This extensive work (originally published in March by Lucha de Clases in Spanish) exposes who controls the world’s economic and health resources, how we can break away from the exploitative and irrational capitalist system that is strangling public health, and how we can ensure healthcare for the working class of the entire world.
Several months have passed since one of the most traditional wet markets in Wuhan – the seventh-largest city of China – saw the first atypical pneumonia outbreak. Since the new virus was isolated, both the Chinese investigators and their counterparts in the WHO have identified the new pathogen as belonging to the coronavirus family, which widely spread in nature, and mostly infects animals, although some strains – particularly those of the beta coronavirus genus – make the leap to humans.
Since then, as if an earthquake were shaking the planet, the whole world has been turned upside down. Overnight, in every country, the bourgeois regimes, their states and governments of all stripes, face the greatest health, social and economic crisis in living memory. Now, everyone assumes that the most favourable outlook would be a scenario similar to the one in the 1930s before World War II, and in the worst of predictions, it could become the most serious crisis in the history of capitalism.
The inability of all governments in the world to face the COVID-19 pandemic has been clear from the beginning, displaying the anarchy that characterises the market economy, its inability to look ahead and its exhaustion as a progressive system.
The first reaction, starting with the Chinese regime, was to hide and downplay the risk that the epidemic posed. They probably calculated the outbreak could be controlled and that, as in 2003 with the SARS-VOC causing the so-called Severe Acute Respiratory Syndrome, transmission would not spread widely, and the virus would quickly disappear. That was the experience they had with SARS. On that occasion, from the first case in Guangdong in November 2002, the epidemic spread over several months to affect 29 countries between Asia, America and Europe, totalling (according to the WHO) 8,403 infected people, and 775 killed. Then, the epidemic disappeared and since December 2003 there have been no new cases reported.
Unfortunately, on this new occasion, the virus spread in a massive way because – among other reasons – unlike SARS, many of the infected people are asymptomatic. After a month of denying the evidence, the Chinese government started to take drastic measures, first in Wuhan, then throughout Hubei, but by then the virus had already spread to the rest of the world.
Far from learning the mistakes made by China, most of the governments of the major world powers initially followed the same path of improvisation and downplaying the danger. Only when the crisis reached uncontrollable dimensions did governments start to react and say that the struggle against the pandemic had to be thought of as a World War.
Of course, as always happens in war, the first victim is the truth. In every country, the ruling class and its governments have used the state and all resources at their disposal to hide the inability of their system to face this pandemic. They intend to hide their criminal responsibility by saying this is everyone’s struggle, and that the virus doesn’t discriminate between rich and poor.
Nothing could be further from the truth! This struggle, like other wars, has a clear class character, as the objective data shows us. It is the workers and our families who are suffering the most harmful health, economic and social consequences of the pandemic. It’s ordinary workers who, putting our health at risk, without any means of protection, guarantee that society can continue to function.
The billionaires who own and control the planet’s wealth and their cohort of privileged agents spare no resources to ensure their own protection. They tell us that, even though there are not enough means of protection and our health is at risk, production must not stop. Their goal is ensuring that profits keep coming to them, and even to turn the pandemic into a business opportunity.
This message that they repeat to us all the time, that the consequences of this virus affect us all equally, is a big lie. The reality is that the workers are suffering the consequences of this crisis, it is our futures and our families that are in jeopardy. For the bourgeoisie, what is really important, as in any past or future conflict, is to achieve the maximum possible profits, perhaps even profiting directly from the pandemic.
Imperialism in the 21st century, the concentration of production and dominance of monopolies
In his book Imperialism: the Highest Stage of Capitalism published in May 1916, Lenin concluded that, from an economic point of view:
“Imperialism is capitalism in that stage of development in which the dominance of monopolies and finance capital has established itself; in which the export of capital has acquired pronounced importance; in which the division of the world among the international trusts has begun; in which the division of all territories of the globe among the biggest capitalist powers has been completed.”
Today, analysing the world economic situation, his thesis has not only been confirmed by the facts, but the process that he anticipated has undergone an exponential development.
According to the Global 500 report of the American magazine Fortune, since the beginning of the 21st century, the 500 largest business groups produce and sell 40 percent of all wealth generated on the planet. In 2018, sales of these huge global capitalist conglomerates totalled $32.7 trillion: 38.12 percent of global GDP (estimated at $85.7 trillion), with net profits of $2.15 trillion. Over the past decade, G500 sales increased by nearly $10 trillion (from 23 to $32.7 trillion) and profits grew by $650 billion. The number of workers currently employed by these 500 businesses is 69.3 million. What is expressed in this data is that this huge concentration of production is generated by a small fraction of the workers of the world: 69.3 million out of 3 billion – just 2.4 percent of the world’s workforce.
|Sector||Businesses||Quadrillions ($)||Total Rev.
|Trillions ($)||Total F 500||Billions ($)||Millions|
|Motor vehicles and components||34||2.77||8.47%||115.682||5.38%||3.897||6.081|
|Grocery stores and pharmacies||18||1.152||3.52%||19.922||0.93%||0.758||4.111|
|Metallurgy and construction||12||0.872||2.67%||20.533||0.95%||1.213||2.464|
|Food, drink and tobacco||18||0.76||2.32%||55.34||2.57%||1.251||2.089|
|Aerospace and defence||14||0.692||2.12%||43.371||2.02%||0.993||2.344|
Table 1: 2018 - Distribution of F500 by sector. Source: Fortune magazine
Analysing the data in Table 1, we can see that healthcare is the F500’s fifth-largest sector with respects to turnover and profits. The 26 monopolistic groups that comprise it turned over $2 billion USD in 2018 and earned $112,076,000 USD. These large multinational corporations include insurers, medical service providers, manufacturers of medical and surgical equipment, distributors of medical equipment, and large pharmaceutical laboratories, with 13 groups represented.
|Billions ($)||Billions ($)||Billions ($)|
|USA||UnitedHealth Group – Insurance||226.247||11.986||152.221||300,000|
|USA||McKesson – Pharmaceutical Distributor||214.319||0.034||59.672||70,000|
|USA||CVS Health – Pharmaceutical Distributor||194.579||-0.594||196.456||295,000|
|USA||Amerisource Bergen - Wholesaler||167.94||1.658||37.670||20,500|
|USA||Cardinal Health – Pharmaceutical Distributor||136.809||0.256||39.951||50,200|
|USA||Anthem – Insurance||92.105||3.75||71.571||63,900|
|China||China Resources – Pharma||91.986||3.475||209.652||421,274|
|USA||Johnson and Johnson – Pharma||81.581||15.297||152.954||135,100|
|Switzerland||Roche Group – Pharma||60.846||10.738||79.680||94,442|
|USA||Centene – Insurance||60.116||0.9||30.901||47,300|
|China||Sinopharm – Pharma||59.98||0.884||49.823||128,600|
|USA||Humana – Insurance||56.912||1.683||25.413||41,600|
|USA||Pfizer – Pharma||53.647||11.153||159.422||92,400|
|Switzerland||Novartis – Pharma||53.166||12.611||145.563||125,161|
|USA||Cigna - Insurance||48.65||2.637||153.226||73,800|
|Germany||Bayer – Pharma||46.718||2.0||144.344||116,998|
|USA||HCA Healthcare – Medical Facilities||46.677||3.787||39.207||229,000|
|USA||Merck – Pharma||42.294||6.22||82.637||69,000|
|France||SANOFI – Pharma||42.105||5.082||127.339||104,226|
|G. Britain||GlaxoSmithKline – Pharma||41.109||4.832||73.941||95,490|
|Germany||Fresenius – Medical Facilities||39.571||2.392||64.812||276,750|
|USA||AbbVie – Pharma||32.753||5.687||59.352||30,000|
|USA||AbbotLaboratories – Pharma – Medical Supplies||30.578||2.368||67.173||103,000|
|Germany||Phoenix Pharma – Pharma||30.296||-0.1745||9.600||29,631|
|Ireland||Medtronic – Medical Supplies||29.953||3.104||91.393||98,003|
|Japan||Medipal Holding - Wholesaler||28.699||0.31||14.619||15,623|
Table 2: Companies in the health sector in the F500. Source: Fortune magazine
The first thing that stands out on an examination of the data in Table 2 is the overwhelming predominance of North American capital. US-based multinationals comprise 15 of the 26 largest conglomerates in the sector, turning over $1.485 trillion USD, or 73.90 percent of the total, with earnings of $66,822,000 USD or 59.74 percent. The other countries represented are Germany with three companies; China and Switzerland with two each; and Great Britain, France, Ireland and Japan with one per country.
