Underfunded and under threat

‘At least 29 US states have passed laws, enacted other initiatives, or succeeded in lawsuits that permanently weaken state and local government authority to protect public health, and similar efforts are pending in multiple other states. The analysis was published by Kaiser Health News and the Associated Press as part of their ongoing series “Underfunded and Under Threat,” which examines how US public health systems were unprepared to confront the COVID-19 pandemic and face ongoing politicization, funding cuts, and other hindrances. Legislators in at least 16 states have limited public health authorities’ ability to issue mask mandates or quarantines or isolation orders, and in some cases, legislatures gave themselves that authority or shifted it to other elected officials. In at least 17 states, lawmakers passed legislation banning SARS-CoV-2 vaccine mandates or passports or facilitated opt-out options. And in at least 14 states, new laws, executive orders, or court rulings ban or limit mask mandates. 

‘Proponents of the new measures argue that they are a necessary check on executive powers, particularly for appointed officials, and give lawmakers a voice in public health emergencies. Public health officials and experts have expressed frustration with these efforts and warned that the consequences of these actions will extend far beyond the current pandemic. These new limits could also impact public health officials’ ability to prevent and contain future outbreaks for any number of communicable diseases. At least 303 state and local public health department leaders have resigned, retired, or been fired during the pandemic, according to the analysis.’ Johns Hopkins Center for Health Security e-newsletter 

• Public health officials face wave of threats, pressure amid coronavirus response (June 12, 2020). Read here
• Pandemic backlash jeopardises public health powers, leaders (Dec 15, 2020). Read here
• Hollowed-out public health system faces more cuts amid virus (July 1, 2020). Read here
• Politics slows flow of US pandemic relief funds to public health agencies (August 17, 2020). Read here

Read here (KHN & AP, as at Sept 17, 2021)  

Privatised health services worsen pandemic

‘Decades of public health cuts have quietly taken a huge human toll, now even more pronounced with the pandemic. Austerity programmes, by the International Monetary Fund (IMF) and World Bank, have forced countries to cut public spending, including health provisioning.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• ‘Government is the problem’
• Neoliberal reforms worse
• Unhealthy reforms
• Austerity kills
• Government not main problem

Read here (IPS News, Aug 24, 2021) 

Suggest pragmatic steps in handling Covid-19 nightmare: Jeyakumar Devaraj

‘We (in Malaysia and in the world) are now facing the biggest crisis faced by humankind since the Second World War. We need our government to do the right thing to steer us out of this combined health and economic crisis. The government has to:

1. Implement movement restrictions as and when required to keep the incidence of new cases from overwhelming the capacity of our hospitals;
2. Ensure that the vaccination programme reaches 80 percent of our population (26 million) as soon as possible. As of date, only 11 million Malaysians have signed up. The rest remain unconvinced, and the anti-vaxxers are not helping the situation;
3. Ensure that those whose incomes have collapsed because of the MCOs are identified and supported; and
4. Raise the funds necessary to do all of the above without compromising Malaysia’s credit ratings in the financial markets.

‘The government needs the support and trust of the people in order to carry out the above measures. I would submit that unfairly running the government down and undermining its credibility does not help in handling the Covid-19 nightmare. 

‘Do criticise if there are shortcomings and if possible, suggest pragmatic steps that can be taken to overcome these. But disparaging everything the government is doing on the basis they are an “illegitimate backdoor government” and therefore everything they do must be faulty, is not helping the situation. Let’s leave partisan politicking aside for now and focus on navigating safely through the Covid-19-induced health/economic storm.’

Read here (Malaysiakini, May 27, 2021)

The mental pitfalls of Covid: Tomas Pueyo

‘If a handful of governments had failed, it would be easy to single them out. Instead, the failure was widespread. Most Western governments failed to contain the virus. When so many humans fail, they are not at fault. Politicians are humans. They’re flawed, biased, like you and me. Their failures are understandable.

‘What failed is the system. Systems should be designed to eliminate human failure. Here, they didn’t. Why have western democracies been so bad at incorporating information quickly? Why was decision-making so poor? Why were they so bad at coordinating citizens, which at the end of it is their sole function?

