A spectre is haunting the world—the spectre of pandemic.1 Invisible to the eye, and indeed even to all but the most powerful electron microscopes, the SARS-CoV-2 virus has nonetheless created panic around the globe. It has brought the world economic system to a grinding standstill and exposed the limitations of governments.2 So how did we get to this situation, despite the wealth of medical knowledge, treatments and diagnostic procedures in the modern world? To answer this question, we need to start with an examination of the virus itself, before going on to examine the nature of science and pseudo-science under capitalism. Then we will also be in a position to consider how socialists should respond to the public health crisis.
The nature of the virus
The pathogen that causes the Covid-19 disease is a type of coronavirus. This class of viruses get their name from their molecular structure, which includes an arrangement of surface proteins that looks a bit like a crown.3 Viruses can cause vast human suffering and death, as well as social and economic dislocation. However, they are also the simplest of forms of life. At their most basic, they consist of a genome of just a few genes and a protein shell. For example, the influenza virus contains only 11 protein-coding genes, compared to around 21,000 genes in our own human genome.4 SARS-CoV-2 is only slightly bigger, with a genome of just 20 protein-coding genes.5 Because of this simplicity, and the fact that viruses can only reproduce inside a living plant or animal cell, some scientists do not even consider them life forms at all, but rather parasites on life.6 Be that as it may, however we describe them, viruses are at the root of some of the most infectious and lethal diseases that afflict humanity.
Prior to the current pandemic, people in the Global North had become accustomed to the effective treatment of infectious diseases that are caused by viruses, bacteria or microbial parasites through anti-viral medicines, vaccines and antibiotics. However, between 13 and 15 million people still die globally every year from infectious diseases such as tuberculosis, HIV, Ebola, malaria, measles, bacterial pneumonia and diarrhoeal disease.7 This compares to the 390,000 reported deaths due to Covid-19 reported by 5 June 2020.8 Nevertheless, these diseases are more easily ignored by governments and citizens in the developed world because they mainly affect poor people with dark skins in the Global South.
Epidemics are, thus, far from unprecedented in recent times. What is new now is for so many people in developed countries to be dying during a viral pandemic, and for the spread of the infection to impact so detrimentally on national economies. Perhaps such a dramatic impact in previous eras could be chalked up to ignorance about the scientific causes of a disease, the means to prevent its spread and the tools to diagnose and treat infected people. Yet we now possess such precise molecular biology tools that it was possible for scientists to determine the genome sequence of SARS-CoV-2 within weeks of the initial Covid-19 outbreak in the city of Wuhan in central China. Scientists were then able to understand its basic molecular structure and similarity to other coronaviruses.9
Nevertheless, this detailed insight into the nature of the infectious substance failed to prevent SARS-CoV-2 rapidly spreading around the world and causing a an enormous global crisis. Moreover, although social distancing and lockdown measures have managed substantially to slow the spread of the virus in many countries for the time being, it is quite possible that once lockdowns are ended, SARS-CoV-2 will start to rapidly spread once more.10 Worse still, in the absence of a vaccine or any drug treatment that selectively targets the virus, there is little that can be done for many vulnerable individuals who develop the most severe forms of Covid-19. Why is it that, despite all the scientific expertise available in today’s world, so many governments were caught unawares by the spread of the virus, failed to protect the most vulnerable and have few answers about what to do next other than to hope for a vaccine?
To answer these questions, we need to think about the role of academic biomedical research within our current economic system, its relationship with clinical medicine and the pharmaceutical industry, and the links between the scientific establishment and governments. In particular, this means looking at the ways in which the values of capitalism shape the practice and application of science in modern society. These values, particularly the drive for profit, affect which scientific questions are deemed worthy of study, which research gets funding and which scientific insights end up contributing to a product such as a vaccine or drug. Furthermore, they shape how seriously scientific advice is viewed by politicians and policymakers, as well as how science is perceived by the public.
Pandemics and demographics in the Global North
There are no excuses for governments in the Global North to have failed so badly in preparing for a coronavirus pandemic. The world had already recently been through two coronavirus epidemics: first the SARS-CoV-1 outbreak in China from 2002 and then the MERS-CoV outbreak in Saudi Arabia from 2012.11 In both cases, there is good evidence that these epidemics were the direct consequence of modern capitalist agricultural practices, chaotic urbanisation, ecological disruption and badly planned and unsustainable resource extraction. All these factors increased the likelihood of the zoonotic transfer of viruses to humans.12
Although there had been very recent outbreaks of diseases caused by coronaviruses, these previous epidemics saw much lower numbers of deaths. SARS-CoV-1 infected a reported 8,098 people and caused 774 deaths, so just under 10 percent of infected people died. MERS-CoV was reported to have infected 2,494 people and killed 858, so a much higher mortality rate of around 35 percent. In contrast, SARS-CoV-2 had infected a reported 5.44 million people and killed just over 340,000 worldwide by 24 May, suggesting a mortality rate of just over 6 percent.13
Due to the lack of mass testing in many countries, the true numbers of people that have been infected by SARS-CoV-2 is likely to be far higher, and the mortality rate much lower. One estimate at the end of April claimed that as many as 4.2 million people in Britain had already been infected by the virus. If true, this would mean a mortality rate as low as 0.6 percent.14 This is still much higher than seasonal flu, which is associated with a mortality rate of about 0.1 percent.15 Nonetheless, we should ask why a virus that is much less lethal than SARS-CoV-1 or MERS-CoV has caused far more deaths and economic disruption. Some of the answers lie in the nature of the SARS-CoV-2 virus, and others lie in how governments in the developed world have become accustomed to dealing with disease.