The predominance of US companies reflects the enormous size of the North American healthcare market: 2.93 billion USD in 2018, 17 percent of US GDP and almost 40 percent of the world market. The US healthcare system, reliant on private management and control and defended by the bourgeois regime and the two parties that support it, uses up the most resources on the planet. It is the third-largest in per capita, spending with $9,403 USD per person, surpassed only by Switzerland ($9,674 USD) and Norway ($9,522 USD), and it is the most profitable to the international healthcare monopoly. Paradoxically, this enormous flow of resources does not guarantee universal healthcare. Only the wealthy sectors of the population with the most purchasing power are guaranteed quality healthcare. Workers, if they have company insurance or can pay for a private policy, see at-best limited health benefits. The system leaves many who fall through the cracks, more than 30 million people, without benefits or medical insurance.
|Country||Investment in healthcare
|% of national GDP spent on healthcare||Investment in healthcare|
Table 3: Healthcare costs in billions of dollars, percentage represents the GDP and cost per capita in the major world economies. Source: Expansión
Another important factor that emerges from examining the data of the healthcare sector is the importance of the big pharmaceutical laboratories, or Big Pharma. In terms of both the number of groups (13, or 50 percent of the 26 in the sector that makes up the F500) and turnover ($624,464,000 USD, or 31.08 percent of the total), it is the largest. Its profit margins are $71,991,500 USD, 64.25 percent of the sector total of $112,076,000 USD.
Global sales of medicines in 2017 represented between 20 and 25 percent of global health spending, 1.1 billion USD, distributed as follows:
- North America (United States and Canada): 37 percent
- Pacific/Asia: 22 percent
- Europe: 20 percent
- Rest of the world: 21 percent
That same year, the 50 largest laboratories on the planet had sales of $642,478,000 USD and earned $121,259,000 USD, with a rate of return on sales of 19 percent.
The origin of patents and their significance today
Not coincidentally, the appearance and legal regulation of patents – that is, the right granted by governments to an inventor of the exclusive use of his invention, keeping it off-limits to others’ use for a given period of time – is closely linked to the very origins of capitalism. The first patent law on record was passed in the Most Serene Republic of Venice in the year 1474. It set a term of 10 years. Subsequently, after the triumph of the American bourgeois revolution in 1787, a law related to patents was included in the American Constitution (article 1, section 8, paragraph 8), which empowered the US Congress “to promote the progress of science and the useful arts, guaranteeing for limited periods to authors and inventors the exclusive right over their respective writings and discoveries.”
An internationally accepted scheme of legal regulation of patents was critical, especially after the end of the Second World War, when international trade became essential to the entire capitalist economy. Thus, the agreement by which the World Trade Organisation (WTO) was created in 1995 established in its Annex 1-C the Agreement on Trade-Related Aspects of Intellectual Property (TRIPS). It details the basic principles of intellectual property aimed at harmonising systems of patent law among the signatory countries and in their relationships with world trade.
Patents for medicines in the United States are regulated by several laws, including the Hatch Waxman Act of 1984. This law establishes a patent term of 20 years from the date of application, renewable for another five years from the patent’s date of expiration. In Europe, as of 2004, the production of generic drugs can be requested eight years after the authorisation of the original drug. These generic drugs can be sold after 10 years.
In the infancy of capitalism, patents helped foster competition among the bourgeoisie, driving new inventions and technological applications, which permanently revolutionised the development of technique and the productive forces. However, this situation quickly became its opposite, and closing the market to less-competitive companies promoted the concentration of production in increasingly larger enterprises. These merged with each other, and with an intense and rapid concentration of financial capital, created a monopoly.
Today, in the pharmaceutical industry, the fight to obtain new patents for novel therapies, far from promoting knowledge and strengthening the fight against diseases, seeks only to guarantee high prices and monopolistic profits.
Patents, research and development, and medicine prices
In pharmaceutical marketing slang, medicines are divided into two main groups:
- “Essential Health”: drugs already tested and in widespread use. Patents have expired on these drugs, so anyone can synthesise them from their active ingredients or produce biosimilar drugs at a lower cost.
- “Blockbusters”: new medicines whose development and patent protection guarantees monopolistic control during the period of exclusive production and marketing rights.
With regard to the “blockbusters,” large labs invest mostly in research and development on diseases that they consider most profitable, especially oncology, HIV, hepatitis, autoimmune diseases, and chronic ailments.
According to sector estimates, the average investment in research and development needed to comply with the necessary legal requirements, register the patent, and market a new chemical or biological medicine amounts to between one and two billion USD.
The largest monopoly investments are dedicated to the production of so-called biological medicines. Unlike chemical drugs, they are not produced by a process of chemical synthesis, but are much more complex molecules derived from living organisms. They are proteins such as hormones or antibodies that humans produce under normal conditions. When people get sick, they do not produce these substances in the required amounts, especially in the case of serious chronic illnesses such as cancer, diabetes, asthma, and inflammatory bowel diseases.
Unlike chemical drugs, biological drugs are not produced in pill form; most are available only as injectables. Some examples of the best-known biopharmaceuticals are growth hormones, insulin, and those used for chemotherapy patients to raise their red and white blood cell levels: EPO for red blood cells and G-CSF to stimulate white blood cell granulocyte colonies. These medications are crucial for the treatment of many serious diseases, and access to them is vital for sufferers and their families.
Over time, biological medicines have become the main source of pharmaceutical industry income for several reasons. First and foremost, the prices that can be exacted during the life of the applicable patents are astronomical. According to a study by the North American Association “Patients for Affordable Drugs,” drugs for cancer treatment are among the most expensive in the United States and in the last 15 years their prices have increased tenfold.
Another factor that helps companies maximise profits on these drugs is that they are complex, making them expensive and difficult to copy. As of 2006 in Europe and 2015 in the United States, any laboratory can legally produce a medicine that is biosimilar to another whose patent has expired. However, even though eleven laboratories have been developing cheaper biosimilar versions for years, the examples are still very limited.
Developing a biosimilar medicine is much more costly in time and money than synthesising the generic of a chemical medicine. To produce a generic drug, the average investment ranges from $600,000 to $4,000,000 USD, and the time needed for its development is around three years. In the case of a biosimilar, the investment rises to a range of between $100 and $300 million USD and its development takes six to seven years on average. As a result, medium-sized companies often develop and produce drugs in developing nations: for example, 26 percent of the generics consumed in Europe and 24 percent of those sold in the US are produced in India. In the biosimilar market, war is waged between the large monopolies in the sector.
The profits at stake in this market are so great that the large pharmaceutical industry allocates hundreds of millions of dollars to finance medical conferences and articles in specialised magazines, simply to cast doubt on the safety of biosimilars. They question the expert criteria of health authorities, who claim that the biosimilar drug has the same therapeutic effects as the original drug. They argue that, if treatment starts with an original biological medicine, it would be dangerous to continue treating the patient with a cheaper biosimilar. The goal is to generate uncertainty and fear among the sick and their families. Big Pharma’s media and legal arsenal aims to ensure that, after the end of the patent, competition with biosimilars is as minimal as possible, thus maintaining the high profit rates guaranteed by monopoly prices.
The propaganda of the pharmaceutical industry lobbyists trumpets the role of private research and development in drug development as a way of justifying their colossal profit margins. However, the reality, according to most publicly-funded studies, is that at least 60 percent of the basic research and development of new drugs is actually carried out in universities and public research institutions. Of course, when there is a molecule capable of being used in a profitable drug, Big Pharma buys the exploitation rights to it and continues with its research and development. If the process ends, the laboratory that bought the idea sells the new drug to the public sector at whatever price the market will bear. Via this vicious cycle, the monopoly reaps multimillion-dollar profit margins.
|Country||Pharmaceutical company||Sales||Profits||%||Sales Billions ($)|
|Billions ($)||Billions ($)||Profits/Sales||Main brands|
|6||USA||Johnson & Johnson||
Table 4: the 20 biggest big pharma companies in the world in 2017, profits in millions of dollars and in percentage over sales, turnover in millions of dollars of the main brands of commercialised medicine. Source: sales on the prescription market PMFarma-Pharmaceutical Executive
In this table, we see this reflected in a concrete way the lion's share of sales and profits of the sector are concentrated in very few brands of drugs.