‘Covid is bad, but thankfully its Infection Fatality Rate is not civilization-threatening. Many upcoming challenges will threaten the collapse of our civilizations, from Global Warming to low fertility, inequality or AI. If our governments have been exposed to be incapable of solving even COVID, what will they do about these more important problems?’

Also discussed why politicians made the errors they made, and what that tells us about ourselves and how to prepare for the future: 

1. Not doing a cost-benefit analysis
2. Not accounting for confidence
3. Dogmatism
4. Social proof
5. Availability bias
6. Authority
7. Escalation of commitment & confirmation bias
8. Reinventing the wheel
9. Desensitization (and hedonic adaptation, framing, storytelling, and anchoring)

Read here (Uncharted Territories, May 25, 2021)

‘We are witnessing a crime against humanity’: Arundhati Roy on India’s Covid catastrophe

‘As this epic catastrophe plays out on our Modi-aligned Indian television channels, you’ll notice how they all speak in one tutored voice. The “system” has collapsed, they say, again and again. The virus has overwhelmed India’s health care “system”.

‘The system has not collapsed. The “system” barely existed. The government – this one, as well as the Congress government that preceded it – deliberately dismantled what little medical infrastructure there was. This is what happens when a pandemic hits a country with an almost nonexistent public healthcare system. India spends about 1.25% of its gross domestic product on health, far lower than most countries in the world, even the poorest ones. Even that figure is thought to be inflated, because things that are important but do not strictly qualify as healthcare have been slipped into it. So the real figure is estimated to be more like 0.34%. The tragedy is that in this devastatingly poor country, as a 2016 Lancet study shows, 78% of the healthcare in urban areas and 71% in rural areas is now handled by the private sector. The resources that remain in the public sector are systematically siphoned into the private sector by a nexus of corrupt administrators and medical practitioners, corrupt referrals and insurance rackets.

‘Healthcare is a fundamental right. The private sector will not cater to starving, sick, dying people who don’t have money. This massive privatisation of India’s healthcare is a crime.’ 

Read here (The Guardian, Apr 28, 2021)

Right to life: Dead in India?

‘Constitution and national health policies should have been the guiding philosophy for leaders and planners. But did we even read them?... The deadly combination of uneducated leaders, greedy corporates, ignorant public, and the contemptuous disregard for science has wreaked havoc. Our priorities are misaligned and actions ill-intentioned.’

Read here (Outlook India, Apr 25, 2021)

PM Modi owns India’s unfolding Covid disaster: Bloomberg

‘As in so many of the pandemic’s worst-hit countries, this tragedy was avoidable — and is largely the fault of a boastful and incompetent government. Yet, judging by the fate of other bungling far-right politicians such as Brazil’s Jair Bolsonaro, the UK’s Boris Johnson, Hungary’s Viktor Urban, and the Philippines’ Rodrigo Duterte, Indian Prime Minister Narendra Modi may well suffer few political consequences for his devastating missteps...

‘Yet, while Trump lost to Joe Biden in large part because of his callous and clueless handling of the pandemic, the margin was disturbingly narrow. Other strongmen look more likely to survive politically — and to continue to add to the toll of needless deaths.

‘For his part, Modi not only enjoys much higher approval ratings than Trump ever did. He has also survived, already, blunders that would have wrecked any other political career: demonetization in 2016 and a botched lockdown last year that caused the biggest and most desperate internal migration witnessed in India since 1947.

‘Modi has flourished with the help of something Trump never had and the likes of Boris Johnson only sporadically enjoys: a compliant media. Indeed, one reason why complacency about the virus spread so widely in India is that Modi personally asked owners and editors of press and television in March last year to focus on “positive” stories. Evidently, as his website put it, “it was important to tackle the spread of pessimism, negativity and rumor.”

Read here (Times of India, Apr 21, 2021)

Covax: A global multistakeholder group that poses political and health risks to developing countries and multilateralism

‘This report concentrates on the political and economic repercussions on the global South and how COVID and the multistakeholder structure of COVAX is driving a transformation of global governance. Multistakeholder governance is not the way to govern vaccine distribution, vaccine production, or the delivery of the vaccine to the peoples around the globe.

