Rediscovery of Health as a Common Good After the Coronavirus Outbreak

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Excerpted from an article by Gael Giraud,


Gael Giraud:

The return of the welfare state

"The partial isolation of Europe has revived the idea that capitalism is certainly a very fragile system, and so the welfare state is back in fashion. In fact, the flaw in our economic system now revealed by the pandemic is unfortunately simple: if an infected person is able to infect many more within a few days and if the disease has a significant mortality rate, as in the case of COVID-19, no economy can survive without a strong and adequate public health system.

Everyone, regardless of their socio-economic status from workers to our leaders and politicians will eventually contract the virus, sooner or later infecting their neighbors. It is impossible to maintain the fiction of individualism implicit in the neoliberal economy and in the policies of dismantling public service that have accompanied it for 40 years: the negatives brought on by the virus radically challenge the idea of a complex system modeled on the voluntarism of “atomized” entrepreneurs.

The health of everyone depends on the health of each individual. We are all connected in a relationship of interdependence. This pandemic is by no means the last “great plague” that will not return for another century. On the contrary, global warming promises the multiplication of tropical pandemics, as the World Bank and the Intergovernmental Panel on Climate Change (IPCC) have been saying for years. And there will be other coronaviruses.

Without an efficient public health service to treat everyone there can be no enduring production system during a coronavirus epidemic. And this is likely to remain so for decades. The appeal launched on March 12 by the Mouvement des entreprises de France (Medef) – the French employers’ union – to “make the production system more competitive” betrays a profound misunderstanding about the pandemic.

How to get out of isolation?

If healthcare workers fall ill, there is a risk of the collapse of the hospital system, as seems to have happened in Italy in Bergamo, Brescia and, to a lesser extent, in Milan. It is therefore necessary for the state to manage distribution of anti- or retro-viral drugs, so that the burden on hospital systems everywhere on the verge of collapse can be relieved quickly. And, it is to be hoped that the citizens of all countries finally show a sense of responsibility.

In order for confinement to be rigorous, together with the well-known basic personal hygiene, everyone must understand the meaning and usefulness of confinement. Confinement effectively slows down the spread of the virus and – let us repeat – in the absence of a screening system, it remains the least negative strategy in the short term. However, if we stop there, the screening itself becomes pointless: if we leave confinement, let us say, in a month’s time, the virus will still be circulating and will cause the same deaths as it would have caused today in the absence of containment.

To wait, through isolation, for the population to immunize itself – more or less, the same strategy initially proposed by Boris Johnson, but “at home” – would require months of confinement. To understand this, it is sufficient to return to the essential parameter of a pandemic, R0, the “basic reproduction number,” i.e. the average number of secondary infections produced by each infected individual. As long as R0 is greater than 1, i.e. as long as an infected individual can infect more than one person, the number of infected people increases exponentially. If we leave containment without further delay before R0 falls below 1, we will have those hundreds of thousands of deaths that the pandemic threatened to cause from the beginning.

However, in order for collective immunization to bring R0 below 1, it is necessary to immunize about 50% of the population, which – given the average incubation time (5 days) – would probably require more than 5 months confinement given there are now more than one million infected. This is an unsustainable option in economic, social and psychological terms. It is the entire production system of our countries that would collapse, starting from our banking system, which is extremely fragile.

Not to mention the fact that, at the moment, the poorest among us – refugees, the homeless, etc. – die not because of the virus, but because they cannot survive unless society is active and looking after them. Not forgetting also that we have no guarantee that our food supply chain can withstand the shock of quarantine for such a long time: do we want to force middle/low income workers to put their lives at risk in order to continue, for example, to transport food for managers who remain quietly at home or on their farm in the countryside?

It is therefore necessary to organize a “first” release from containment, in a few weeks at the latest. Taking this risk collectively only makes sense, however, on one condition: to apply, this time, the strategy adopted in South Korea and Taiwan with the utmost rigor. The time we are gaining by locking ourselves up at home should serve to:

– Bring R0 (which was probably about 3 at the beginning of the infection) as close to 1 as possible;

– Encourage the conversion of certain sectors of the economy to mass produce the lung ventilators that intensive therapy needs to save lives;

– Assist local manufacturers to produce screening equipment and materials immediately, while the necessary systems are put in place within the next few weeks. At the moment there are two enzymes in particular, whose stocks are very insufficient, and therefore limit our ability to carry out screening[6];

– Increase production of personal protective equipment, essential to stop the spread of the virus when we leave our home.