For example, the Swiss company Roche, the third-largest pharmaceutical company in the world, earned $8,717 million in 2017 with its three best-selling drugs alone, Rituxan, Avastin and Herceptin, all of which are used for cancer treatment (for rectal, colon and breast tumours) and had a turnover of $21,179 million that year, 53.55 percent of the total.
This process reaches its most extreme levels in some of the large laboratories of the United States. Take the case of Abbvie, where sales of a single drug, Humira – destined for the treatment of pathologies of the immune system such as ulcerative colitis, rheumatoid arthritis or psoriasis arthritis – amounted in 2017 to $16,078 million, 63.55 percent of its turnover. In the first half of 2018 alone, its sales reached an astonishing $13,960 million. The same situation is evident in the case of Celgene with Revlimid sales – implicated in the treatment of hematologic cancers as myeloma and lymphomas – that amounted to $6,974 million in 2017 versus a turnover of $11,114 million, 62.75 percent of the total.
Monopoly profits and healthcare monopoly merger with the state
Commodity production is inherent to capitalism. It is geared around the market and aims to achieve the highest rate of profit possible. This is a running theme in every productive sector. It does not concern itself with meeting the basic or social needs of humanity, nor does it care to improve or look after human health.
In an article published last year, Laura Marcos, of the Right to Health Association, details the following: nine out of ten businesses in Europe that received the most subsidies for health projects between 2010 and 2016 were big pharmaceuticals. Nevertheless, 75 percent of new drugs approved in Europe in 2015 either did not contribute to the market at all, or existed alongside better therapeutic alternatives. We’re at a point now where estimates have shown that the wasted R&D in healthcare could account for up to 85 percent of total funding.
In its pursuit of maximum profit, Big Pharma doesn’t think twice about putting the health and lives of millions of sick people at risk. It’s able to count on government health control bodies who turn a blind eye to the whole affair and are openly complicit in the activities of the monopoly.
Bayer and the side effects of Xarelto
Bayer, the German multinational pharmaceutical company, launched the first synthesised rivaroxaban molecule to the market in 2008 with wide acclaim from German and European public health authorities. This drug is used to dilute the blood and prevent clots, which could cause strokes. It aimed to replace two anticoagulants that were already on the market for years: Sintrom, with acenocoumarol as its active ingredient; and Aldocumar, a compound derived from warfarin. The drug was marketed under the brand name Xarelto, and Bayer reached an agreement with Janssen, Johnson & Johnson’s healthcare division, to distribute the drug in North America.
Through an aggressive marketing campaign, it quickly came to dominate the market. In 2017, 42 million patients were prescribed the drug, and this year, sales brought in $2.698bn for Bayer and $2.288bn for the North American multinational pharmaceutical.
However, they failed to warn the public of a particular side effect: the use of rivaroxaban may cause massive haemorrhages in some patients. Cases of patients suffering from the side effect started to appear as soon as it was made commercially available, and thousands of them either suffered from severe sequelae or died as a result of the haemorrhages. Bayer and J&J were held jointly and severally liable for 25,000 lawsuits in the US alone from family members of people who died from using Xarelto, and in late March of 2019 they had to pay $777m to those affected in the U.S.
A similar situation occurred with dabigatran, an anticoagulant, also synthesised in 2008, by the German multinational pharmaceutical Boehringer Ingelheim and launched to the market under the brand name Pradaxa. In 2014, they had to allocate $650m to over 4,000 lawsuits as a result of the lethal side effects of their anticoagulant.
Paradoxically, when the deaths from Xarelto started to become public, the renowned British Medical Journal warned in an article that the clinical trials that were conducted to justify the approval for Rivaroxaban’s release to the market were riddled with errors and flaws.
Purdue Pharma, the Sackler family and the public health crisis brought on by opioid consumption in the U.S.
In October 2017, the recently elected US President Donald Trump declared a public health emergency in order to deal with the wave of opioid addiction affecting millions of Americans. The previous public health alarm was decreed in 2009 in order to combat the outbreak of Influenza A (H1N1).
The situation was so severe that death by overdose became the biggest killer of adults in the U.S., on par with traffic and firearm-related deaths combined. In fact, overdose deaths rose from 16,849 in 1999 to 36,000 in 2007, 60,000 in 2016 and over 70,000 in 2017.
Trump argued, in an address to justify the declaration of a Health Emergency, that the fight against drug trafficking plays a critical role in combating the epidemic of addiction, and the most effective way to combat the trade is by building a wall across the Mexican border. Of course, as is usually the case with Trump, the reality behind the thousands of deaths from drug abuse did not feature at all in the presidential address.
The true cause of the over 400,000 overdose deaths in the last 20 years in the U.S. has its roots in the mid-90s, when U.S. healthcare authorities, under pressure from healthcare and Big Pharma lobbies, declared chronic pain the fifth vital sign, meaning its assessment, management and treatment must be deemed as important in terms of health as body temperature, blood pressure, respiratory rate and heart rate.
The immediate aftermath of this decision was that regulation became laxer, which facilitated the production of painkillers much stronger than those already on the market. In the following year, healthcare authorities authorised the use of two opiates: oxycodone and hydrocodone. The active ingredients for these drugs are extracted from the opium poppy, or the Papaver somniferum. Neither the labs nor the authorities explained that the increased potency of the painkilling effects of these new drugs was directly proportional to the risk of patients who were prescribed the drug developing a strong addiction.
In December 1995, the FDA’s first decision was to authorise the use and distribution of OxyContin, a painkiller introduced by Purdue Pharma of the Sackler brothers. The total subordination of state bodies to the interests of the monopoly was made public three years later, in 1998. That year, Dr. Curtis Wright, the FDA medical officer who gave the Sacklers the go-ahead, quit his job with the FDA and went on to hold a senior position in Purdue Pharma.
Once they had obtained government approval, the pharmaceutical company began an intense marketing campaign in an attempt to bolster the heavy sale of the oxycodone-based painkiller. Synthesised for the first time in 1916 in Germany, oxycodone is a derivative of thebaine, the same molecule heroin is obtained from. It is three times as potent as morphine.
From the very beginning, the pharmaceutical company directed its marketing strategy towards the inhabitants of the “Rust Belt” (a region in the Midwest states blighted by industrial decline) and rural areas within the country. They focused on the poorest states: those suffering from huge social issues, where job losses, subsequent drops in self-esteem and broken homes were the perfect breeding ground to get hooked on OxyContin.
They spared no resources in achieving their aims; their advertising budget rose from $187,500 in 1996 to $4m in 2001 and continued to increase year in, year out. In 2016, much of the media denounced the four biggest manufacturers of the three most-sold opioid painkillers in the U.S. (OxyContin and Vicodin, which contains hydrocodone; and Percocet, which contains oxycodone and paracetamol) for paying $46m in food, travel and other fees to over 68,000 doctors in order to encourage them to prescribe their opiates.
Their million-dollar strategy was simple: they had to normalise opioids, and the best way to do that was by counting on highly qualified medical speakers to back up the virtues of OxyContin and other drugs. In the Sacklers’ case, among their most active collaborators, they had secured the support of the AAPM (the American Academy of Pain Medicine) and the APS (the American Pain Society). They were generously reimbursed in compensation, and many of the two association’s members were contracted as lab consultants. In fact, Dr David Haddox, chair of the APS committee and staunch defender of the therapeutic benefits of opiates, was contracted by Purdue from 1999 to 2019.