One of the reasons why SARS-CoV-2 has been able to wreak such havoc in the developed world is that it is able to spread so rapidly because most people who catch it show only mild symptoms or none at all. This is unlike SARS-CoV-1 or MERS-CoV, which tended to kill a substantial proportion of the people they infected, thus limiting the ability of these hosts to spread the infection further. A recent modelling study has estimated that as many as 86 percent of Covid-19 cases may have symptoms so mild that they go unreported.16 Combined with modern international air travel, this is one reason why SARS-CoV-2 was able to spread to so many countries from the initial outbreak in China and then continue to spread rapidly within those countries. Then comes the deadly twist. Although the virus seems to have hardly any effect on the substantial majority of people, in certain people it is life-threatening. Importantly, the size of that vulnerable section of the population can vary between countries.
Early studies from both China and Italy first identified some especially vulnerable parts of the population—elderly people and those with existing serious illnesses such as diabetes, heart disease and lung disease.17 Both these conditions and age weaken the immune system, thus boosting the deadliness of the infection. Unfortunately the initial perception that only old people and those with existing serious health conditions were vulnerable seems to have motivated some governments in the developed world to be complacent about the spread of the virus at first. Some politicians clearly viewed elderly people and those with chronic health conditions as disposable. This is surely the only explanation for the strategy of “herd immunity” that was initially put forward in British government circles.
In its usual scientific application, herd immunity refers to the vaccination of the overwhelming majority of the population so that a particular disease cannot take root, thus protecting everyone.18 Nevertheless, the British government deployed the term in order to justify the idea that SARS-CoV-2 might be allowed to spread through society until most people had acquired immunity. Patrick Vallance, the government’s chief scientific adviser, initially defended this strategy.19
Such a strategy has all sorts of potential problems—not least that it was far from clear at that stage whether people who had become infected acquired immunity. A figure of 60 percent is often cited as the proportion of the population who would need to become infected for herd immunity to develop; but even in May, many months into the pandemic, the actual proportion who had developed antibodies to the virus was far lower. Even in badly-hit New York, only 19.9 percent had antibodies; in Stockholm, it was just 7.3 percent.20
However, by far the biggest problem with the herd immunity strategy was its callous implication that the vulnerable should simply be left at the mercy of the virus. The evidence suggested that there was a 15 percent chance of dying for people over 80. An article in the Sunday Times claimed that Boris Johnson’s senior adviser Dominic Cummings had summarised the government’s strategy as “herd immunity, protect the economy and if that means some pensioners die, too bad”.21 The government has denied that Cummungs said this, and yet it went on to leave elderly people in care homes with little or no protection against the virus. This abandonment of an extremely vulnerable demographic has been one of the most scandalous aspects of the British government’s handling of the epidemic.22
As SARS-CoV-2 spread around the world, other facts about the most vulnerable started to emerge. One of the most striking is that obesity is a major risk factor—perhaps the greatest risk factor—in those under the age of 60. Obesity is defined by a body mass index (BMI) of 30 or above, and it increases the likelihood of Covid-19 becoming a serious condition.23 This is an important insight: 42 percent of the United States population and 29 percent of British people are classified as obese. In contrast, although obesity has become an increasing problem in China in recent years, particularly in cities, it affects only 5 to 6 percent in the country as a whole. Moreover, there is a strong link in developed capitalism between poverty and obesity. About 30 percent of women and 25 percent of men who are classified as the most deprived in Britain are obese, as opposed to 19 percent and 22 percent obesity rates for the least deprived.24 This exhibits one way that Covid-19 deaths are a class issue.
All this also shows why we need to be careful when comparing the numbers of deaths due to Covid-19 in different countries and estimating those that could occur if an exit from lockdown happens too hastily. This is true more generally, and not just with regard to obesity. Of course, one important starting point is to compare deaths per million people in a country, rather than making absolute comparisons. But this is only a starting point. Other factors that should be considered are population density, the proportion of people who live in cities, the age profile of the society, customs that influence the degree of physical interaction between individuals and the quality of available healthcare.
