Nature can sometimes does worse things than capitalism. An earthquake, a tsunami, a volcanic eruption wipes out great numbers of people in a matter of minutes. And tens of thousands, perhaps hundreds of thousands of deaths may occur if COVID19 is not effectively contained. We have now witnessed the panic reaction of governments around the world to the COVID19 pandemic. The problem is that everybody is guessing, from wild speculation to educated estimates. For the capitalist class and the pharmaceutical industry, in particular, when a local epidemic becomes a global pandemic that is where you invest your money for a healthy (sic) return!
There is a tendency to blame the pathology of the disease (and the victims) for the epidemic. Back in 2014 when discussing the Ebola epidemic,John Ashton, at the time, president of the UK Faculty of Public Health, places this crisis in its proper context, explaining:
“We must also tackle the scandal of the unwillingness of the pharmaceutical industry to invest in research to produce treatments and vaccines, something they refuse to do because the numbers involved are, in their terms, so small and don’t justify the investment. This is the moral bankruptcy of capitalism acting in the absence of an ethical and social framework.”
The danger of epidemics do not always spare the wealthy. The public health reforms initiated by the 1848 Public Health Act which reduced deaths from cholera by improving sanitary facilities were motivated by fear of the spread of epidemics to the rich. The conflicts between health needs and capitalist pursuit of profit are only well shown by history where improvements have occurred usually because of political expediency or because it is profitable to do so such as the consequences of the escalating cost of poor relief to families made destitute by disease upon the public purse. The continued existence of private practice makes it possible for overall standards in the NHS to be reduced without affecting the health care of the decision makers themselves
The ‘Inverse Care Law’ as described by Julian Tudor Hart explains that “In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support and inherit more clinically ineffective traditions of consultation than in the healthiest areas; and hospital doctors shoulder heavier case loads with less staff and equipment, most obsolete buildings, and suffer recurrent crises in the availability of beds and replacement of staff. These trends can be summed up as the inverse care law: that the availability of good medical care tends to vary inversely with the need of the population served. This operates more completely where medical care is most exposed to market forces and less so where it is reduced”.
Trachoma is a highly contagious eye infection. It scars the eyelids and turns them inward, so that the eyelashes scrape the cornea with every blink, causing great pain. Untreated, it leads to permanent blindness. Trachoma is endemic in many poor rural areas and affects over 21 million people, over a million of whom are already blind. However, the bacterium that causes trachoma is known. The condition is easy to treat, cure, and prevent. The WHO says it could eradicate this scourge if it were able to allocate $250 million a year to the task for 4 years. How much does it currently allocate for trachoma? Published data do not answer this question. The WHO’s Programme Budget 2018—2019 does not give figures for any specific communicable diseases except HIV and hepatitis (which are lumped together), tuberculosis, and malaria. Trachoma is placed in the category of ‘neglected tropical diseases’ (NTDs) alongside river blindness, leprosy, trypanosomiasis, lymphatic filariasis, elephantiasis, and dracunculiasis. This is not a complete list because ‘new diseases are constantly being added to the portfolio’; all low-income countries are affected by at least 5 NTDs. The amount spent by the WHO in 2018—2019 on all NTDs was $107.3 million. Of this $42.6 million was spent at headquarters, leaving only $64.7 million for work in the field, mainly in Africa and Southeast Asia. How much of this went to treat trachoma we do not know, but clearly it must have been far below the $250million required for eradication within 4 years.
Pharmaceutical companies neglect these diseases because hardly any of the people who suffer from them can afford to buy medical goods and services. As economists say, they create negligible ‘effective demand.’ And relieving their misery evidently comes very low on lists of governmental priorities.
A gloomy picture, to be sure. But it does draw attention to the vast scale of the resources that could be redirected to satisfy people’s needs and meet the climatic, environmental, and other global challenges faced by our species, once those resources are appropriated by the human community and brought under its democratic control. We can assume that under socialism profit would no longer be the criterion for making decisions about production or consumption.