitalist society is likely to have to contend with some shortages of one kind or another for a while. However, this should not present too great an obstacle to such a society functioning properly as intended.

The reorganisation of productive capacity to realise its full potential to meet the reasonable demands of people everywhere would be happening under new conditions in that effective market demand would no longer be the determinant of what gets to be produced, as it is today under capitalism.

In a post-capitalist society, the relationship between our subjective preferences and the products we desire would be a direct one – not one mediated by money or, for that matter, labour vouchers. Insofar as comparisons need to be made between products in terms of their value to us, this would be effected entirely according to our preferences, which would simply be ranked.

Productive activity would be guided by a flexible hierarchy of production priorities, responding to shifts in the pattern of supply and demand. Our values would thus be able to directly engage with, or find expression in, the process of material production itself – by continually informing and guiding it rather than production being dominated or regulated by the impersonal laws of the capitalist market economy.

The single most important way in which productive capacity to meet human needs can be rapidly increased in a post-capitalist society is to convert that large chunk of existing productive capacity currently having nothing to do with directly meeting these needs and diverting enormous quantities of resources and labour away from those needs. This means progressively eliminating the enormous legacy of capitalism’s structural waste.

As a result a lot more in the way of socially useful output could be produced while, at the same time, the amount of resources needed overall or in the aggregate would decline significantly by comparison with what is required today. This will alleviate the unsustainable pressures currently being exerted on our global ecosystem.

In post-capitalist society we will see a dramatic shrinkage in the extent of the social division of labour, with many of the socially useless jobs we are obliged to do today no longer being required. This will allow much more labour and resources to be redirected towards socially useful production. The resultant increase in socially useful output will have obvious implications for the question of any shortages.

Dealing with shortages

Given that some shortages are likely to remain in the beginning – even if to a steadily diminishing extent, how would we deal with these shortages under the very different set of circumstances of a post-capitalist society?

In considering what form of limitation on the consumption of some goods might be most appropriate in a post-capitalist society, the possibility, however remote, needs to be taken into account that it might lend itself to the re-emergence of some form of market exchange through the back door, as labour vouchers might. Any system that would need to be implemented in a post-capitalist society would need to be scaled down to only what it was absolutely necessary to limit. It would need to be, in other words, a limited, partial system, targeting only those goods that are clearly in short supply.

What kind of goods are we talking about whose consumption might require limitation in the early years of a post-capitalist society? These would be goods that figure rather low down in our hierarchy of production goals – most notably, inessential or luxury goods. The objective would be to strictly limit or restrict only those goods subject to shortage. This would minimise the adverse psychological, cultural, and administrative costs that any system of restricting consumption unavoidably entails.

Targeting only some goods is exactly what a system of labour vouchers disallows; by its very nature, it is a universalistic form of rationing. However, the need to restrict the consumption of some good arises only in the case where there is a shortage of the good in question. Consequently, a universal system of rationing, which is what a system of labour vouchers amounts to, would therefore seem to imply, on the face of it, a condition of generalised or widespread scarcity applicable to each and every good.

But how can this be reconciled with the claim that a communistic post-capitalist society is firmly predicated on the real prospect of material abundance? How can we even envisage that such a society might be possible if all around us we see, not the portents of post-scarcity, but a chronic and all-pervading shortage of everything?

While there might well be some shortages in the very early stages of a post-capitalist society, the idea that there will be shortages of everything – universal or generalised scarcity – is hardly credible. Even today under capitalism this is not the case, as for example in food production and housing.

For a system of ‘free distribution’ to come about, people need to be mature and adult enough to recognise what is and what is not possible. They also need to feel confident that, broadly speaking, all their reasonable requirements for food, shelter, clothing, medical attention and so on are capable of being satisfactorily met under this arrangement, allowing for the occasional shortage of some items.

Robin Cox

Editorial: Capitalism and the food shortage (1946)

Editorial from the March 1946 issue of the Socialist Standard

THE Governments of the world are worried about the food problem. Mr. Herbert Lehman, Director- General of U.N.R.R. A., declares that: “More men, women and children in Europe and the Far East are hungry this winter than at any time in modern history." He calls it “the greatest critical emergency which has faced the United Nations since the end of the war.” The defenders of capitalism do not admit that the existence of the problem and the inhuman and bungling way in which it is being handled are evidences of the inherent defects of that social system, but that is what they are. It is not true that the shortage exists only as a bye-product of war, for in pre-war years, when there were great surpluses of wheat and other products there were, alongside of them, millions of undernourished workers and peasants too poor to buy the food they needed. War is itself an inevitable outcome of capitalist trade rivalries and has, too, a result that is welcome from the capitalist standpoint, of removing for a time the huge unsaleable surpluses of raw materials and foodstuffs. One of the reasons why war propaganda like that of the Nazis was listened to by the workers was that it was linked up with promises that territorial expansion would provide more food. Presumably with this in mind, Mr. Clinton Anderson, Secretary of Agriculture in the United States, demanded, in a broadcast in October, 1945, that: “hunger must be eliminated as a primary cause of war,” and “ the United Nations must not permit the pangs of hunger to bring about the basic fears and greeds which result in war.” —The Times, 15 Oct., 1945.

He went on to say that “two-thirds of the world’s population was undernourished, yet science and technology had advanced to such a point that the earth’s agricultural resources could fill the need of all.”