Other factors that influence SARS-CoV-2’s infection and mortality rates may only become clear in years to come. One potential factor is the seasons. Australia and New Zealand in the southern hemisphere seem so far to have coped relatively well with the Covid-19 pandemic, and this could either reflect the speed with which they dealt with the situation or that their summer weather also hindered the virus’s spread. Yet while environmental heat does seem to have some inhibitory effect on the spread of SARS-CoV-2, this is only partial. Initial hopes that the onset of summer might bring a premature end to the pandemic in countries such as Britain and the US have been dashed.25
Covid-19 and the Global South
As for the developing world, one of the more unexpected features of the Covid-19 pandemic, at least at the time of my writing this article in early June 2020, was its apparently limited public health impact on the Indian subcontinent and Africa. This is despite predictions that the pandemic might have its greatest impact in these regions. Some commentators claim that African countries may have been much better prepared to deal rapidly with the spread of SARS-CoV-2 because they have to tackle so many other lethal diseases.26 However, it may be the case that climate and demographics played a role. For instance, the relatively youthful populations of many countries in the developing world could result in a slower spread.27 Given the role of air travel in initially spreading Covid-19 from China, another factor may be the paucity of flights to Africa. Similarly, although there are many internal flights in India, there are relatively few from China. Nonetheless, there is no room for complacency. Reports from Ecuador, Chile, India, Indonesia and South Africa all indicate that Covid-19 epidemics are now taking off, albeit at a slower pace in the countries with lockdowns and social distancing.28 The devastation that SARS-CoV-2 can cause in the Global South has been shown by Brazil, which was rapidly becoming one of the countries with the highest death toll globally at the start of June. This is partially thanks to the disastrous health policies and hands-off approach to the virus that were pursued by the right-wing Brazilian government.29
Any benefit from regional factors in the Global South could soon be negated. The disease spreads by poor general healthcare, and its effects on those who are malnourished or have diseases such as malaria, tuberculosis or HIV are not properly understood. In addition, the current focus of the Global North on Covid-19, and the economic dislocation that the pandemic is causing, could have a devastating effect on the health of the world’s poorest. The International Labour Organisation has recently predicted that 1.6 billion workers in the developing world—nearly half the world’s total workforce of 3.3 billion—“stand in immediate danger of having their livelihoods destroyed” by the lockdown’s impact on world trade.30 In early May, the World Health Organisation announced that polio vaccinations for up to 12 million children in Africa would be delayed as resources are switched to fighting Covid-19. Polio is a deadly and debilitating disease, and this delay will inevitably lead to more children being afflicted with it in the future.
All of this means that any considered socialist response to the Covid-19 pandemic needs to take into account other aspects of health, rather than focusing solely on SARS-CoV-2. This is doubly the case in the poorer countries of the world.
Pharmaceuticals, pharmacology and the pursuit of profit
Currently, the only way to minimise the ill health and mortality that SARS-CoV-2 causes is through social distancing and lockdown of all but essential services. There are no vaccines to protect people from the infection gaining hold in their bodies, nor have any drugs been identified that selectively target the virus. Despite a major push to produce an effective and safe vaccine, the most realistic estimates envisage that it will take at least 18 months before such a product is ready for use on a mass scale. More pessimistic projections claim that it could be years before a vaccine is developed, if one is at all.31 As for drugs, despite a series of misleading claims by Donald Trump about the usefulness of existing pharmaceuticals such as the anti-malarial chloroquine, no drug has currently been identified that effectively targets SARS-CoV-2—although a non-selective steroid, dexamethasone, has been shown to have a partially protective effect against death in the most serious cases.32 So why has modern medicine found it so difficult to respond, particularly given that SARS-CoV-2 has so many similarities to the coronaviruses that caused two previous lethal epidemics?
Providing an answer requires looking at the pharmaceutical and healthcare sectors and how they operate in a capitalist system. Though these industries have their own unique features, they share two main characteristics that are common to all capitalist enterprise: they produce things with a use value, but they do so to produce profit. These two activities take place simultaneously, but it is nevertheless possible to identify products that are particularly useful in protecting human life and products that are particularly useful in generating profit. The two do not necessarily coincide.
The pharmaceutical industry demonstrates that science and technology, even under capitalist conditions, have the potential to transform lives in ways that were unthinkable in previous eras. Antibiotics, anaesthetics, vaccines, drugs used to treat high blood pressure and heart disease, painkillers, agents for treating asthma, anti-viral chemicals such as the ones used to treat HIV, anti-cancer chemotherapeutic agents, drugs for inducing and managing childbirth, the contraceptive pill, monoclonal antibody treatments, the vast array of molecular methods available to accurately diagnose disease: these are just some of the pharmacological innovations that have transformed modern life and save lives on a daily basis, globally.33
However, the fact that the pharmaceutical industry is driven by profit means that drugs or vaccines that could save millions of lives are denied to those who need them because of their cost and the poor healthcare infrastructures in many countries.34 These include drugs that could be used to treat some of the most deadly infectious diseases such as tuberculosis, HIV, Ebola, malaria, measles, bacterial pneumonia and diarrhoeal disease. The profit motive also means that drugs that do make huge profits for pharmaceutical companies are produced and marketed, despite having limited scientific value. At the same time, other drugs that could make a huge difference do not tend to get developed because they make little profit.