The practical outcome of their actions became evident in no time. Sales of OxyContin shot up from $80m in 1997 to $2.1bn in 2001, and year-on-year turnover and profits continued to increase. In 2010, turnover surpassed $3bn and made up 80 percent of the lab’s sales and profits. It is estimated that, between 1996 and 2016, thanks to OxyContin sales, Purdue made over $35bn. This is in parallel with the exponential growth in wealth of the Sackler brothers, owners of the laboratory, making them one of the richest families in the exclusive American Billionaire Boys Club. According to Forbes magazine, they have amassed a fortune of over $13bn.
As the labs earned billions of dollars in profit, social and public health consequences rocked towns and cities in every U.S. state. Millions of Americans began to take opiates prescribed to them by the healthcare industry. Middle-aged Americans were the first to take them, as they are more likely to suffer from pain. No one informed them that they were strong, addictive drugs and that they could easily get hooked.
The situation was so extreme that, in 2012, over 286 million prescriptions were given for OxyContin, Vicodin and Percocet (that is, one prescription per U.S. inhabitant). States such as West Virginia, with little more than 1,800,000 inhabitants, were literally flooded with pills, as reported by Eric Eyre in the Charleston Gazette Mail in 2013. According to the DEA, between 2007 and 2012, labs and pharmaceutical distributors dispatched over 780 million opioid pills, 87 pills per inhabitant per year, to West Virginia. In the small town of Williamson alone, with a population of 3,000, Dr. Katherine Hoover gave out 333,000 prescriptions for opiates between December 2002 and January 2010 (14 per inhabitant per year). The little town soon became known as “Pilliamson”. According to the NBC network, Williamson emergency services treated an average of 50 patients each month due to overdoses in 2017.
State authorities and federal government were cognizant of the public health crisis from the outset. In 2006, Dr. Leonard Paulozzi of the CDC (the Centre for Disease Control and Prevention) published an article that warned of a 91 percent increase in opiate-related deaths between 1999 and 2002. A direct consequence of the exponential rise in painkiller addiction was the increase in the consumption of illegal drugs that were cheaper than the pills, such as heroin. Following this, and other such whistleblowing reports in 2007, the state of Virginia sued Purdue Pharma and three of its executives for the first time. The company reached a settlement in order to avoid a public trial. It acknowledged its role in deceiving doctors, patients and regulatory authorities and in hiding the serious addictive effects of OxyContin, and agreed to pay a fine of $635m.
Following the settlement in 2007, Purdue continued to break records in sales and profits with OxyContin. From 2013-2015, when their legal troubles started to mount and their sales in the North American market began to fall, the company turned to Mundipharma, its international affiliate, to use the same tactics to advertise the analgesic’s treatment of pain and to extol the drug’s virtues. This was in an effort to achieve high OxyContin sales in markets in Brazil, China, Russia, Great Britain, Spain etc.
Before the federal government was forced to recognise the gravity of the situation – which according to estimates by some economists, in the year 2015 alone cost the public $504bn dollars – and before finally declaring a public health emergency in autumn of 2017, over 500 cities and counties in Alabama, California, Illinois, Kentucky, Massachusetts, Wisconsin, Virginia, Utah, Tennessee, Missouri, New Hampshire, New Mexico, Indiana y Michigan and eight Native Indian tribes had already brought thousands of lawsuits against the labs responsible: Purdue, Janssen, Teva Pharmaceutical, Abbott Laboratories, McKesson distributors, Cardinal Health, and AmerisourceBergen, claiming over $50bn.
Despite all the evidence on the disastrous effects of these drugs on public health, business continues on unabated, and even continues to supply over 58.7 prescriptions of opiates per 100 inhabitants in the U.S. two years following the declaration of a Public Health Crisis.
Alzheimer’s, Parkinson’s and the anti-inflammatory Enbrel from Pfizer
In January 2018, Pfizer, the world's leading pharmaceutical company, announced the closure of its neurological department and the dismissal of its 300 employees. In its statement, Pfizer explained that its decision to abandon research for the development of new drugs, aimed at treating Parkinson's and Alzheimer's, had been adopted to reallocate those resources to investment areas where its product portfolio and scientific expertise were much greater.
A year later, on 5 June, 2019, journalist Christopher Rowland of the Washington Post, made public that, since 2015, Pfizer had hidden from the public that one of its teams of researchers, based on statistical treatment of hundreds of thousands of claims from insurers in the health sector, had made an important discovery that linked the intake of its star anti-inflammatory drug Enbrel – intended for the treatment of rheumatoid arthritis – with a reduction in the risk of contracting Alzheimer's by at least 64 percent. The researchers reached that conclusion by contrasting the incidence of the severe neurological disease between a similar number of people taking the anti-inflammatory drug, and the same number of those who did not.
To verify the potential therapeutic effects of Enbrel in the prevention, treatment, and delay of Alzheimer's, the researchers proposed to the executives of the multinational that a clinical trial be carried out among a trial of 3,000 to 4,000 people, both those who were treated or not with the anti-inflammatory drug. The estimated cost was $80 million.
The decision made by the Pfizer board of directors was not to conduct the clinical trial, nor to make public the conclusions of the study by its researchers.
Once the Post uncovered their scandalous conduct, the directors of the multinational were forced to try to explain it. They then claimed that their decision was based on the fact that their experts had concluded that Enbrel was not a therapy that could offer results in the treatment of Alzheimer's. Their rationale was that, according to them, the active ingredient in Enbrel was a molecule too large to pass through the blood-brain barrier and be able to act on inflammations of brain tissue. For that reason, they gave up the clinical trial. Likewise, they maintained that the decision not to make the study public was to prevent scientists outside the firm from directing their efforts in the wrong area.
Their ‘arguments’ did not convince anyone, and many front-line researchers on Alzheimer's from Universities like Harvard, John Hopkins, Southampton, demanded that the studies be made public and that it should be the scientists who evaluate their usefulness.
What Pfizer executives never mentioned was that the Enbrel patent expired in 2018; in fact, they had been marketing their new arthritis medicine, XELJANZ, for several years. What motivated their decision was the low return that their investment would have yielded, even in the case of a positive result, having to compete from the outset with much cheaper similar generics.
Their refusal to disseminate information that would open a promising field of research in Alzheimer's prevention was motivated by the same reason that at other times leads them to hide the harmful side effects of a new drug. The search for the maximum profit was prioritised, regardless of the therapeutic suitability of the medicine to be marketed.
In search of El Dorado, or the race to find the COVID-19 vaccine
Days after the first cases of COVID-19 occurred in Wuhan, Chinese authorities identified the new coronavirus and informed the WHO. Studying the new pathogen, the Chinese researchers and those of the WHO reference laboratories, found that it was very similar to the SARS-CoV that in 2002-2003 caused the epidemic of the Severe Acute Respiratory Syndrome. The new virus shares with SARS between 80 percent and 90 percent of its genetic material and its similarity is such that scientists named it SARS-CoV-2. There were also quite a few similarities with the so-called MERS-CoV, which in 2012 caused the first cases of the so-called Middle East Acute Respiratory Syndrome in Saudi Arabia.
The similarity between the two viruses is reflected in the fact that some of the symptoms and characteristics of COVID-19 coincide with those displayed by people infected by SARS. The similarity is greater in the most-severe cases, in which both pathogens have been found to cause pneumonia and excessive inflammation in the lungs, which stop working properly.
The most significant differences are also known. First, in the case of SARS, it was known from the beginning what was the animal from which the jump was made to contagion in humans: a civet. This information is still unknown in SARS-CoV-2. Secondly, the average mortality rate for SARS was 9.2 percent – 775 deaths of the 8,403 infected – and among those over 65 years of age or with preexisting hypertension, cardiac, respiratory or immune complaints, it shot up to 50 percent. In the case of COVID-19, with the partial and incomplete data available, the average rate ranges between 1.5 percent and 4 percent, and, as in SARS, it rises significantly among those over 65 and the chronically ill, where 20 percent of serious cases requiring hospitalisation are concentrated.
Finally, the qualitative difference between the two lies in their differing effectiveness in spreading contagion. In the case of SARS, the prevalence of contagion was 10 days and asymptomatic patients were not contagious. In COVID-19 patients, the prevalence can be up to 28 days and the asymptomatic ones are very much contagious. The much greater efficiency of SARS-CoV-2 in its transmission between humans facilitates massive contagion, which is what makes the new virus much more dangerous.