In a Socialist world, if a general or local shortage of food existed all the resources of the world would at once be available to move foodstuffs to the area where they were needed, or to increase total production if that was necessary. If, as a temporary measure, consumption of food generally had to be reduced to help a locality where shortage existed, there would be no obstacles in the shape of private ownership and the profit motive.

In the world as it exists to-day not even the realisation that starvation or semi-starvation threatens millions of people can prevent capitalism from functioning in its normal way. People in Europe need dried eggs, while in America, according to the Daily Express (8 Feb., 1946), there is “a glut of eggs” and “poultry farmers are facing ruin as a result." In the same country farm output could have been increased, but because farmers consider the price offered for their grains is too low “ they prefer to feed them to their stock rather than to sell" (The Times, 9 Feb.), and they have deliberately kept output below what it could have been (Daily Telegraph, 9 Feb.). American farmers had not forgotten the ruin that faced them before the war because they had produced too much, not too much for the needs of the population, but more than they could sell at a profit. The Times (9 Feb.; says that with the ending of the war the “fears of agricultural surpluses which haunted the United States between the wars were revived. In spite of the golden prosperity brought by the war years, the farmers recollection of the deep agricultural depression of the twenties and thirties is as active a political force as the ghost of the hungry forties was for a long time in the political history of this country. But the fear of being under an avalanche of farm surpluses, attended by a catastrophic collapse of prices, has proved to have been a misreading of the portents, and the miscalculation has been aggravated by the determination of farmers to hoard grain as a protest against the price levels imposed by Washington.”

At the same time that millions are undernourished—in U.S.A., as well as in other countries—because they cannot afford to buy more, there is not a country in the world in which the rich cannot buy the best food; either openly or in the black market, in unrestricted amounts. In every country labour and resources that could be used to supply the needs of the ill-fed and ill-clothed masses of the population are being used, often with the deliberate encouragement of the Governments, on production of luxury articles for the wealthy or goods for the export drive, or armaments. Hundreds of millions of pounds being spent by the leading Powers on perfecting the bomb or building up peace-time armies, navies and air forces. In Britain, simultaneously with the declaration about the need for more food, we read of booming exports of British cars and other products. The Evening News (9 Feb.), under the heading “British Car Exports Booming,” reported that the Nuffield organisation alone will have sent abroad 20,000 cars by the end of June, when its production will have grown to 1,000 cars a week.

Britain is short of food and because we live under capitalism low-paid agricultural labourers are so anxious to escape to the relatively better paid work in industry that the Labour Government—while refusing to carry out the Labour Party’s own oft- repeated demand that land workers should have wages not less than those in industry—uses the war-time emergency powers to tie agricultural workers to their jobs.

Capitalism is indeed a mad and sorry system, which has long outlived its usefulness

Toothache? Pay private fees or do it yourself (2023)

From the August 2023 issue of the Socialist Standard

Many will know that, while most people have to pay something for NHS dental treatment, it is still free to a certain section of the community: children and pregnant women and new mothers. But, as George Monbiot pointed out in his column in the Guardian on 2 March:

‘Every child in the UK is entitled to free treatment by a non-existent dentist. Some people on benefits, pregnant women and those who have recently given birth also have free and full access to an imaginary service. Your rights are guaranteed, up to the point at which you seek to exercise them’ (tinyurl.com/s7epuzad).

Dental practices, being profit-seeking businesses, consider that what they are paid for treating NHS patients is not enough – they claim that in some cases it doesn’t even cover their costs – and so are increasingly reluctant to offer it and have not been using up all their NHS funding. In February it was reported that ‘Around £400million allocated for dental care went unspent this year because of a shortage of dentists willing to do NHS work’ (tinyurl.com/yrrpakv2).

What this ultimately means is that any patient requiring urgent treatment is forced to make a choice between suffering or paying privately for the treatment there and then.

With private dental treatment running into the hundreds, sometimes thousands of pounds, it is obvious that those on lower incomes are really faced with no choice at all.

The system does appear to offer an alternative. Since 2006 the necessity to ‘register’ with a particular dentist has been abolished. What this means is that a patient whose regular dentist is unable or unwilling to provide NHS-funded treatment can shop around for another dentist prepared to treat them under the NHS.

The reason this only ‘appears’ to be an alternative is because it is another of Monbiot’s rights to a non-existent service. You won’t find another dentist prepared to treat you as they won’t find it profitable. So, when you look at those same low-income families and elderly people who can’t afford to ‘go private’, you see that really this is not much of an alternative at all.

In any event, going to another dentist obviously can involve increased travel costs if the dentist is out of the area. While merely inconvenient for some it could mean the difference between having the treatment and not for others such as the very low-waged who do not have access to personal transport or the rurally housed elderly who rely on poor public transport coverage. When you add the psychological factor of forcing people to see a dentist they are unfamiliar with which, as we know, can have a particular impact on older members of our community, you can see why so many people elect to wait for their own dentist to be able to do the work or forgo the treatment altogether.

There is another option – DIY dentistry – which, apparently, some have been taking. As Monbiot noted:

‘The result, in one of the richest nations on Earth, is that people are extracting their own teeth, making their own fillings, improvising dentures and sticking them to their gums with superglue, and overdosing on painkillers’.

We continue to be forced into a situation where, when we need treatment which is vital to our health and well-being, we either pay extortionate private fees, are forced to seek out another dentist at our own cost or, if none of the above are possible for us because of our financial situation, simply wait, with our condition worsening.