An example in the former category is remedies for coughs and colds with little proven effect. Another example is drugs used to treat mental health conditions whose exact mechanism of action is unclear, and which may simply suppress symptoms rather than provide any kind of cure. There are many conditions that are treated with drugs, but which have a strong social component, such as type 2 diabetes, heart disease and stroke, which are linked to obesity. These illnesses might be much better prevented from occurring in the first place by progressive social policies that eliminate poverty, job insecurity and lack of educational opportunities. The same may be true of depression, which is associated with societal pressures.
In the latter category are vaccines, new types of antibiotics and new treatments for diseases that affect people in the Global South, rather than those in the developed world.35 The drive for profit also means that vast sums of money are spent on developing and marketing drugs that are essentially the same as those already produced by other companies. These medicines are given slight molecular alterations to get around patent laws. These sorts of profit-centred operations are a central focus of the industry, crowding out proposals for vital new research. Amazingly, a 2008 study estimated that the US pharmaceutical industry spends almost twice as much on promotion as it does on research and development.36
What about academic research into new diagnostics and treatments? One common misconception on the left is that academics like myself who work in pharmacology departments, because our work relates to the identification and development of new drugs, are in the pay of the pharmaceutical industry, and that consequently our findings are suspect. This view does not fit with my experience. First, it neglects the fact that pharmacology—defined as the study of the effects of chemicals on living systems—is first and foremost a basic science. Its practitioners’ primary interest is in using drugs to uncover the molecular and cellular mechanisms that underlie how our cells, tissues, and organs work. But second, even though a secondary aim is developing chemicals that one day may have medical (and commercial) benefit, I have yet to see any colleagues make any substantial amounts of money from this side of their work. This is despite the fact that I work in a pharmacology department that has been rated the best in the world. Instead, faced with job insecurity, attacks on their pensions and downward pressure on their salaries, pharmacologists were just as likely as other academics to be out on picket lines during the recent strikes in the British universities.37
Nevertheless, there are two important ways in which the profit motive that drives the pharmaceutical industry affects what it is possible to achieve in academic pharmacology. First, grant funding increasingly tends to go to projects whose goal is a specific pharmaceutical product, rather than to long-term, fundamental research into how the body works. Such research can be more risky in terms of future practical outcomes, but is also often much more ground-breaking in clinical potential.38 Second, even if a basic science finding does identify a chemical that may be a potential valuable new drug, there are many barriers to getting funding to develop such insights further.
Although academic pharmacology, clinical medicine and the drug industry are often unduly conflated with one another, and it is important to note the distinctions, it is still worth mentioning that the marketing and prescription of drugs is also affected by the profit motive. For example, a 2011 article in The Guardian, which focused on psychiatric drugs, highlighted how it is common in the US for pharmaceutical companies to pay clinicians to recommend particular drugs to their colleagues.39 If doubt or criticism of the drug is expressed, the clinician’s subsidy ends. Another common practice is for drug companies to ghost-write scholarly articles praising their own drugs, which they then pay clinicians to amend slightly and add their names to.
The search for a vaccine
One unfortunate consequence of the short-termism and profit-seeking of the pharmaceutical industry is that the recent SARS-CoV-1 or MERS-CoV coronavirus epidemics have not led to any specific vaccines or drugs that could be used to combat SARS-CoV-2. The story of a team led by Peter Hotez of Baylor College of Medicine in Houston is one example of the failures of the industry. Hotez and his team developed the prototype of an anti-coronavirus vaccine but when they tried to get funding for a clinical trial in 2016, their application was rejected. “We tried like heck to see if we could get investors or grants to move this into the clinic,” said Hotez. “But we just could not generate much interest”.40 Such prior work would have been important because creating an effective and safe vaccine is far from a straightforward task.
The very first vaccine was developed by Edward Jenner in 1796 for use against smallpox. It involved inoculation with cowpox, a related virus that causes almost no symptoms or lasting damage in humans—unlike the disfiguring and often lethal smallpox.41 Standards in 18th century medical ethics were somewhat different, and Jenner’s first experimental subject was an eight year old boy called James Phipps. Luckily, Phipps showed no ill effects when he was subsequently deliberately infected with smallpox. The Royal Society initially refused to accept the validity of Jenner’s findings, arguing (quite rightly from a purely scientific perspective) that he experiment on more individuals.40 In response, Jenner successfully inoculated 23 other individuals. Astonishingly, this included his 11 month old son. Ethical issues aside, Jenner’s pioneering work had demonstrated that immunity against an infection could be induced artificially. We now know that this is because the body produces protective antibodies against the inoculated substance.
Until fairly recent times, vaccination generally involved injecting a form of a pathogenic virus that had been inactivated by heat. However, a new discovery in the early 1970s revolutionised vaccine production. Scientists found out how to generate the protein products of genes—whether of humans, animals, plants or, crucially, viruses—in bacterial cells. These cells are genetically engineered to “express” (that is, produce) the proteins, which can then be isolated in a purified form.41 Once an individual viral protein could be produced in this way, it was possible to inject this protein into a person in order to induce immunity without any risk that this could in itself cause a viral infection. Alternatively, genetic engineering can be used to make a disabled version of a virus that can trigger an antibody response, but not the disease. The newest vaccine technology involves injecting viral genes so that the body’s own cells will translate these genes into viral proteins that trigger an immune response.42 Out of the eight anti-SARS-CoV-2 vaccines that are currently in clinical trial, three involve the inactivated virus, two use artificially generated viral proteins and three employ the virus’s genetic material.43
The speed at which a vaccine is being developed is impressive in some ways, and shows how rapidly medicine can proceed with modern molecular biology approaches. An anti-SARS-CoV-2 vaccine was prepared and tested in rhesus macaque monkeys within months of the original outbreak, and several other vaccines against this virus are now in the middle of clinical trials in humans. However, there still remain substantial obstacles to a vaccine becoming available for widespread use.