To all this previous information was added the sequencing of the genome and of the virus proteins, which China made public in early February. So the target protein (AC2) became known, which, as in SARS, the new virus uses as a key to penetrate the human cell.
Based on the similarity of the new virus with those of the SARS CoV and MERS, what a priori would seem more promising to accelerate the development of a prototype of vaccine and effective antivirals against COVID-19 would be to build on the progress made in the research carried out over the past 18 years on those other coronaviruses.
This has been the guideline followed by the team of researchers from the National Centre for Biotechnology (CNB) – belonging to the Spanish National Research Council (CSIC) – led by virologists Luis Enjuanes and Isabel Sola.
As Dr. Sola explained, with 35 years of accumulated experience working with coronaviruses, the combat strategy against COVID-19 is twofold: guarantee prevention; that is, to obtain a vaccine that provokes an effective immune response, and to produce antivirals to treat already infected patients.
Based on this double strategy, the objectives that have been set at the CNB are to create a prototype of the vaccine, using a technique called reverse genetics, which her team was the first to develop precisely for the study of SARS in 2002. It consists of eliminating the genes of the virus that neutralise the defences of the infected person – what they call virulence genes – which are the ones that induce such an excessive inflammation of the lung to the point of damaging it.
Once those genes are removed, the pathogen attenuates and becomes a good vaccine candidate. Once the attenuated virus has been generated, it is tested in cells and it is verified to behave as expected, then it will go on to the next phase: animal tests.
To start this second phase, an adequate animal model must be created in which the virus can be injected and cause a disease similar to that observed in humans. This model would be transgenic mice. At the time, they were created for SARS but they were not kept active in the animal facility and now they have to be recreated. This is accomplished through genetic engineering techniques. The aim is to ensure that the human virus receptor protein, AC2, is integrated into the mouse genome, thus guaranteeing that, when viral infection is induced, it is expressed in the target organ of interest, which in this case is the lung.
Once the animal model is available, the vaccine is given two to three weeks before the animal subject is infected with the virus, allowing time for an immune response to develop. When the vaccine prototype is confirmed to be effective and safe, it could then be moved to human testing. After verifying its efficacy and safety in humans, a so-called virus or vaccine strain would be produced, and from that moment on, the vaccine manufacturing process can begin.
As for antivirals, the starting point of the CNB laboratory will be to resume the tests with the prototypes that they have already developed to be used against SARS. On that occasion, the animal testing phase was reached, confirming that the antivirals were effective and that, when injected into the infected specimens, they protected them at a rate of 80 percent.
Given the similarity between SARS and the new SARS-CoV-2, it seems reasonable to think that compounds that already demonstrated their efficacy in 2002 could also be valid now. This possibility has already been confirmed with the antiviral Remdesivir that the multinational Gilead tested on animals, and then abandoned. Based on this hypothesis, their first objective, once they have the virus, will be to inoculate them into cells and check if they can contain the inflammatory response that the virus causes at the cellular level and thus combat one of the main causes of the disease.
The same guideline as that of the CNB team is the one being followed in other coronavirus groups by virologists around the world, who also started in those years the development of effective drugs against these viruses.
The handicap faced by all the research teams was synthesised based on Dr. Sola's personal experience:
“What happens is that when there is an epidemic, like with SARS in 2002, in that initial moment, there is greater investment in research, but once it has been contained, we forget. Lost is the opportunity to continue advancing the studies that had been initiated, to finish the development of a vaccine, or to complete the identification of antivirals that may be useful when a new epidemic appears.
“In our team, we have found that, at the time of presenting a research project to obtain funding for a vaccine against MERS-CoV, responses from the evaluation committees affirming that the research of a virus that affected a relatively low number of people, was not relevant. I have heard these kinds of comments personally when evaluating our project to develop a vaccine for a coronavirus very close to SARS COV2. With that idea in mind, one is not realistic, because viruses such as influenza and coronaviruses are emerging viruses and have pandemic potential, as we are seeing now. That reality should not be ignored. It would be irresponsible to abandon the research thinking that once an epidemic has been overcome, it will never happen again. Heaven forbid, the ability of viruses to emerge in the human population and to wreak havoc with this virus, or that could cause pandemic influenza is there. All this serves to make us aware of the importance of research.”
The same reflection was made by the professor at the UAB Animal Health Research Centre, Joaquim Segales, who in an article published in the Vanguard on March 23 recalled:
“For the SARS epidemic of 2002-2004, very effective vaccine prototypes were obtained and there were even several very successful clinical trials, but no product was registered. The same thing happened again in 2012 with MERS.”
Without a doubt, their opinions are shared by the overwhelming majority of the scientific community, which for years has been warning that it was necessary to prepare to be able to respond to a possible pandemic like the one we are suffering today.
Dr. Sola is absolutely right in highlighting the irresponsibility of abandoning research, the significance of which is evident today. We too sympathise with her sincere wishes that this will serve to convey the importance of scientific research.
Unfortunately, all those good wishes collide against the wall of laws that govern the market economy, and, in the case that concerns us, with the interests of the pharmaceutical monopoly. The motive that pushed large laboratories to invest in the research of Severe Acute Respiratory Syndrome was to take advantage of the business opportunity and the juicy profits, and, if the epidemic were to spread and lengthen over time, the patent for the vaccine and antivirals for the treatment of SARS. It was the same reason that moved them to abandon the research months later once the epidemic was extinguished.
Now that the pandemic, which researchers have been warning about for years, is a cruel reality, the rulers of the world do not tire of repeating to us that, only by joining together will we defeat the virus. If there were only one atom of truth in their proclamations, the first measure they would have taken would have been to coordinate the efforts of researchers from all countries, and make available to them all the necessary economic and technical resources. Undoubtedly, such an appeal would have had the enthusiastic support of the entire scientific community and in record time, a viable prototype of the vaccine could be available, with effective drugs to combat the disease and then be able to be manufactured and distributed throughout the world.
Instead of collaboration, behind a toxic cloud of propaganda, is an open confrontation between the most-powerful states. Their objective is to defend their prestige and the interests of their respective bourgeoisies. They compete to be first in the race to get the vaccine and antivirals necessary to treat COVID-19. Rather than defending public health, the interests that are truly at stake are strengthening power and prestige in the international sphere and having their industries obtain the largest portion of business and the potential profits.
In mid-March, when the first confinement measures began to be taken in Spain and Italy, many leaders still continued to question the importance of the pandemic, among others this was the case with the loquacious Mr. Trump. All his speeches were limited to lashing out at the “damn Chinese virus.” His cynicism knows no bounds! While in public they denied the gravity of the crisis, for weeks at the White House discreet meetings had been happening between the executive branch, regulatory administrations, and the pharmaceutical industry. This same process was happening in the ministries of the other powers.
On 23 March, in the Spanish newspaper La Vanguardia, the data published the previous day by the World Health Organisation was echoed. According to the WHO, at the moment, there are at least 40 institutions, public bodies, and pharmaceutical multinationals involved in the fight against the clock to synthesise the vaccine. There are already four prototypes for which animal clinical trials have started, and another two that will start in April. From all of these, the two most-advanced projects are being developed in China and the USA.
In China, research is conducted by the Ministry of Defence through the Military Academy of Medical Sciences in collaboration with the biotech company Cansino Biologics. As of mid-March, The South China Morning Star reported several successful clinical trials with primates had already been conducted. They are planning to start human trials with 108 volunteers in April.
The US project is being undertaken by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Health (NHI), the Coalition for Epidemic Preparedness Innovations (CEPI), and Moderna Therapeutics, which is the laboratory that is developing the vaccine, using a new genetic engineering technology called messenger RNA. The first human tests were scheduled to start on 14 March with 45 healthy volunteers between the ages of 18 and 55.
The main handicap of the Moderna project is that until now, health authorities have never authorised any of the drugs based on this technique, as they did not meet the safety standards required by the regulations. Coincidentally, a few days later, a meeting was held in which the International Coalition of Medicines Regulatory Authorities (ICMRA), the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) all participated. In this meeting, it was decided – in view of the exceptional nature of the COVID-19 crisis – to relax the criteria and requirements that have been applied until now. Anything goes in the search for El Dorado!