In socialism dental treatment would be provided freely to anyone who needed it. Unshackled from the financial pressures of the capitalist system, freed from the necessity of eking out an inadequate funding budget, the health services would be able to treat all those in a timely fashion to the best possible standard.

The fact is that no-one should be forced to make such dire choices when it comes to this or any other area of their health. The NHS was originally intended to implement the admirable principle: ‘Treatment free at the point of need’. Where our dental treatment is concerned, this principle has long had a thread tied between it and the door handle, and the door slammed shut.

Material World: A pox on capitalism (2022)

The Material World column from the November 2022 issue of the Socialist Standard

Vaccine shortages in poorer countries have revealed the callous nature of the capitalist profit system and its inability to protect the lives of vulnerable people and avert unnecessary preventable deaths and suffering from health inequality. Shortages of vaccines are endemic to capitalism. One would have thought the mistakes made during the Covid-19 pandemic would have improved the distribution of vital medicines. Apparently not when it comes to the recent spread of the monkeypox virus.

According to Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases, ‘Our lives are not the same; their lives are worth more than ours…’ Happi continued, ‘Any outbreak anywhere should concern the whole world, which is not how they are dealing with it now’ (bit.ly/3QhwNOy).

‘In the Covid-19 pandemic, world leaders have allowed pharmaceutical companies to place extraordinary profits ahead of saving lives,’ said the People’s Vaccine Alliance’s Mohga Kamal-Yanni. ‘And we have seen the huge impact on life and livelihoods in lower-income countries that is far more than in rich countries. Unless we change course, the world’s response to a crisis like monkeypox will be just as brutally unequal’ (bit.ly/3A0fvAr).

Prof Chris Beyrer of Johns Hopkins University and a member of the medical journal Lancet’s commission on health and human rights, pointed out that ‘It turns out that monkeypox emerged out of its central African endemic zone into west Africa in 2017, five years ago, and that outbreak has been ongoing for five years with no urgency, no response, no WHO engagement around vaccines in those countries. Now that it has gone from six endemic countries to 76, and is the new emerging global health threat in the wealthy world, we have this sense of urgency’ (bit.ly/3BGyIs3).

Meg Doherty, WHO’s director of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, said, ‘We can’t have a monkeypox response that’s only responding to the UK, Canada, the United States. We need a response that also addresses what’s happening in the DRC right now; in Nigeria where cases are going up.’

Are the limited supplies of vaccines being rushed to Africa?

Unlike when COVID first spread, vaccines for monkeypox already exist. A new vaccine called Jynneos is available, plus millions of doses of ACAM2000, an older smallpox vaccine that also works against monkeypox. Of the 16.4m doses of Jynneos that existed in July, low-income countries are already losing the race to buy sufficient doses.

The American government has the world’s largest stockpile of monkeypox vaccine, which includes stored vaccine bulk that could be converted to more than 10 million doses. In addition, the US holds nearly 80 percent of the Jynneos vaccine used to fight monkeypox, despite having only 36 percent of the global monkeypox cases, even as many countries go without access to any doses. The US has 22 times more doses than the EU and the UK. For every monkeypox case reported in the US, sixty-six doses are available. No countries in Africa have any doses (bit.ly/3pXOI1E).

Naïké Ledan, associate director of international policy and advocacy at HealthGAP protested at the 24th International AIDS Conference in Montreal, ‘We’re demanding immediate equitable global sharing of supplies of testing, treatments, and vaccines. We’re demanding rejection of any and all intellectual property, because it’s a global crisis, not an opportunity to make money again’ (bit.ly/3QhxuYa).

While rich countries have ordered millions of vaccines to stop monkeypox within their borders, none have announced plans to share doses with Africa.

‘The mistakes we saw during the Covid-19 pandemic are already being repeated,’ said Dr. Boghuma Kabisen Titanji, an assistant professor of medicine at Emory University (bit.ly/3P23nmo).

‘Africa is still not benefiting from either monkeypox vaccines or the antiviral treatments,’ said Dr. Matshidiso Moeti, WHO’s Africa director (bit.ly/3LO4kyK).

If only the problem was just monkeypox.

Politicians and pharmaceutical CEOs boasted of the speed at which the Covid-19 vaccine was developed, put into production and distributed. Much less has been said on their tardy roll-out of a new malaria vaccine.

A new vaccine R21 could eradicate malaria. And has already shown to be 77 percent effective after the initial doses and maintains its high efficacy after a single booster jab. It could help to reduce deaths from the disease by 70 percent by 2030 and eradicate it by 2040. Good news. The bad news is, delivering it to millions of African children who most need it is presently without sufficient funding.

And, of course, deaths from HIV/AIDS still persist. In Africa 460,000 people died from HIV-related causes in 2020. A new long-acting drug called Cabotegravir works by blocking the HIV genome, which means that the virus is prevented from integrating itself into human DNA and that stops it from replicating. So, it can’t spread and take hold in the body. Yet, WHO notes it is too expensive for poorer nations to afford.

‘While many in the global north are getting access to long-acting HIV prevention tools and medicines, Africans are overwhelmingly denied the opportunity… As long as the price is unaffordably high for our governments and for funders to purchase, we will continue to be locked out from being able to access them. They are vital to preventing new HIV infections and they could become transformational in treatment. Our message is simple: all of our lives matter,’ said Lilian Mworeko, regional coordinator of the International Community of Women Living with HIV Eastern Africa (bit.ly/3d8X96Z).