The first obstacle is that vaccines are not always effective. A vaccine works by inducing the body to make antibodies that can then bind to a virus, inactivating it or preventing it gaining entry to a cell. Unfortunately, sometimes antibodies fail to do this. At least two of the vaccines currently in clinical trials have protected macaque monkeys from some of the effects of SARS-CoV-2, and this is a good sign. However, it still remains possible that the vaccines will behave differently in humans.
A second obstacle is that some vaccines can actually enhance the pathogen’s virulence in the body instead of protecting against it. Some vaccines developed in the past against similar coronaviruses led to a strong, counterproductive immune response in experimental animals. Rather than protecting the animals from the virus, they caused unexpected adverse effects such as lung damage in monkeys and liver damage in ferrets.44 This is why vaccines are usually first tested on animals: not only to see if they are effective, but also whether they are safe. Despite this, some researchers have decided to test anti-SARS-CoV-2 vaccines directly on people without prior animal testing. This is potentially risky due to the potential for unexpected consequences.
The final obstacle is that a virus may mutate. The viral proteins that are targeted by a vaccine may develop a slightly different molecular structure that is no longer recognised by the vaccine.45 The mutuation of viruses is common: this is why people need to be vaccinated against influenza virus every year. Viruses such as hepatitis and polio have genomes made of DNA (just like the genomes of human beings and other animals). Influenza has an RNA genome. RNA is DNA’s chemical cousin, but RNA genomes are generally much less stable than DNA genomes. Thus DNA viruses can generally be targeted with long-lasting vaccines. But this is not the case with influenza and even more mutable RNA viruses such as HIV. The changing molecular make-up of RNA viruses means that they are rapidly moving targets that are difficult to pin down. That is not to say that long-lasting vaccines for RNA viruses are impossible: measles and mumps also have RNA genomes, but these are relatively stable, so successful and long-lasting vaccines have been developed to combat them. We simply do not yet know how stable the RNA genome of SARS-CoV-2 is in the long-term. It is possible that a vaccine might be produced against this virus in its current form, but then prove useless against a later, mutated version.
Understanding this scientific backdrop helps us grasp how vaccine development and production is shaped by capitalism. The pharmaceutical industry is organised through market competition. Pharmaceutical companies develop their products in competition with rival firms, and this leads to a great deal of secrecy surrounding their research.46 Academic biomedical science is superficially different: the primary way that academic scientists gain recognition is by publishing their work in high-profile academic journals. However, because any one publication may require many years of work, there is often much secrecy between different research groups working in the same field of research. This leads to duplication of work and wasting of resources.
Even obtaining a research grant is an increasingly fraught business. Only a quarter of grant applications end up being funded, and medical research is an expensive endeavour. A typical UK programme grant involves several million pounds, and research council budgets have been underfunded and cut back for years. This encourages competition and secrecy between academics. Moreover, projects that use tried and tested approaches, more obviously realisable goals and clearer immediate practical benefits are more likely to be funded. More ambitious and daring “blue skies” projects are often not funded because they have a higher chance of failure. Nevertheless, these are often precisely the sort of research programmes that might result in the development of fundamental insights into how the body works and thus important new technologies.
Since the two most recent viral epidemics were due to related coronaviruses, it is surprising that that no specific drug has been developed against these coronaviruses. This has proven to be a major deficit for our battles against SARS-CoV-2. If a specific anti-coronavirus drug had already been developed before the current pandemic, this could have had a major impact on the management of the pandemic and greatly reduced the number of deaths.47 But neither government funding agencies nor pharmaceutical companies saw it as important to continue developing drugs against SARS-CoV-1 and MERS-CoV once these epidemics had petered out with a limited number of deaths in confined areas of the globe. If they had continued to fund research into fighting these viruses, we might have had a battery of specific drugs that could have been used to treat the serious Covid-19 cases and thus save lives. That this didn’t happen is one consequence of the short-termism that is a growing feature of drug development.
After belatedly responding to the Covid-19 pandemic with social distancing, and as daily death tolls and infection rates drop in many countries, governments are asking how to get people back to work. States are doing this while also attempting to manage the risk of new outbreaks and further deaths. Increasing evidence suggests that people who have been infected generate antibodies to the virus, and thus probably develop some immunity, so an obvious next step would be to carry out mass antibody testing. This would give us a better indication of the number of people who have been infected, as well as the actual mortality rates.46 This information could then be used to prevent the chance of a new outbreak of infection and to protect those who are most at risk from the virus. One way to do this would be to track any new spread of SARS-CoV-2 and take rapid measures to isolate and contain new outbreaks. However, in Britain we are still a long way from these goals. All the scientific expertise and technology in one of the world’s wealthiest countries has not translated into what should have been easily achievable results.