State response, improvisation and lies
Without drawing any conclusions from China’s experience, where on 23 January drastic lockdown measures were implemented in Wuhan and Hubei; across the globe, most governments continued to spread reassuring messages in the media. They asserted that the symptoms of the novel virus would be akin to those of the flu and that there was no cause for alarm. According to experts, the only thing for us to do if imported infections were detected would be to monitor the infected and their network of contacts, place them under quarantine, prevent the virus from spreading and prevent local transmissions.
A month and a half after China, on 8 March, once the situation was already spiralling out of control (118,000 people testing positive in 114 countries, and 4,291 dead), WHO declared a global pandemic. From that moment on, at a speed worthy of the best conjurer, both authorities and experts changed tack completely and decided to defend the need to wage a global war against the virus.
The situation has forced them to change the script to such an extent that, in order to justify their incompetence and lack of foresight, everyone started to repeat the same piece of misinformation at once:
“No one is responsible for the improvisation or the lack of resources because it was not possible to anticipate the pandemic, nor its extreme severity. Such severity is comparable only to the events of World War II”.
Working by Goebbels’ old maxim that the biggest lie, if permanently repeated, will end up looking like an unquestionable truth, they got to work and began a campaign of large-scale indoctrination which continues on today.
They cover their backs with the intellectual authority of every manner of experts in any position and repeat the same message to us ad nauseum: “We are not responsible because no one, not even the scientists, could anticipate the virus that would surface and when and where it would do so, nor could they anticipate its severity or its infection capacity.”
Behind their forceful assertion is a truism. They are reaffirming what any moderately intelligent person already knows, which is that: every scientific prediction has its limits, whether these limits be in the field of virology or in any scientific branch, and these limits reveal the level of developed knowledge and technology at that moment in time.
The unanswered questions they use to attempt to justify their lack of foresight are certainly obvious enough that only a fortune teller could be asked to answer them beforehand. Everyone knows, or has at least heard, that constant mutations and changes that produce new virus strains, distinct from the original, form part of the intrinsic nature of the broad spectrum of viruses that live within animals and occasionally infect us humans – you do not need to be an expert in virology to know this. Just like reliable weather forecasts, they have a time limit, and if this limit is exceeded, a good forecast becomes less probable. Virologists and epidemiologists could anticipate the risk and bet on the family of viruses the pandemic would emerge from using current resources and knowledge, however it was not feasible for them to know the specific mutation beforehand.
Even with the influenza virus, WHO’s Global Influenza Surveillance and Response System (GISRS) has been tracking the virus systematically for 65 years. It doesn’t know if the vaccine developed each year to combat the two periodic seasonal outbreaks – one for each hemisphere – will be more effective or less; it all depends on whether the three or four targeted strains are right or not.
The scientific evidence: a report on the predicted pandemic
The thesis that achieved practically unanimous consensus among researchers, but as of yet has not provoked an “institutional” reaction, was contextualised within the current situation by Julià Blanco, PhD in biochemistry and director of the Cellular Virology and Immunology Group at IrsiCaixa (La Vanguardia, 23 March 2020).
“What’s important is to think long term, not only regarding this coronavirus but for the other viruses to come. We have to get used to viral cross-species transmission becoming more and more common. Humans and animals live very close to each other. We are experiencing elevated population density levels and we are so mobile that any virus can travel globally in no time.”
He concludes with this:
“It is therefore important to prepare for future outbreaks by creating vaccines, capable not only of combatting the virus specifically, but all the other possible viruses to come.”
In stark contrast to the official arguments, simply listing out pandemic episodes and the emergency of new zoonotic viruses in the last 100 years more than justified the appeal from experts to healthcare authorities to adopt necessary preventative measures. All empirical evidence pointed to the urgent need to provide enough resources and funding to scientists in order to prepare for the threat to human life posed by the emergence of new pandemic viruses.
What was a predicted risk yesterday has turned into a harsh reality today, and the future is still uncertain.
|1918-1920||Spanish flu||Pandemic||Influenza A(H1N1)||500,000,000||50-100,000,000|
|1957-1958||Asian flu||Pandemic||Influenza A(H2N2)||Global||1.5-2,000,000|
|1968-1969||Hong Kong flu||Pandemic||Influenza A(H3N2)||Global||0.75-1,000,000|
Table 5: Summary of the most severe epidemic and pandemic outbreaks triggered by the influenza virus, smallpox virus and other viruses of the past 100 years. Source: WHO and Wikipedia
1. In the case of SARS-CoV, although the number of affected people was small, it was dubbed a pandemic because infections were transmitted in 29 countries across many continents.
2. In addition to the cases in question, two seasonal influenza outbreaks had to be added to the total, which lead to an average of between 3 to 5 million critical cases and between 250,000 and 500,000 dead.
Behind the “institutional explanation” lies their true objective: by any means possible, to avoid responding to these two main questions:
- Would we already have adequate (antiviral) vaccines for COVID-19 if we had heeded the researchers’ warnings?
- Why were the necessary resources and funding not being dedicated to preventing what today has become a harsh reality?
They know that simply asking these questions places the burden of criminal responsibility on their system – capitalism – where all is sacrificed on the altar of profits. The class that stewards this system is also culpable; a negligible minority of big bourgeois who, counting on the obedience and collusion of states and governments, control the commanding heights of the world economy with an iron fist, and also decided that investing in preventing a hypothetical pandemic was not profitable.
Nature, pandemics and humanity: a shared history
Last 12 April, the Spanish Público newspaper interviewed archaeologist and anthropologist Eudald Carbonell Roura, who has been co director of the Atapuerca excavations for over 30 years. A figure of international renown, Roura is one of the most famous experts in his field. The interview was published with this enlightening header: “COVID-19 is our last warning and humanity will soon collapse without collective awareness of our actions as a species”.
Anyone willing to understand the watershed moment we currently find ourselves at and explore the future of humanity must familiarise themselves with and bear in mind the deep reflexions and conclusions drawn in the interview, both of which contribute significantly to good judgement.
In response to one of the many questions put forward in the interview on the existence (or lack thereof) of epidemics in prehistoric times, Carbonell made the following statement:
“Of course, pandemics have always existed, but it’s difficult to find evidence of them because you have to consider that pandemics work according to the demographics of the time. It is not the same when 200 to 1,000 people are affected in an area to the point where they all end up dying and the virus does not have a host to infect because many kilometres away no one was aware of it. Today, in a globalised world, with large media outlets and means of transportation, virus hosts multiply exponentially.”
At least 70 percent of human diseases are of animal origin and that viruses and bacteria were already an integral part of nature long before our birth as a species. Bacteria have been found in the teeth, stomachs and faeces of fossil fish from 350 million years ago, and traces of pathogenic bacteria from 70 million years ago in mammal fossils. It would be logical to think that, through our contact with plants and animals, the emergence of pathogens transmitted between species would be inevitable. In fact, just as all who are born must die, health cannot be conceived of without disease; they are both an inherent part of the experience of any living being.
During much of prehistoric times, humans could only rely on a small set of tools and had not yet made a significant impact on nature. Human groups were isolated, and few and far between. The risk of an epidemic existed, but low population density and infrequent contact between distant groups reduced the potential for it to spread.
This limited interaction between humans and infectious pathogens begins to change from the Neolithic Revolution. The discovery of agriculture and the domestication of wild animals provide the guarantee of sufficient levels of food for increasingly higher human populations. The growth in population encourages exchange and contact between different settlements, and indirectly encourages the development of new microorganisms capable of sparking an epidemic.
It is no accident that there is evidence of the emergence of some of the more well-known viruses in this period. This is the case with smallpox (or the variola virus) the presence of which has been confirmed in 11,000-year-old Indian farming communities. Polio (or the poliovirus) is a disease found in an Egyptian funerary stele from the 18th dynasty in 1580 BC. The same is true of measles (the morbillivirus) of which there are traces in the Middle East and India dating from 2,500 BC.