Socialists say it is possible for the world to cooperate and collaborate for the common good. The basic networks such as the WHO already exist. Once socialism is established, it and similar agencies can re-focus and re-prioritise to serve communities and not corporations. 

ALJO

Editorial: Human Nature, the Black Market and Socialism (1942)

Editorial from the July 1942 issue of the Socialist Standard

Many who are vaguely sympathetic towards Socialism complain that they cannot see what basic difference there is between the S.P.G.B. and the organisations which seek to reform the capitalist system. They think we are exaggerating when we say that there is a fundamental similarity between the admirers of capitalism and the reformists which separates both from the Marxist. A glance at a topical problem, the “black market,” will show that there is no exaggeration in our claim, for both the admirers of capitalism and the reformists believe that it is possible to retain the basis of the capitalist social system and yet to change its operations and the conduct of the human beings who live under it, by means of Acts of Parliament and appeals to goodwill.

When the war began we were told by those who claimed to know that there would be no “profiteering” in this war. Socialists smiled and were disbelieving, knowing that a system built on a foundation of private ownership and profit-making will go on producing its evil results whether in peace or war. We smiled again when the News-Chronicle, nearly two years after the war began, said “the days of, the profiteers in clothing and other necessities of life are numbered” (News-Chronicle, July 25th, 1941). We were not impressed with the story that the capitalist thistle would suddenly produce a crop of social figs because of the appointment of “34 Board of Trade inspectors” who were going to track down the “profiteers.” Nor were we mistaken. Here are some brief items from the Press in June, 1942 : —

“The retail price of salmon was controlled. At once salmon disappeared from the shops. Now the salmon is a case in point of a great public evil. The Black Market must be destroyed or it will destroy us”. (“Sunday Express,” June 7fH, 1942.)

The News-Chronicle (June 18th, 1942) reported that when a “slight accident” occurred to a railway van containing furniture

“The backs of half the wardrobes were missing. On the floor lay a litter of asbestos chips. Superficially got up with a lacquer sprayed ‘oak’ graining, the wardrobes were intended for sale in a big industrial town. . .”

Again the reporter says : —

“I saw wardrobes, chests and dressing tables made of cardboard, and was told of others made of linoleum. They will be sold wholesale at £30 a suite. When they get to the shop windows they will be ticketed from 50 to 60 guineas—pegged prices authorised by the Board of Trade’s recent control order.”

Then there are motor cars. An investigation is being made into the prices of second-hand cars.

“In the last 18 months car prices have soared to a fantastic level. A car which cost £265 at the beginning of 1939 would have realised only about £160 a few months after the start of the war, but shortly afterwards prices rocketed so that it could be sold for £365, and even to-day such cars are being sold in the region of £300” (“Evening Standard,” June 18th, 1942.)

And food ! After the start of the Order fixing 5/- a head as the maximum charge for food in a restaurant the Daily Express (June 16th, 1942) reported the following; at a small fashionable restaurant . –

“Two luncheons 10s., two house charges 4s., six Martinis 22s. 6d., one bottle of Burgundy 27s. 6d., four cups of coffee, 6s.—Total £3 10s. 0d.”

It was all quite legal, “the prices of drinks are controlled only in the case of whisky, gin and beer.”

The following extracts are from articles in the Sunday Express (June 14th, 1942) : —

“The racketeers are using the existing shortage of supplies as a suitable occasion to corner stocks of many commodities and re-sell them for big profits. . . . One of the biggest profiteering ramps to-day is the whisky racket. . . . The furniture profiteering ramp to defeat both income tax and maximum controlled prices is worked in this way: A small manufacturing firm sells to the “boss” for absurdly low prices. The furniture is installed in a luxury apartment and resold at prices often 300 per cent. above those paid, and the profits are shared out. Jewellery, furs, silk stockings and underclothing are sold for cash in £1 notes in the West End by racketeers, who do not ask for coupons. Cosmetics and beauty preparations, too, can be bought in any quantity for cash.”

Lastly, there is the Judge sentencing some men charged with frauds in connection with corporation contracts who said : —

“This corruption will either be cut out of commercial life or it will destroy the State.” (“Daily Mail,” June 20th, 1942)

A pretty black picture. But, retorts the reformer, make the penalties more severe, copy Russia and Germany and introduce the death penalty, then it will cease. How little they know of that “human nature” they so often talk about. The history of capitalism has demonstrated beyond refutation that given the opportunity (the ownership of goods for sale and a ready market) and given the motive (big and quick profits) nothing will stop illicit deals in one form or another, from robbery and smuggling to black marketeering, and to the numerous operations that can be conducted just on the borderline of legality. The severity of the penalty may to a degree restrict, but it will never stamp out such deals, for operators will always be found who will discount the risk. Even within the limited sphere of keeping the number of such transactions to a comparatively moderate total, experience has proved that it is not the severity of the penalty but the small chance of escaping detection that is alone effective. Otherwise the intending law breaker always hopes that he will not be caught. This was the lesson of the Factory Acts, of the legal minimum wage of agricultural workers, and of income tax evasion. What alone made any impression was not the size of the penalty imposed on law breakers who were caught but the appointment of sufficient inspectors and the use of other means of convincing the offenders that their chances of escaping discovery were small. Even so, most legislation of such a nature is largely a dead letter. The capitalist basis which provides opportunity and motive still prevails against the puny efforts by law or pious resolution to make a competitive system work for the social good.