While the British government in early June 2020 was stressing the importance of a policy of “test, track and isolate”, former chief scientific adviser Sir David King warned that the measures in place would not detect 80 percent of the contacts of people with the virus. He argues that the infection rate will rise unless there is better tracking:
The government has placed huge emphasis on their test, track and trace system in recent weeks, even labelling it “world-beating”. It is clear from our research that this simply isn’t the case—indeed, the system as it stands is not fit for purpose.48
Such criticism reflects both the lack of an adequate mass testing system in Britain, and the fact that any isolation would purely be left to the judgment of affected individuals, rather than being administered by central and local health authorities. This exposes both the fragmentation of Britain’s academic and clinical infrastructure and the government’s lack of political foresight.
Science, pseudo-science and Covid-19
Keith Thomas published his Religion and the Decline of Magic: Studies in Popular Beliefs in Sixteenth and Seventeenth Century England in 1971. The book showed how magical ways of thinking about the world were central to the mindsets of both ordinary people and the ruling classes in the feudal era. A key feature of the English Revolution of 1642-9 was a shift to a scientific way of thinking that directly clashed with magical and superstitious beliefs. Following the revolution, this shift led to the flourishing of new scientific advances ranging from the discovery of the cell as the biological unit of life by Robert Hooke to Newton’s theorisation of the laws of motion.49 Similarly, the period around the French Revolution of 1789 was associated with major scientific discoveries and technologies. Examples include the isolation of chemical elements, advances in the understanding of human metabolism and the physics of electricity, and the first theory of evolution.50 Remarkable technical innovations at this time included the metric system, ballooning, the invention of canned food and the semaphore telegraph.
Today we tend to take for granted the centrality of science to modern society. But there are good reasons to ask whether a scientific approach really is that key to how governments make decisions in capitalist society. Moreover, economic crisis has affected attitudes to science among both politicians and ordinary people. Superstitious and unscientific ways of thinking are far more common in modern society than is commonly imagined. Particularly as the economic health of the global capitalist system has declined, politicians with anti-scientific attitudes have become more prominent and won followings among ordinary people. All of this has affected the response to the Covid-19 pandemic.
In some cases, this has led to people trying pseudo-scientific remedies that have no impact on the virus and have even resulted in accidental poisoning. In particular, Trump has issued many misleading and unscientific comments about the origin and spread of Covid-19, and about remedies that might treat it.51 But a number of right-wing political leaders and influencers around the world have also been responsible for misleading information. Moreover, a lack of scientific understanding among many politicians and within the wider population have had a big impact on how both governments and ordinary people have responded to Covid-19.
The often quite wide differences of opinion among scientists themselves has also had an impact. Such divergent opinions about the same basic set of available scientific “facts” challenge the widely accepted notion that science is a purely objective body of findings and insights. Although science may provide real, objective truths about the world, it is not neutral. Indeed, there are competing versions of science. We should reject governments’ attempts to hide often very political, and sometimes very reactionary, decisions behind a facade of “following the science”. We should recognise that disagreements between scientists may not only reflect valid divergences in opinion based on a different reading of the “facts”, but also a particular scientist’s links to the scientific and political establishment.
More fundamentally, we must ask why is it that an apparently rational society based on 21st century science and technology often concedes so much to irrationality. To answer this question, it is helpful to define what is a scientific way of thinking. A good starting point is Karl Marx’s statement that “all science would be superfluous if the outward appearance and the essence of things directly coincided”.52 In other words, science can help us to understand things as they really are, not just how they superficially appear. Another important aspect of a scientific way of thinking is a willingness to exclude supernatural explanations from one’s mindset. It was just such a willingness that elicited the famous response of French scientist Pierre-Simon Laplace to Napoleon Bonaparte’s question about where God was situated in Laplace’s view of the universe: “Sire, I have no need of that hypothesis”.53
We should be careful not to overstate this point. Famous scientists ranging from Isaac Newton to Francis Collins, who led the Human Genome Project, have held deep religious beliefs. There are many religious scientists who do excellent work in cellular and molecular pharmacology.
Nevertheless, a truly consistent scientific worldview should only base itself on materialist explanations and not on supernatural ones. An ability to weigh up the available evidence is important for the practical aspects of a scientific way of thinking, but this must be peer-reviewed expert scientific evidence, not someone’s unsubstantiated statements. Moreover, although peer review is a key part of how science is assessed, we should be aware that the review process is far from perfect. Peer review is carried out by scientists themselves and is therefore open to all sorts of biases, both conscious and unconscious. These biases range from ideas about what constitutes “good” scientific practice and the relevance of science to wider society to the perceived status of the scientists carrying out a particular piece of research.54 Scientific evidence should itself be based on experimental studies or a scientific analysis of, to give an epidemiological example, existing healthcare data. Someone with a scientific point of view should be prepared to revise their opinion radically if new evidence suggests that they ought to do so. As part of this, a scientific thinker is always trying to think up new hypotheses that might provide a better explanation for a changing situation, compared to previous hypotheses.
