From the very beginning of this pandemic, the Socialist Review has been very clear that the fatal nature of the Covid-19 virus is not primarily due to the nature of the virus itself, but from the global social contexts it continues to impact upon. In April, we wrote, ‘Globally, populations experience health differently, and not for genetic or individualised health behaviours reasons as global capital would have us believe, but for social and political ones…This social determinant of health approach highlights the fact that our everyday health, and our capacity to withstand disease is determined by the types of societies we live in’. We discussed the rise of the so-called ‘Non communicable diseases’ (NCDs) — diabetes, heart disease and others — more properly called socially transmitted disease, how they and their increasing prevalence were directly linked to the increase in rates of exploitation and austerity since the 1980s. We showed how these underlying conditions make vulnerable specific sections of the population — older people, BAME communities, workers in low paid jobs. We referred to this phenomenon as a ‘syndemic’, how the health effects of any particular virus are amplified and worsened according to social conditions. As long ago as March, we asked, ‘What can we do? Are more and stronger antiviruses the answer? This is the dominant scientific idea, what Rob Wallace [the leading Marxist biologist] calls ‘a molecular narrative’, an argument that reduces disease and ill health to the fight between nature and science.’ We concluded then that any long term solutions will not derive from more and more vaccines. In September, Richard Horton, editor of the Lancet and voice of the medical liberal intelligentsia, said ‘Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes. In the case of Covid-19, attacking NCDs will be a prerequisite for successful containment.’ He concluded, ‘The vulnerability of older citizens; Black, Asian, and minority ethnic communities; and key workers who are commonly poorly paid with fewer welfare protections points to a truth so far barely acknowledged—namely, that no matter how effective a treatment or protective a vaccine, the pursuit of a purely biomedical solution to Covid-19 will fail’. This is the context in which we need to understand the vaccines about to be made available to populations around the world. Firstly, it is important to note that we are not about to enter into a world where the success of the vaccine is already assured. With the drug being hurriedly made available by Pfizer, we are about to enter Phase 4 of its clinical trials. This is the period during which the vaccine is tested on a mass scale in the population at large and during which any side affects will be observed. As my father-in-law used to say, an immunologist and alumni of Strathclyde University who worked in the vaccine industry all of his life, side affects will range from ‘red blotches to death’. We discussed the current nature of the pharmaceutical industry in June and won’t repeat those arguments here. However, there are specific worries now. At the level of experimental detail there are many concerns. The speed with which the drug has been produced begs questions of how rigorous the testing — on this drug and others in the pipeline — so far has been. It has come to light, for example, that the AstraZeneca drug currently under construction in Oxford, during Phase 3 trials was shown to be more effective when, completely by accident, the dosage of the first dose was reduced by half. Also, given, as stated above, we are living through a syndemic when many health-determining factors are interacting, has the drug been adequately tested on the vulnerable groups who have suffered the worst consequences? How well does the vaccine work for someone with heart disease, for example? But a more fundamental concern must be with the underling motives driving those developing drugs. We have spoken many times about the wealth and power of the so-called ‘medical-industrial-complex’ and of the billions and billions of dollars to be made from drug treatments. A glaring example of the purely financial motives behind pharmaceutical development came with the release of news of the possibility of a vaccine at the end of November, when the CEO of Pfizer, Albert Bourla, made almost $5.6m in one day as shares in his company rocketed. As long as health plays second fiddle to profit, we can never trust the motives or fully trust the products of the pharmaceutical industry. All of this begs the question, of course, how would socialists deal with a global health crisis such as this? There are two ways of answering this. Firstly, let’s pretend there could be a socialist government in a capitalist world. There would be all sorts of practical things we could in the here and now. Most fundamentally, we would not have attempted to develop an anti-Covid-19 strategy drawing on the so-called ‘Chumocracy’, that odious and despicable cabal surrounding Johnson and his inner circle who have gobbled up billions and billions of our tax-pounds and completely failed to address the pandemic in any way. These people, and their paymasters, have committed a crime against humanity, are responsible for sending thousands of working people to an early grave. They should face the most severe of consequences for their greed and inaction. Instead, a socialist government would centrally and democratically plan a strategy, drawing on the experiences and knowledge of people population-wide. The various online meetings platforms have once and for all put paid to the idea that democratic discussion needs to be limited in space. We would instigate such things as fully paid furloughs, the suspension of all rent and mortgage payments — payments which produce no wealth but merely transfer it from one less-well off pocket to another richer one. We would re-purpose industry to ensure PPE and other needed equipment was produced. We would reduce food prices and advise and support people towards diets that better supported immunity, find ways of supporting the lonely and isolated and so on and so on. A socialist approach, once begun, would be multifaceted and utterly creative. But the second way in which our approach would differ from theirs is summed up by the punchline of the old joke: ‘We wouldn’t start from here’. A socialist society would be one where the threat of pandemics — along with the threats of climate catastrophe We can never trust the motives or fully trust the products of the pharmaceutical industry or nuclear apocalypse — would be forever removed. As we argued, again in March and in specific reference to how Covid-19 has been set free by how this capitalist world produces its food, ‘We need to end the factory farming and industrial agriculture which strips the earth of forests and leaches the soil of natural nutrients, and replace these practices with planned, collectivised, safe and humane livestock and agricultural practices that are sustainable and provide humankind with the nutrition we need.’ To do that means to end capitalism.