So much for those who hope to change by Act of Parliament the conduct of people living under capitalism as its exists to-day. But almost equally foolish are the Labour Party and I.L.P. reformists who believe that they can retain the capitalist or State-capitalist basis, with its rich and poor (but with the degree of inequality lessened), with its production of goods for sale, its property incomes and profit-making, and its whole paraphernalia of money, bonds and banks, and can yet persuade or compel capitalists and workers to desist from conduct which flows naturally from a two-class, private property social system, and go over to conduct appropriate to a social system based on human needs alone.

The present spectacle of the “profiteers” and racketeers and the comparative futility of the efforts to stamp them out should be a warning to all who believe that capitalism can be reformed. Socialists take their stand on the very different principle that only by a fundamental change in the basis of society, from private ownership to the common ownership and democratic control of the means of production and distribution will human conduct likewise change. It is to the economic foundation, not to the legal and ethical superstructure of society, that attention needs to be directed.

'Can we panic now, Captain Mainwaring?' (2021)

From the November 2021 issue of the Socialist Standard

In the halcyon summer days of 1914 when all was right with the world and God was in his place in the British empire, dependent upon your social status in the scheme of things of course, the shock caused by the assassination of some minor Austrian prince was seen as an opportunity to bare Albion’s teeth to Johnny Foreigner, and everywhere the cry echoed down the expansive avenues and the meanest back alleys: ‘It will all be over by Christmas!’ Plus ça change, plus c’est la meme chose. Isn’t it just?

We all know Marx’s remark that history repeats itself, the first time as tragedy and the second time as farce. Marx had in mind the tragedy of Napoleon’s regime and the later farcical reign of his nephew Napoleon III. Back in the 1960s, Herbert Marcuse remarked that the lesson of Nazism seemed to be the opposite way round: first as a farce (throughout the 1920s, Hitler and his gang were mostly taken as a bunch of marginal political clowns), then as a tragedy (when Hitler effectively took power). Unfortunately, Karl, old boy, history seems to be in a place whereby it’s repeating constantly, like a three-week-old pickled egg. It’s doesn’t feel the least bit humorous this time round.

Crystal balls are not de rigeur for writers in this journal, but, this from the Socialist Standard, December 2020, seems a little prescient: ‘Eat, drink’ depends on whether the supply chains are still intact and irrational locust behaviour hasn’t swept the shelves cleaner than vultures on a wildebeest carcass in the Serengeti. Be merry? The human spirit is always able to find something positive in the most dire of circumstances. Acceptance of a bad situation whilst saying, gosh it’s terrible but there’s nothing we can do about it, is not acceptable however. After one of the most dramatic years which continuing on may have profound negative societal changes in global society it is no longer good enough to complainingly accept what is being implemented. Contrary to what a Tory leader once said, there is an alternative’.

At present the supply chains seem to be under considerable strain and there are apocalyptic warnings that toys, electricals and luxury goods all the way from China may not be lining the shelves of those stores and outlets which rely on the Christmas period in a ‘normal’ year to provide them with a hefty addition to their annual turnover. Had they but known then, the Ypres Times would have been running op-eds on how much better off they all were stuck in the trenches at Christmas, rather than the terrible deprivation of not getting your overpriced disposable trash-trinkets delivered in time.

The Mail Online, September 2021 has: ‘Panic buying is back! Shoppers queue to fill up trolleys with toilet roll and other essentials after one in six couldn’t find what they wanted on the shelves as supermarket bosses are told to co-operate to save Christmas and petrol shortages continue’ and ‘Shelves empty across UK on sell-out Saturday as supply crisis leaves one in six Britons claiming they have been ‘unable to buy essential food’ – and a third start Christmas stockpiling – ahead of winter squeeze’.

The sense of déjà vu cannot have long left the memory. As the Institute of Economic Affairs noted in sanguine tones, in the days when we didn’t even need to wait until Christmas because this would all be well over within three weeks: ‘No-one can have failed to notice the half-empty supermarket shelves and long queues for essentials. Loo rolls even rivalled flowers as the Mother’s Day gift of choice. Fortunately, this is one phase of the coronavirus crisis which should be over soon' (March 2020). Up to a point, Lord Copper, up to a point. The IEA didn’t borrow the services of Corporal Jones in order to tell us all ‘Don’t panic! Don’t panic!’ A stiff-upper-lipped ‘Keep calm and carry on’ seemed to be their advice. What have we here? Were they employing the economic tenets of Adam Smith or Malthus? Panic buying? Fine chaps, no problem! Carry on, as you were.

The IEA: ‘To be fair, panic buying is not necessarily irrational, for two reasons. The first is that the fear of empty shelves may be correct because it is self-fulfilling. Panic buying is similar. It would be best if no-one does it. But if you are worried that supplies might run out because other people will beat you to it, then it makes sense for you to rush to the shops too… However, there is also a second factor to consider here: even if there are plenty of goods in the pipeline and shops will soon be well stocked, some people may be unable to get to them. As the new coronavirus spreads, any household in the UK could be obliged to self-isolate for a period of several weeks, or even longer, at a moment’s notice. It may then make sense for every household to buy several weeks of essentials, just in case.’