If we assess them by these criteria, many governments around the world have shown a lamentable lack of scientific thinking. There has been a willingness to ignore the advice of scientists about the necessary response to Covid-19 if it does not fit with states’ wider political goals. One big mistake was the failure to take seriously the evidence that the SARS-CoV-1 and MERS-CoV outbreaks were part of a dangerous trend towards the emergence of new and deadly coronaviruses.55 A second and perhaps even bigger mistake was the failure to recognise the significant differences between SARS-CoV-2 and these previous other two viruses. The fact that this virus led to few or no symptoms in the vast majority of people, yet could be lethal in a small but significant minority, should have set off alarm bells far sooner than it did. Clear warning signs of this from the initial outbreak in China were ignored. Indeed warnings were coming from some scientists. Their failure to be heard until it was far too late reveals both a lack of scientific thinking at the heart of many governments and a willingness to ignore scientific advice that does not tally with political goals.
These are the failures at the top of society. When we look at the relationship between ordinary people and science during the pandemic, we see a contradictory situation. On the one hand, the overwhelming majority of people have followed instructions from public health experts to socially distance and stay at home. The many recorded examples of people looking out for vulnerable neighbours or applauding healthworkers goes against the right-wing idea that people are naturally selfish.56 On the other hand, the Covid-19 pandemic has exposed a lack of scientific thinking among certain sections of the population. This is not simply due to lack of scientific education amongst the population: it also reflects the effect of alienation in capitalist society.
For Marxists, alienation means more than its general sense of a feeling of separateness or being alone and apart from others. The Marxist understanding of alienation refers to the contradictions that stem from the need of workers in capitalist society to sell their labour in return for wages. The worker creates something—a plate of food, a piece of clothing, a scientific research report—and receives a wage for doing so. The object is then sold for more than it cost to make, which is the source of the employer’s profit. At the end of the process the product no longer belongs to the worker but to the employer. It now appears to the worker as an alien object rather than a product of their own labour. Moreover, it is not just individual products that come to seem alien. The inhabitants of capitalism come to see society itself as an oppressive and unknowable object rather than a product of the collective efforts of human beings. Such a feeling can lead to science itself becoming an object of suspicion and unease.
What does this mean in the context of Covid-19? On the one hand, many people may be unclear about the actual material basis of the pandemic and so can fall prey to pseudo-scientific ideas about how to protect themselves or what constitutes a sensible social response to the pandemic. Because of this, socialists have a duty to engage in informed and honest debate, and to challenge commonly held misconceptions about Covid-19.
One very significant misconception is that SARS-CoV-2 is generally a lethal virus. Although the virus is very deadly for a certain proportion of the population, this is not the case for the majority. This is an important point. The novel coronavirus is not some invincible foe that governments could only struggle against and were doomed eventually to fail to contain. In fact, if proper isolation practices had been followed, the spread of infection could have been prevented and those most at risk from the virus could have been protected from serious illness and death. This misconception could also lead to an unclear sense of the actual risks of catching SARS-CoV-2 among people less at risk from Covid-19. That said, such fears may have played a useful role in encouraging compliance with social distancing guidelines.
Another common misconception concerns how viruses spread, and how they infect our bodies. There is confusion about the best ways to stop the spread of viruses in social environments as compared to how we prevent a viral infection from taking root in a person or treat it if it does take root. In fact, in terms of preventing the spread of SARS-CoV-2, the measures to be taken are quite straightforward. Minimising human social contact is one obvious way to stop the spread, as is avoiding contact with surfaces that might harbour the virus and regular washing if such contact might have occurred. This only requires soap, because coronaviruses are enclosed in a fatty membrane that can be dissolved by detergent.57
Although the many easy measures that minimise the spread of SARS-CoV-2 have been widely understood, some people have found it more difficult to grasp how to treat people once infected. Sadly, there have been cases of individuals who believed claims that injecting bleach or exposing oneself to high doses of UV can protect oneself against SARS-CoV-2 since these things can kill the virus outside the body. However, rather than simply scoffing at those gullible enough to believe such claims, it is important to point the finger squarely at those making these claims—most significantly President Trump, who is ostensibly the most powerful man in the world.58 Moreover, we should ask how a person with such an unscientific outlook was able to rise to such a prominent position.
Trump, Johnson, Brazilian president Jair Bolsonaro and various other right-wing leaders around the world have won power by articulating a feeling among many ordinary people that their views and concerns are not taken seriously by the neoliberal establishment that has dominated politics for decades. Because that establishment has tended to cloak itself in the guise of scientific rationality, it is unsurprising that the political backlash against it can take an anti-scientific form.