Researchers are mostly of the same opinion that most of the pathogens we know have probably been with us for thousands of years, some of which include influenza. Hippocrates describes flu symptoms in 412 BC. They are of zoonotic origin: influenza and diphtheria derive from the pig, measles from the dog, tuberculosis from cattle and leprosy from the buffalo. Their hypothesis is based on the similarity between other viruses present in animals. It is also based especially on the close contact between humans and animals due to their domestication, a process which began in 8,000 BC in the Mediterranean Basin.
Pandemics in classical antiquity
One of the first epidemics for which there is written evidence is the one caused by smallpox in Athens in 430 BC, which was described by the Athenian historian Thucydides.
The first written references to pandemics affecting large geographic areas take place after the consolidation of the Roman Empire. Rome controlled large geographical areas in Europe, Asia, and North Africa, grouped a very large population that lived in cities, and had excellent land and sea communication routes, which facilitated exchanges and trade. Without intending to, they created the ideal conditions through which an infectious disease could spread among the population.
The first known historical episode of a pandemic was called “Antonine Plague or Plague of Galen”, which took place between the years 165 and 180 during the mandate of the emperor Marcus Aurelius. According to the description by the great physician Galen of Pergamumit was a smallpox epidemic, the first outbreak of which in 165 was unleashed among Roman troops besieging the city of Seleucia in the Middle East. The contagion quickly spread throughout the empire. Nine years later there was another outbreak that mainly affected Rome. An estimated five million people died.
Many historians describe Marcus Aurelius as the last of the great emperors. The slow decline of the empire began later with the reign of his son Commodus and the subsequent rise to power of the Severan dynasty, which culminates with the fall of Rome and the western empire in the latter part of the second half of the 5th century.
The second pandemic was the “Plague of Justinian", between 541-543. It occurred a few decades after the fall of Rome. According to Procopius of Caesarea, the plague, which is known today as a bubonic plague, spread throughout the Byzantine empire, Africa, Europe and Asia. It is estimated that between 25 and 50 million people could have died, from 13 percent to 26 percent of the world population at that time. The pandemic coincides with the attempt by the Emperor of Byzantium, Justinian the Great, to reconquer the lost territories in the West and rebuild the Roman Empire. This objective finally failed, despite the initial military successes, with the victories against Vandals and Ostrogoths by the great general Belisarius, opening the way in Europe to the consolidation of the Barbarian kingdoms and at the beginning of the Early Middle Ages.
The early Middle Ages
The fall of Rome, with which the Early Middle Ages began in Europe (6th to 10th centuries), meant the collapse of commerce and the physical destruction or irreversible deterioration of much Roman public works: roads, ports, bridges, aqueducts. This led to the abandonment of cities and a general process of ruralisation of the population.
The tremendous setback that occurred in all spheres, economic, technological, and cultural, together with the continuous wars to divide up control of the territory, caused a drastic fall in the population, which in the 10th century barely exceeds half of the population 400 years earlier. This explains why the more or less serious periodic epidemic outbreaks that continue to occur had a limited geographic and population extension.
The exceptional period of “The High Middle Ages”
Between the 11th and 13th centuries – a period that some historians call the High Middle Ages – the situation changed drastically.
The Vandal, Norse, and Hungarian wars over the search for territories to settle had ended. In the Iberian Peninsula, after the disappearance of the Caliphate of Córdoba in 1031, the Muslim advance stopped. Soon after, the crusades to conquer the Middle East and Jerusalem began in 1095-1291. The Islamic sphere was reduced to the Southern Mediterranean Basin and the Interior of Asia, and was no longer a threat, generating a situation of relative political and military stability in Europe.
The appearance of the iron plough with wheel and mouldboard, the use of the horse as a draught animal instead of the oxen, the cutting of forests for new crops and their triennial rotation, the installation and use of water and windmills, the use of iron tools – all these innovations came to pass alongside exceptional climatic conditions. Some historians speak of the Medieval Climate Optimum that even allowed the cultivation of vines in England. Production and agricultural surpluses multiplied, which in turn encouraged and developed trade. At the same time, there were important technical improvements in navigation and shipbuilding, such as the incorporation of the rudder and the compass.
In the Far East, Mongol rule over much of Asia ensured the safety of trade expeditions and allowed the Silk Road between China and Europe to be restored during the 13th century.
The sum of these factors led to a demographic explosion. The population doubled, and in the middle of the 13th century, it reached 73 million inhabitants. The increasing importance of trade caused cities to gain in size and power, multiplying the urban population. In some areas, such as northern Italy, the process was even more intense. In 1300, per capita income had tripled, the literacy level of the urban population was the highest in Europe, 50 percent of men could read and write, and 20 percent of the total population lived in large cities with more than 100,000 inhabitants such as Milan, Venice, and Florence, and many others such as Bologna, Lucca, and Genoa that exceeded 50,000.
‘The Black Death’, or the greatest biological disaster in human history
The previous situation of exceptional climatic boom and intense economic and social advances began to show signs of exhaustion at the beginning of the 14th century. The fertile land under cultivation was not enough to meet the needs generated by the large increase in the population. In addition to the shortage of new lands and draught horses to increase crops, there was a sudden worsening of climate conditions, with the start of the ‘Little Ice Age’, which caused a drastic drop in temperatures that further reduced agricultural production. Malnutrition and famine became widespread in many areas.
That was the scenario across Europe when the Black Death Plague of 1347-1353 was unleashed.
Although the exact place where the first cases occurred is not known, it is known that it started in Asia and also that it reached Messina, on a ship from the Genoese colony of Caffa in the Black Sea. From there, it spread throughout the Italian peninsula. That same year, Louis I of Hungary had started a military campaign to impose his dynastic rights on the crown of Naples. The contagion between his troops and the death caused by plague forced him to demobilise his army, and it was the soldiers that returned to their home countries who spread the epidemic to the rest of Europe. Ultimately, only Iceland and Finland were spared from the pandemic.
The name black plague or black death described the symptoms that patients developed in the final phase of the disease. It started with blue or black spots on the skin, caused by small skin haemorrhages. Later, black buboes appeared in the neck, arms, legs or behind the ears, due to the inflammation of the lymph nodes. The fingers and toes became gangrenous and finally the rupture of the buboes festered a liquid with a rancid smell. The duration of this final phase was about five days, causing the death of the infected in 90 percent of cases. There was no effective treatment.
After observing thousands of cases, it was concluded that the development of the disease was a maximum of 39 days, and any infected person that exceeded that time was not going to relapse again. From that moment, anyone who tried to enter a town or city had to remain isolated for 40 days.
From then on, the term “quarantine” was coined, which is used universally to describe any case in which it is necessary to isolate someone to check whether or not they have an infectious disease.
Although the exact number of victims is not known, it is estimated that in Europe between 24 and 48 million people died, from 30 percent to 60 percent of the population, with 75 to 200 million deaths worldwide. The incidence by geographical areas was very variable. While Florence and other cities in Northern Italy lost up to 80 percent of their populations, in the west of what is now Germany, one in 10 inhabitants died, and in France and England it was between 30 percent and 50 percent.
Many historians consider this pandemic to this day the worst biological disaster in the history of humanity, which continued to make its mark on all aspects of life for several decades.
Flu, smallpox, measles, and the colonisation of America
The 15th and 16th centuries represent the swan song of the Middle Ages throughout Europe. The deep meaning of this historical stage was summed up by Karl Marx in Revolutionary Spain:
“It was in the sixteenth century that were formed the great monarchies, which established themselves everywhere on the downfall of the conflicting feudal classes – the aristocracy and the towns. But in the other great States of Europe absolute monarchy presents itself as a civilizing centre, as the initiator of social unity. There it was the laboratory in which the various elements of society were so mixed and worked, as to allow the towns to change the local independence and sovereignty of the Middle Ages for the general rule of the middle classes, and the common sway of civil society.”
And referring to the particularities of the process in Spain, Marx added:
“In Spain, on the contrary, while the aristocracy sunk into degradation without losing their worst privilege, the towns lost their medieval power without gaining modern importance.” (1854)
In the Iberian Peninsula, the two ascending monarchies, Portugal and Spain – once their internal unification process was completed, with the defeat and annexation in the Spanish case of the last Muslim strongholds – focused all their interests on the search for new territories and trade routes.