Hang on there Jack, as the economists have it, ‘ceteris paribus,’ we’re not on an equal and fair playing field here are we? If you’ve the sufficient disposable income, the transport, the freezer space, the storage space for your six months or more supplies, plus the utter contempt for the plight of others less fortunate, then good for you Jack. That’s a rational capitalist economic decision. Foxtrot Uniform, I’m alright. This form of economic selfishness no doubt has opponents of socialism (who generally misunderstand what that is anyway) leaping about like the ten lords in the Christmas carol, waving their fingers and chanting in E flat Major, human nature! human nature! The Socialist Party’s demolition of this spurious straw man is amply demonstrated elsewhere. 2021 was certainly another year seeing profound negative societal changes in global society. And as amply demonstrated by us, there is an alternative.

Dave Coggan

The NHS — nothing for something ? (1977)

From the April 1977 issue of the Socialist Standard

“The love or my life”, Barbara Castle called it, and her successors still try to tell British workers that they’re getting something for nothing.

But what are the facts? Dr. David Owen, until recently the Health Minister, says: “The NHS was launched on a fallacy. We were going to finance everything—cure the nation—and spending would drop. That fallacy has been exposed now we realise that no country, even if prepared to pay the taxes, can supply everything.”

“Supply everything”! What does it supply?

On the “free” health service a specialist consultation for a patient requested by a general practitioner has to wait for anything up to 10 months. In some places an appointment for a child with recurrent tonsillitis to see the ear, nose and throat surgeon may take 4-5 months and then, if the surgeon thinks removal of the tonsils is indicated—the wait for operation is measured not in months but in years. A middle-aged woman may have to wait as long as seven years to receive her hysterectomy.

And most of the hospitals where the operations are done are ramshackle, overcrowded and out of date. Beds are close together, operating rooms have damp-stained ceilings and peeling walls. Furniture is battered and linen thread-bare. Only 41 of Britain’s 2300 hospitals are less than 30 years old.

The sport at Oldham General Hospital among patients is taking bets on the number of cockroaches crossing the floor in a given time span. One local medical officer says: “This hospital is so permeated with the filth of the ages that the only answer is to raze it.”

One feels there should be an energetic programme to build new hospitals, but the reverse is the case. New hospitals are not being completed and existing ones being closed down. John Pilger in the Daily Mirror (25th Jan. 1977) tells us of the coming closure of the Connaught and Metropolitan Hospitals as part of the Government’s public spending cuts. Both hospitals' secretaries say that closure will mean “unimaginable suffering” for ill patients who will have to be sent home. Quote: “Mr. Peter Richardson, secretary of the Connaught, a 121-bed community hospital, which closes on Monday said last night, 'To close down now, in the middle of winter, is madness. We have a “yellow alert” at this hospital right at the moment and that means the beginning of an emergency. Many of our 100 patients are the elderly with chest infections, such as bronchial pneumonia’.”

Also from John Pilger, the Daily Mirror (26th Jan. 1977) quotes the surgeon at the impoverished Northampton hospital who pleaded: “How can I allay the fears of a woman who has to wait weeks and weeks for a breast cancer operation?” And at the Hackney General Hospital the casualty department was being forced to turn away children. The Daily Mirror continues: “Northampton and Hackney are typical of a great many British hospitals which have been starved of funds for years and are now being called upon to make cuts which are impossible without incalculable suffering and—as the doctors have said—deaths.”

But “solutions” appear to be on the way—though not very pleasant ones for the working class. Apparently the time has come for them to pay (even more) for their “free” health service. A front page headline in Medical News, 19th Jan. 1977, announces: “£2 a Day Charges for Hospital Patients would raise £300 million.” Below we read: "BMA Council believes that the Royal Commission should consider approving hotel charges for hospital patients . . . Council is recommending daily charges for bed and board in hospital, and increases in prescription charges. It believes a flat rate weekly compulsory payment for health services to be paid into an independent NHS fund should also be looked at . . . Basically the Council was unanimous in feeling that a totally free NHS at the point of consumption led to the undervaluing of the health service. Charges would impose a more thoughtful attitude on the part of the public, and also among doctors, who sometimes have no idea what the treatment they prescribe is costing.” Says Medical News: “. . . the feeling was that quite serious illness could be treated at home by a GP, and the patient there had to pay for his accommodation and food, so there was no reason why the hospital patient should not do so.”

And on the front page of Medical News 26th Jan. 1977: "Doctors Warned to Monitor Prescribing Costs —or Else.” The article reads: “If doctors do not monitor their prescribing patterns in terms of both efficacy and cost more effectively, they may have controls imposed on them.

"This is the underlying message for doctors following a report into the work of the Prescription Pricing Authority (PPA) published last week.

“The main recommendation of the report is that the work of the PPA should be computerised to speed up the processing of prescriptions and also to provide a better flow of information on prescribing patterns and costs.”

Mr. Tricker told Medical News, amongst other things: “The report makes no recommendations on the control of prescribing, and I argue for self monitoring by the doctor. However, the report does raise the question of alternative forms of control by the state if doctors seem unable to control prescribing for themselves.” Various forms of controlling prescribing were considered. Two suggestions were the exclusion of certain drugs from free treatment under the NHS, or restricting doctors’ prescribing to the BNF (British National Formulary).

Another form of control would be to introduce a local drug expenditure based on the population of an area. Funds would be allocated by the DHSS. The budget could be monitored by the local medical and “local peer group interest could be brought to bear” on a doctor. (In other words—set general practitioners to compete with each other to supply the least and cheapest treatment.)