The Covid-19 pandemic is challenging for politicians like Trump and Johnson. The reality of the pandemic, expressed most starkly in the daily death toll, has exposed some of the rhetoric of these politicians. Of course, it would be foolish to underestimate the possibility of right-wing politicians mobilising discontent among working people in the course of this crisis, despite the fact that they are themselves responsible for the current mess. Trump and Bolsonaro have been able to direct the anger of some ordinary people against effective public health measures because the lockdown is having a much more negative effect on those at the bottom of society. Of course, socialists need to channel the horror and rage against government mismanagement of the pandemic and the huge numbers of unnecessary deaths. However, they also have to articulate the anger of people whose livelihoods and physical and mental health have been impaired by the continuing lockdown and the failure of the government to provide enough support to them.
May 2020 began with Trump supporters mobilising demonstrations against Democratic Party state governors to lift lockdowns, but ended with the biggest uprising against racism since the late 1960s. The almost insurrectionary response to the murder of George Floyd by a police officer shows how volatile the current situation is. Frustrations and divides that may have been exacerbated by the pandemic can lead sections of the population in completely opposite political directions.59 Ben Crump, a lawyer for Floyd’s family, exposed the links between the uprising and the pandemic when he revealed that the murdered man had recovered from coronavirus after testing positive in April. “It was that other pandemic that we’re far too familiar with in America, the pandemic of racism and discrimination, that killed George Floyd,” he said.60
What is to be done to stop the pandemic?
If governments across the world had taken prompt action in order to stop the spread of SARS-CoV-2 in its tracks, much of the current crisis could have been avoided. Instead, we are faced with an escalating death toll and a global economic crash as countries apply the only strategies they now have to contain the pandemic—social distancing and lockdown. This disaster has been caused by the inability of many leading politicians to understand basic epidemiological principles, a tendency to see elderly people and those with existing serious health problems as dispensable and a failure to plan ahead by developing vaccines and drug treatments. Opportunities to learn from the SARS-CoV-1 and MERS-CoV epidemics were tragically missed. The scientific establishment must share some of the blame. It is so aligned with the values of capitalism that it failed to criticise governments sufficiently at the start of this crisis.
In the developed world there will be increasing pressure by governments to get people back to work and restore “normality” as soon as possible. Socialists must argue that this should only happen in a safe manner. This is not only a matter of stopping even more needless deaths. A premature restoration of the status quo is likely to backfire and trigger a new wave of the pandemic. A recent study suggests that a second pandemic wave could be even more lethal than the first. Too rapid an end to lockdown, combined with colder autumn weather that enhances the spread and lethality of the virus, could be catastrophic.61 At the same time, socialists have to be attuned to the effects that a prolonged lockdown is having on working people. The growing ranks of the unemployed will face destitution unless much more significant support is given to them. We have to be aware of the serious impact that impoverishment can have on both physical and mental health. Our demands should be shaped by a concern for the all-round health and welfare of working people.
In the Global South, the direct impact of Covid-19 seems to be far less severe. The reasons are not yet fully understood, and we should not assume that this will remain the case. Furthermore, we should highlight the massive indirect effect of the pandemic in the less developed world. The lockdown that has resulted from the Covid-19 pandemic is likely to greatly increase the pressures on the poor in the Global South. This could lead to a huge rise in deaths from the other infectious diseases that already kill millions of people every year in the world’s poorer countries. A recent study predicted that an extra 1.8 million people would die from tuberculosis over the coming years because of a redistribution of resources from tackling this disease to focusing on Covid-19.62
Working class people in Lebanon have recently taken to the streets in mass demonstrations—thereby ignoring social distancing measures—because they claimed they were less afraid of dying from Covid-19 than of the effects of lockdown.63 In recent discussions in Ghana about how soon the lockdown might be eased, the main pressure for a return to work came from the country’s poor. Middle class professionals mainly wanted to prolong the lockdown. A worker called Raphael Awitor explained, “I planned to come to work on Monday whether or not the lockdown was lifted. We were really hungry.”64 Raphael’s job is making cement. Toiling in the hot sun, on a good day he earns a mere £11. Stories like this should give pause for thought.
Ultimately, the only force that can liberate humanity from the threat of infectious disease, hunger and poverty is the working people of the planet. There is a sharp need to overturn the capitalist system that has led us into this public health catastrophe in both the Global North and South. Only a socialist society can end the poverty, hunger and squalor that fuel infectious diseases, and ensure that the marvels of modern medicine benefit everyone, not just a tiny minority. Although a pharmaceutical cornucopia has been opened up under capitalism, the benefits have often been squandered by our unequal and oppressive system. Moreover, this system has stifled the far greater possibilities that exist for the development of new drugs. This means that the battle against the misery and death caused by infectious disease is also a struggle for a very different type of society.
John Parrington is an associate professor in molecular pharmacology and a tutor in medicine at the University of Oxford. He is the author of The Deeper Genome: Why There is More to the Human Genome Than Meets the Eye (Oxford University Press, 2015) and Redesigning Life: How Genome Editing will Transform the World (Oxford University Press, 2016). His new book Mind Shift: How Culture Transformed the Human Brain (Oxford University Press) will be published in January 2021.
1 Thanks to Esme Choonara, Joseph Choonara, Martin Empson, Sheila McGregor, Camilla Royle and Martin Upchurch for their comments on an earlier draft of this article.
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