Lee Humber completes the fourth part of his analysis of medicine’s response to the pandemic with a critique of the global machine that more and more dominates our healthcare
The Swine Flu epidemic of 2009, and the Ebola crisis still active in West Africa after nearly seven years, both attest to the problems and unknowns regarding vaccine development and deployment. With Swine Flu, not only were supplies of the vaccine extremely limited, there were a range of short- and longer-term side effects causing, in some cases, years of suffering. These included arthritis, fibromyalgia, lymphadenopathy, rashes, photosensitive rashes, to name but a few. Up to half of family doctors surveyed at the time refused to be vaccinated against swine flu because of doubts about the drugs, believing it had not been tested enough. In Britain, some health workers given the vaccine suffered extreme side effects and were still battling drug companies for compensation nearly a decade later.
One nurse, interviewed a decade after being treated with GlaxoSmithKline’s Pandemrix, was still living with incurable, debilitating narcolepsy and cataplexy, a sudden, uncontrollable loss of muscle tone causing her to collapse without warning.
The Ebola outbreak in West Africa shines a light on another aspect of vaccine development, the use of unlicensed drugs on vulnerable populations. Initial supplies of a drug developed by Merck dried up as production arrangements proved totally inadequate. An alternative developed by Johnson & Johnson, the world’s richest drugs company, proposed the mass distribution of their partially tested, unproven and unlicensed vaccine.
“The only way to get the key data is to test it in large numbers of the population, and see how it stacks up against the virus,” said Carleigh Krubiner, a policy fellow at the Center for Global Development in Washington. “We could have another vital tool in our toolbox for future outbreaks—we just don’t know yet.”
Though Johnson & Johnson was willing to risk the lives of African people, Oly Ilunga Kalenga, the former minister for health for the Democratic Republic of Congo, wasn’t. He first banned the use of the drug then resigned in protest when it was forced upon the country.
The treatment of African populations as laboratory subjects for new treatments follows a shameful pattern of unproven and unsafe medical interventions over the course of the continent’s colonialist past up to this day. In fact, the history of vaccine development and use is generally one of over-hyped expectations with, in the vast majority of cases, disappointing results.
Philospher Ivan Illich has carried out extraordinarily well-researched analysis of vaccine development. In his Limits to Medicine he says: “A vast amount of contemporary clinical care is incidental to the curing of disease, but the damage done by medicine to the health of individuals and populations is very significant.” More than 30 years after scientists isolated HIV, the virus that causes Aids, we have no vaccine. The dengue fever virus was identified in 1943, but the first vaccine was approved only last year, and even then amid concerns it made the infection worse in some people. The fastest vaccine ever developed was for mumps. It took four years.
Scientists have worked on coronavirus vaccines before, so are not starting from scratch. Two previous coronaviruses – Sars and Mers – were both analysed in search of a vaccine. But none were licensed, partly because Sars fizzled out and Mers was regional to the Middle East so drugs companies lost interest. The lessons learned may help scientists create a vaccine for Covid-19, but there is a lot to learn about the virus and there are no certainties.
If we know this, why the frantic focus on a vaccine?
It is absolutely clear that the hunt for a vaccine is central, not to safeguarding the health of global populations, but for giving the ruling class a basis — even a completely untrue one — for re-starting economies. The promise of a medical way of combatting Covid-19 is another excuse in its armoury of excuses to get people back to work, regardless of the increased case fatality rates and high likelihood of a second wave of infections later this year.
There has been, over the past 20 years, a global shift towards private healthcare and an increasing concentration of health capital into fewer, larger corporations. Meanwhile public health provision globally has shrunk to bare minimum levels. The global industrial-medical-complex of major chemical-pharmaceutical producers and retailers, health insurance companies, the higher echelons of the medical profession and governments of leading economic powers, has never been as profitable or as powerful. This unholy alliance is wedded to a biomedical model of health which focuses on curing us when we fall ill, rather than preventing us from getting ill in the first place. It is a conceptual, and deeply ideological, model embedded in the modern state and private institutions of health.
Despite all the evidence showing how health is conditioned by our relationship with the environment, the biomedical model continues to dominate, overwhelmingly concentrating resources on funding for increasingly fewer, centralised hospitals, and medical research on techniques and technologies. Public discussion about health is confined to an individual’s relationship with natural disease, ameliorated by the expertise of the medical profession as part of the industrial-medical-complex.
This biomedical model is based on an understanding of health as the absence of biological abnormality where diseases have specific, and largely unchanging biological causes identified and known to the medical profession. The human body is regarded as a machine to be restored to health through personalised treatments that arrest or reverse the disease process, irrespective of the social conditions in which patients live, abstracting health out of its determining environment. Resulting from this approach, the health of a society is dependent on the level of medical knowledge and the availability of medical resources.
This is a complete fabrication, its assertion over time no more than a politico-ideological offensive. As physician and epidemiologist Thomas McKeown first showed in 1976, medical advance has always lagged behind population health improvements a position that has been widely accepted ever since. Medical and scientific advance is important, of course, but as only one among many social determinants of health.
It has never been sufficient to improve general health outcomes across populations, and has never been enough to consistently and conclusively protect us against infectious disease outbreaks. For that, preventative health-related measures, for example, good standards of sanitation, housing, diet and employment practices, are required.
It is clear the biomedical model serves the financial interests of health capital. However, the model also serves an important ideological purpose for the capitalist class generally.
Essentially, biomedical approaches help turn human health into a commodity. Through a process of what Marxists term ‘reification’, health becomes a thing that we need to buy in order to avoid ill health and the poverty and downward spiral of greater ill health and social exclusion that that entails. As the Hungarian revolutionary socialist Gyorgy Lukacs most clearly explained, reification turns the human relationship with material objects upside down so that objects are transformed into subjects and subjects are turned into objects.
Subjects become passive and determined, while objects become the active, determining factor. In the case of health, concepts of health as encapsulated in biomedical models become the active object while the passive subjects are you and I. We are subject to a determining concept of health, which we must strive to possess — by changing our ‘health behaviours’ to those prescribed for us and buying the right drugs — or face the material consequences of ill-health and disease.
So, our human capacity to be healthy, to make empowered choices about what is and isn’t good for our survival is alienated from us, and our health becomes the property of an objective ‘health’ commodity, possessed by the industrial-medical-complex, for sale.
The biomedical model will retain its hegemonic position until the institutions of health in which it is embedded are dismantled and new, preventative models of health based on expanded and more thoroughly dialectical social determinants of health take shape.
The work of dismantling this is intimately tied in with the broader task of ending an economic system based on the anarchic pursuit of profit above all else, and replacing that with a democratic, planned and egalitarian socialist society based on need – not profit.
(Lee Humber is the author of Vital Signs: The Deadly Costs of Health Inequality, published by Pluto Press)