In Doctor (10th Feb. 1977), however, we read: “Mr Ennals (Social Services Secretary) was full of praise for the prescribing standards of GPS. They were unequalled in the world, with the cost of drugs per head of population being lower in this country than elsewhere in the EEC.

“ ‘But there may still be scope for further economy (in drug costs) without harm to patients,’ he added.” Thus we learn from the boasters of the best community health service in the world that although we’re doing it the cheapest—we might still do — “better?”!

And now there are new worries for those professing to have the welfare of the sick of Britain at heart. Quote: General Practitioner, 21st Jan. 1977: “Fears Mount on Doctor Surplus. The BMA is demanding an immediate inquiry into the threat of unemployment among doctors in the early 1980s. Fears that medical schools are producing too many graduates have been highlighted by the Hospital Junior Staffs Committee after a four year investigation. The BMA is to ask for an interim report on whether these fears are justified in its evidence to the Royal Commission. The juniors believe that unless medical school places are cut immediately by 1000 a year, there will soon be too few jobs for newly qualified doctors.”

And in Medical News, of 26th January, 1977, Cyril Clarke, the retiring president of the Royal College of Physicians, has urged Britain’s 26 medical schools to consider cutting back student intake to prevent the hardship of an unemployed “bulge” later.

“The situation, he said, could not wait for the Royal Commission. It was far too urgent.”

“We must not run into a school teacher situation,” said Sir Cyril. “We should not bank on too much NHS growth.”

So, while patients wait for months for appointments, years for operations and queue up for hours in outpatients’ departments to see junior doctors who are elsewhere and working 80 hours a week, the powers that be are at pains to decrease medical manpower. Tragically—like other unenlightened workers—some junior doctors think that this is a “solution”. They fear the threat more help from an increased number of colleagues would make to their industrial bargaining power. There is, of course, and will be for a long time to come, a dreadful shortage of doctors in real terms. Apart from the dearth in existing premises there is a desperate need for them to man many vital hospitals. The trouble is that those hospitals are either not being built, or not being completed or being closed down.

The situation is similar with trained nursing sisters. They find themselves redundant whilst their colleagues desperately try to cope with endless lines of patients.

It is a “teacher situation”. Students rallied to the call for more teachers to reduce the numbers in school classes. Result—most of them out of work and still we have overcrowded classes.

And it’s all because people aren’t working hard enough, isn’t it. Mr. Callaghan? They’re not getting their backs into it and paying their way. Why don’t you leave it to the Tories to tell the working class that the trouble is they don’t like work? They’ve had (a bit) more practice at it than you have!

All this rottenness doesn’t have to plague us. There are enough men and women who want, and have the ability to be—good doctors, nurses, teachers, hospital and school-builders and organizers, to make mankind healthy, happy and secure. Only the capitalist system, which the vast majority of workers support, maintains need amidst potential plenty in every sphere of human life. Why not vote that system out of existence?

R. B. Gill

Freeze Up: Waste, inefficiency and chaos (1963)

From the March 1963 issue of the Socialist Standard

Everyone knows about the world-wide waste of armaments and the destructiveness of war, but quite a lot of people have a feeling that capitalism is really rather marvellous in the way it gets things done; quickly, cheaply, efficiently and all tailor-made to the requirements of “the customer who is always right.”

You only have to spell it out like this to see what a laugh it is.

And whether it is fact or only a misleading impression, there seems to have been more and more criticism in recent years of what is done and the way it is done. Readers of Which, the Shoppers Guide and the Daily Press and any who spend a few hours browsing in the Molony Report on “Consumer Protection” will have had confirmed in general what they already know from particular experience, that capitalist production's smiling image isn't a bit like the reality. (And when we read about Kruschev telling the Russians to improve their efficiency by copying the western capitalist countries it gives a grim impression about Russian standards.)

But in January and February of 1963 the shivering inhabitants of Britain had an unprecedented opportunity (worst for a century) of watching and suffering from capitalism's deficiencies—the blocked roads and railways, the frozen pipes, the failures of gas and electricity supply and inability to get coal because the millions of unsaleable tons were stored in places made inaccessible by snow and frost.

The Molony Committee said in their Report (Para. 12) that apart from solid fuel, they had not thought fit to consider whether “the consumer” needed protection against the nationalised power industries (gas and electricity) because “their functions, duties and monopolistic relationship to the public have been determined as a matter of governmental policy and there is no room to apply the ordinary consumer/retailer/producer principles." Its meaning is rather hard to define, but in January and February quite a lot of would-be but frustrated consumers could have told the Molony Committee a thing or two.

The supply difficulties in cold weather led to demands that the gas and electricity authorities should have surplus capacity in hand to meet emergencies and that they and other suppliers of services should be organised to deal with cold spells.

The howls of complaint were very loud because this time it wasn't just the poor who were going without but often the rich as well: no such volume of criticisms are heard in other winters when supplies are sufficient and only those who can't afford to pay suffer.

The Gas and Electricity Boards defended themselves with the plea that it isn't necessary to have a lot of capacity lying idle for ten months a year just for use in the cold spells. The Guardian backed them up, declaring that to have enough surplus capacity would cost something over £100 million. “This would not be good sense but extravagance.”

Here speaks the true voice of capitalism. Thousands of millions of pounds on armaments, yes, but not a tenth of that amount on providing something useful which might not pay! To the capitalist, capital, whether privately invested or in the nationalised industries must earn its proper return. Idle capital like workers idling on the employers time makes them shudder.