If we end our collective confinement when our detection equipment is not ready or the masks are missing, we will again run the risk of a tragedy. Unfortunately, it is impossible to measure R0 today. Therefore, we must wait until we are organized for screening and plan an orderly exit from quarantine as quickly as possible.

What will happen then? Those who are “released” must undergo systematic screening and wear masks for several weeks. Otherwise, exit from confinement will have a worse outcome than at the beginning of the pandemic. Those who are still positive will then be quarantined, along with family and those around them. Others may go to work or continue isolating. Testing will have to continue throughout June/July/August to make sure that the virus has been eradicated by the northern hemisphere autumn.

Health as a global common good

The pandemic is forcing us to understand that there is no truly viable capitalism without a strong system of public services and to completely rethink the way we produce and consume, because this pandemic will not be the last. Deforestation – as with the wildlife markets at Wuhan – exposes us to animals with unknown viruses. The thawing of the permafrost threatens to spread dangerous epidemics, such as the “Spanish influenza” of 1918/19 and anthrax. Intensive breeding also facilitates the spread of epidemics.

In the short term, we will have to nationalize unsustainable companies and, perhaps, some banks. But very soon we will have to learn the lessons of this painful time: reconvert production, regulate financial markets; rethink accounting standards to improve the resilience of our production systems; set carbon and health taxes; launch a major recovery plan for green industrialization and massive conversion to renewable energy.

The pandemic invites us to radically transform our social relations. Today capitalism knows “the price of everything and the value of nothing,” to quote an effective formula by Oscar Wilde. We must understand that the real sources of value are our human relations and those with the environment. To privatize them, we destroy them and ruin our societies, while putting human lives at risk. We are not isolated monads, connected only by an abstract price system, but beings of flesh interdependent on each other and with our environment. That is what we must learn again. The health of each individual concerns everyone. Even for the most privileged, the privatization of health systems is an irrational option: they cannot remain totally separate from others; disease will always reach them. Health is a global common good and must be managed as such.

The “common goods,” as the American economist Elinor Ostrom defined them in particular, open a third space between the market and the state, between the private and the public. They can guide us into a more resilient world, capable of withstanding shocks like the one caused by this pandemic.

Health, for example, must be treated as a matter of collective concern, with articulated and stratified modes of intervention. At the local level, for example, communities can organize themselves to react quickly, by isolating clusters of people infected with COVID-19. At the state level, a robust public hospital service is needed. At the international level, WHO recommendations to combat an epidemic situation must become binding. Few countries have followed the WHO recommendations before and during the crisis. We are more willing to listen to the “advice” of the International Monetary Fund (IMF) than that of the WHO. The current scenario proves us wrong.

Recently we have witnessed the emergence of several “common goods”: like those scientists who, outside of any public or private platform, have spontaneously coordinated through the OpenCOVID19 initiative[7] to share information on best practice in virus screening.

But health is just one example: the environment, education, culture and biodiversity are also global common goods. We need to imagine institutions that allow us to value them, to recognize our interdependencies and make our societies resilient.

Some such organizations already exist. The Drugs for Neglected Disease Initiative (DNDI) is an excellent example. An organization created by some French doctors 15 years ago for the procurement of drugs for rare or forgotten diseases: a collaborative network of third parties, in which the private sector, the public sector and NGOs cooperate, which can do what neither the private pharmaceutical sector, nor states, nor civil society can do alone.

On an individual level, then, we discover the fear of scarcity of goods. Can this be a positive aspect in this crisis? It frees us from consumerist narcissism, from “I want everything and now.” It brings us back to the essential, to what really matters: the quality of human relationships, solidarity. It also reminds us how important nature is for our mental and physical health. Those who live locked up in 15 square meters in Paris or Milan know this very well. The rationing imposed on some products reminds us how resources are limited.

Welcome to a limited world! For years, billions spent on marketing have made us think of our planet as a giant supermarket, where everything is available to us indefinitely. Now we abruptly feel the sense of deprivation. It is very difficult for some, but it can be an opportunity to save money.

On the other hand, even a certain “collapsological”[8] romanticism will quickly be mitigated by the concrete perception of what the brutal economic difficulties imply in the current situation: unemployment, bankruptcy, broken lives, death, daily suffering of those in whom the virus will leave traces for a lifetime.

In the wake of Pope Francis’ encyclical Laudato Si’, we want to hope that this pandemic is an opportunity to direct our lives and institutions toward a happy sobriety and respect for the finitude of our world. The moment is decisive: we can fear what Naomi Klein called the “The Shock Doctrine.” Some governments must not, on the pretext of supporting business, further weaken workers’ rights; or, to further strengthen police surveillance, permanently reduce personal freedoms." (