The central objective that moved them was to discover new sea routes that would facilitate their access to new sources of raw materials and to trade in spices and other goods with Asia. The Ottoman conquest of Constantinople in 1453, with the closure of the Bosporus and therefore access from the Black Sea to the Silk Road, propelled them further in that direction.
Competing with the Portuguese sailors who, bypassing Africa and through the Red Sea, managed to reach the Indian Ocean, in 1492 the Spanish expedition began, led by Christopher Columbus, who in his search for a new Atlantic route to the Indies ended up reaching the American continent. The confusion lasted until in 1507, when they verified that the new world had no land connection with Europe.
For the first time, since the end of the last ice age when the rise of the Bering Sea made the so-called “Bering Land Bridge” that connected Siberia and Alaska disappear, the arrival of the Spanish broke the 10,000 years of isolation between America and Eurasia. Accidentally, the confrontation between civilizations with an uneven degree of development was combined with the time bomb that involved putting millions of Amerindians in contact with new diseases and pathogens against which they were immunologically virgin.
The Spanish conquerors came into contact, first in the Caribbean Islands and later on the continent, with peoples and civilizations such as the Aztecs, Mayans and Incas who had formed powerful empires, with very large populations, and who had their own highly developed cultures. The enormous, quantitative disproportion between the few thousand men that made up the bulk of the occupying forces and the millions of inhabitants that populated the entire continent is only partially offset by the comparative advantage of the much superior means of transportation, iron tools, supplies, and above all the armaments (swords, armor, cavalry, firearms and artillery) which they received by sea from Europe.
From the first contact with the native Caribs and Arawaks, the inevitable occurred. The latest studies confirm that, already in 1494, the troops of the second Columbian expedition were accompanied by an unexpected visitor: the swine flu virus. The infection did not take long to spread, ravaging the native population. Along with the flu, most of the pathogens responsible for the contagious diseases of Eurasia reached the coasts of the new world: smallpox, measles, typhus, cholera and so on. In this way, with each new military expedition of conquest, contagion would spread throughout the continent, generating a demographic hecatomb.
According to historian and writer Chris Harman, in his book A People’s History of the World, of the more than one million natives who, upon the arrival of the Spanish, populated the island that they baptised “Hispaniola” (Santo Domingo and Haiti), in 20 years the census fell to less than 28,000, and in 1562, only 200 survived.
At the beginning of the 17th century, in little more than a century of colonial rule, practically all pre-Columbian cultures had disappeared. Of a population of between 10 and 25 million that lived in what is now Mexico and Central America, barely 2 million survived, the same happened with the peoples encompassed by the Inca empire, which went from 7 million inhabitants to just over half a million.
There is no doubt that the impulse that led to the conquest and colonisation of the Americas reflected the historical need to break with the particularism and limitations of the old feudal order, thus laying the foundations for the development of a new economic model: capitalism, which from a historical point of view was progressive. But it is also evident that, in this development, the biological accident caused by the rupture of the American continental isolation accelerated the process in a very significant way.
As a cruel historical irony, the two powers that made their mark throughout the sixteenth century were soon relegated to an irrelevant position in the new scenario that they inaugurated worldwide, which also took shape with the rise of the bourgeoisie between the 17th and 19th centuries.
As Leon Trotsky masterfully explained in his book The Revolution in Spain:
“Spain belongs unmistakably to the group of the most backward countries of Europe. But its backwardness has a singular character, weighed down by the great historic past of the country Spain knew periods of great bloom, of superiority over the rest of Europe.
“The discovery of America, which at first enriched and elevated Spain, was subsequently directed against it. The great routes of commerce were diverted from the Iberian peninsula. Holland, which had grown rich, broke away from Spain. Following Holland, England rose to great heights over Europe. Beginning with the second half of the sixteenth century, Spain had already begun to decline. With the destruction of the Great Armada (1588), this decline assumed, so to speak, an official character. The condition which Marx called ‘inglorious and slow, decay’ settled down upon feudal-bourgeois Spain. The old and new ruling classes – the landed nobility, the Catholic clergy with its monarchy, the bourgeois classes with their intelligentsia – stubbornly attempted to preserve the old pretensions, but alas! without the old resources." (1931)
Objective data shows us that pandemics that have endangered humanity's very existence coincide with turning points in historical evolution. The necessary preconditions for the biological incident to occur are generated or greatly facilitated by the social situation of the time, and at the same time, this delays or accelerates the original process.
The qualitative difference between the COVID-19 crisis and all the previous pandemics, including the one caused by the Spanish flu of 1918-1920, is that today, for the first time in the history of humanity, there are the necessary technological and scientific means to anticipate an epidemic emergency and combat it. The biological disaster that yesterday was unpredictable and uncontrollable, today is a direct product of the incapacity of the bourgeois system.
The revolutionary implications of COVID-19
The health and socioeconomic crisis caused by COVID-19 represents an abrupt change in the lives of millions of people around the world, faced with an unprecedented situation: an emergency about which no one warned them.
Overnight, the outbreak of the pandemic has caused one of the greatest biological disasters in human history, with potentially more serious consequences than those of the 1918 Spanish Flu.
The tragic result, with millions of infection and tens-of-thousands of deaths endured by workers of the most developed countries, is only a small preview of the endless horror faced by hundreds of millions of disinherited in the Indian subcontinent, Central Asia, Africa and Latin America. These regions of the world, in which millions of human beings are crammed together in the suburbs of large megalopolises, with hardly any services and minimal health infrastructure, will be the ones that suffer the most devastating health and social consequences of the pandemic.
The virus has detonated all the explosive material in the foundations of economy, which has been accumulating for years in the form of underutilisation of current productive capacity, fall in productive investment, public and private indebtedness, financial speculation, trade tensions, and open battles for the control of raw materials and markets. COVID-19 has opened Pandora's Box: all the evils that were anticipated and expressed in 2008 have come to light, reflecting the organic and global nature of the crisis of a system that threatens the future of humanity.
The experts of the ruling class are astonished to see how, with each new economic downturn, their worst omens are confirmed. Although many questions remain, everything indicates that the acceleration and deepening of the contradictions that the virus has fueled are pushing the world economy into a crisis so deep that it will make 2008 seem like child's play.
The immediate consequences in the lives of millions of people have in many cases have meant moving from a situation of relative stability to seeing their jobs, living conditions, and the future of their families at risk.
The uncertainty over the epidemic, together with the slowdown in the economy, are a tremendous psychological blow that has suddenly broken all the securities, certainties, and routines that until recently marked people’s lives. Faced with such a radical and unexpected change, it is not surprising that what predominates at first are fear, confusion and doubt. Tomorrow, when the situation finally begins to normalise and the confinement is lifted, the pendulum of consciousness will swing violently and thousands will begin to reconsider, ask questions, and demand responsibility. Starting with young people and the most conscious sectors of the working class, the incipient questioning of capitalism that had been developing since the 2008 crisis will make a leap in quality. Breaking with the ideological ties of the past, thousands will ask themselves: how do we end this nightmare? Many will look to organise and take action.
The accident of COVID-19 has performed the work of the old mole of history, which for years moved hardly perceived, and in a few months has taken a giant leap, bringing to light all the contradictions of capitalism.
Abruptly, a parallel process of revolution and counterrevolution has opened, the outcome of which will be decided in the coming years!
The dilemma to be solved comes down to: who will prevail? There are two alternatives. Either the multiform hydra of the old social order will triumph, which uses all the material and ideological shields of states and governments to hide and protect the Dictatorship of the Capital, to whose selfish benefit the general interest is subordinated, putting at risk the very future of humanity.
Or, the tremendous potential power of the working classes that make society function, and who, learning from the harsh experience of the dramatic events of the current period, will become an effective creative force to expropriate the Aristocracy of Capital to create a new social order, based on the socialisation of knowledge, and accumulated technological and productive resources. Planned and controlled collectively, these would in a short time put an end to all the ills of unemployment, misery, disease, and barbarism. This would lay the foundation for a giant leap into a new era in the history of humanity.
The dilemma that humanity faces is the same that Frederick Engels anticipated more than 150 years ago: “Socialism or Barbarism”. Today, in the 21st century, this acquires an even sharper character and is reduced to: socialism or destruction of humanity.