Edgar Hardcastle

Pathfinders: Under Siege (2020)

The Pathfinders Column from the April 2020 issue of the Socialist Standard

It seems hardly possible to many of us, confined indoors with no prospect of an exit strategy, that the world could have changed so much in a few short weeks. Things that seemed important a month ago are irrelevant now. Normal politics doesn’t matter. Nobody could care less about Brexit. Now the only topic of conversation is the coronavirus.

Panic-buying has been fuelled by panic-reporting. Even the normally sober BBC, or at least some over-caffeinated junior staff writer, temporarily succumbed to manic hyperbole by claiming that this was the greatest health threat in history (BBC Online, 20 March, since removed). Of course it wasn’t, as anyone who’s heard of smallpox or bubonic plague knows very well, and anyway the Beeb were misquoting the UK chief nurse, who had said it was the health service’s biggest threat in its history.

Panic has been evident among governments, who have not known how to react. Worryingly, experts have been praising totalitarian China’s ability to track air and rail passengers since 2000, including where they sat and who was in the nearby seats. When asked which countries had coped best, the WHO’s assistant DG included China and also Singapore, another poster boy for authoritarian uber-surveillance (New Scientist, 21 March).

The panic wasn’t helped by inconsistency over numbers. The estimated worst-case mortality figure of 400,000 for the UK failed to take into account the average 600,000 annual deaths, mostly from age-related conditions, meaning that estimated fatalities were being reckoned twice over. This was confusing, because the annual estimate of 8,000 deaths from seasonal flu is always cited in addition to and not as part of the normal 600k death rate (bbc.co.uk/news/health-51979654). Thus it was made to seem as if virus mortality rates could be up to 50 times normal background influenza rates, which was utterly misleading.

At least it’s only a coronavirus and not something worse, like bubonic plague. That’s not as unlikely as it sounds. Capitalism has through largely unnecessary and stupid reasons created a global antibiotic crisis which it is doing nothing serious about, so the Black Death, or some other forgotten pathogen, may one day ride triumphantly out of the history books to stalk the world again like the horsemen of the apocalypse in a Hammer horror movie.

The temptation for jaded socialists will be to think this is all somehow capitalism’s fault, but that’s hardly realistic. A new virus could surface at any time in any society. The difference may be what that society then does about it. Capitalist governments are keen to avoid getting blamed for wasting ‘taxpayers’ money (in reality, ruling-class money) on preparations for disasters that might not materialise, and instead tend to cross their fingers and hope that those disasters won’t happen, or at least, won’t happen on their watch. A socialist society wouldn’t be in thrall to any ruling class holding any purse strings, and would collectively agree on the major threats and what to do about them ahead of time.

Capitalism tries to shave costs wherever and whenever it can, because costs impact on profits. So public health services tend to operate at maximum capacity, with no margin for error or emergency, on the risky assumption that nothing will go wrong. When inevitably it does go wrong, leaders distance themselves from blame by protesting that they are not fortune tellers. For socialism, a job is either worth doing properly or not at all, so it’s certainly not worth doing something badly. In obviously important spheres like healthcare it would be considered pointless to reduce resources and effort to unsustainable levels.

Capitalism’s ‘just-in-time’ distribution system saves money on storage, but collapses very quickly in the face of any large-scale social disruption. People know this, so their logical response at such times is to panic-buy, thus exacerbating the problem. Socialism, having no storage ‘costs’ as such, would use local storage in the same way as electrical capacitors, smoothing out peaks and troughs and making supply more robust and reliable. People would know this, and would see no need to overstock.

But what about a vaccine? This is a clever, insidious virus, with tricks that are hard to work around. The Ebola vaccine took 5 years, and that was only by breaking a lot of regulatory rules. Drug companies were urged to throw money at it, and they did, but the 2014 Ebola epidemic died out naturally before most of them could see a return on their investment. Because they lost money on Ebola, they have been very reluctant to put money into coronavirus research (bbc.co.uk/news/business-51454859). Just as with antibiotics, capitalism won’t put its coin in the slot if it doesn’t think there’s a jackpot, even if the entire world needs that vaccine desperately. Socialism would have no such hesitation.

And yet, credit where it’s due. In desperation, capitalism is suspending its own rules. Governments have put aside economic considerations in favour of something that looks almost like humane compassion. While global economies plunge into the abyss they are frantically recruiting factories to build ventilators, raiding the exchequer to ward off a social deprivation crisis, and belatedly pumping funds into vaccine research.

But it shouldn’t take a global pandemic before capitalism is prepared to work in the interests of the people in it. In fact this is capitalism trying NOT to behave like capitalism, trying temporarily to impersonate something quite different, quite alien to itself, a cooperative system where mutual well-being is the main concern and knowledge and resources are shared for the common good.

Capitalism only resorts to this under extreme duress. It is like a coach and horses trying to walk backwards. As Dr Johnson would say, we are not surprised that it is done badly, rather that it is done at all. Yet it can’t keep up the effort for long. The ruling class’s sociopathic drive for profit and perpetual growth will soon reassert itself.

The world would do far better to adopt a stable social model where cooperative and sharing behaviour is built in by design, and by whose steady operations such crises may be better managed, and even less likely to emerge in the first place. People have been under siege from capitalism for too long. Now it has shown it can take a temporary holiday from itself, humanity’s smartest move would be to make that holiday permanent.

Paddy Shannon

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.