‘Multistakeholderism is premised on marginalising governments, inserting business interests directly into the global decision-making process, and obfuscating accountability. There are no standards of responsibility, obligation or liability for multistakeholder bodies. The multiple layers of the bodies ‘overseeing’ the multistakeholder COVAX program obscures any moral obligations, even while COVAX makes profound life decisions for hundreds of millions.

‘Probably no other commercial product has been produced that in its first years expects to have the entire world as its consumer base. COVAX as a multistakeholder body provides a gathering spot for business interests which otherwise may not be allowed to jointly plan marketing, productions, investments, and distribution in what is for them a major evolving vaccine global market. There is significant potential for commercial self-interest to be injected inappropriately into Covax decisions.’

Read here (Friends of the Earth International, Apr 7, 2021) 

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)

Is Noor Hisham a bystander in the Covid-19 crisis? Frankie de Cruz

‘Some claim the director-general of health, who wasn’t fazed by whatever was thrown at him in the early days of the crisis, is in a political straitjacket. Could it be that his views have narrowed the political and economic choices of those in power to relatively tight parameters?

‘If that is true, it needs fixing. In the meantime, the people expect professionalism and strong leadership at a time when Covid-19 infections and deaths are rising. That means Noor Hisham has to be firm and shoot straight to give Malaysians the confidence that the war is being fought with confidence.’

Read here (Free Malaysia Today, Jan 31, 2021)

Pandemic fatigue? How adherence to Covid-19 regulations has been misrepresented and why it matters

‘To the surprise of many, adherence to stringent behavioural regulations has remained extremely high (over 90%), even though many people are suffering considerably, both financially and psychologically. Equally, despite anecdotal observations about growing violations and polling which shows that people report low levels of adherence in other people, both self-reported data and systematic observations of behaviour in public places suggest that adherence stayed high during the second lockdown. Some 90% of people or more adhere to hygiene measures, to spatial distancing, and to mask wearing most of the time. Moreover, people generally support regulations and, if anything, believe that they should be more stringent and introduced earlier. This pattern has been repeated in the past few days, with 85% of the public endorsing the January lockdown and 77% thinking it should have happened sooner...

‘The problem, then, is that in psychologising and individualising the matter of adherence, one disregards the structural factors that underlie the spread of infection and the differential rates in different groups. One also avoids acknowledging the failures of government to provide the support necessary to follow the rules (most obviously in the case of self-isolation). Additionally, one overlooks the fact that some of the rules and the messaging around them may be the problem (such as encouragement to go out to the pub—doing one’s “patriotic best” according to the prime minister—and to return to work after the first lockdown). It is particularly misleading and unfair to ask people to do things and then blame them for doing so.’

Read here (BMJ, Jan 18, 2021)

Covid has exposed how incompetent the British state is, from top to bottom

‘Coronavirus has revealed a country so ill-governed that current politicians cannot be blamed for all of it. The traditional model holds that ministers decide on the general direction of policy and officials interpret and implement it. This balance of roles has been eroded at least since the turn of the century, largely by a ministerial craving for headlines that led to a daily welter of central initiatives, interventions and vanity projects. Officials are expected not to challenge but to obey.

‘This has clearly affected the calibre and morale of the civil service, with high-profile departures from Downing Street, the Home Office and Foreign Office. Johnson also gave too much prominence to scientists, hoping to blame them if things went wrong, and then found himself in perpetual conflict with them. This in turn allowed Scotland, Wales and Northern Ireland to appear blessed with decisive and clear-sighted leadership by contrast.’

Read here (The Guardian, Jan 4, 2020) 

There are thousands of Covid strains, so this new scare is NOT a big deal, but politicians just love their new authoritarianism

‘Let me set the scene. The world (we are told) is in the grip of a deadly plague. Health services (we are told) are on the brink of collapse. And just when you think things cannot get any worse, the horrific news comes down from on high that our invisible enemy has mutated into an even scarier form. Although it is too early to know anything of substance about it, it is entirely possible that it is more contagious, or more dangerous, or – who knows – maybe both.

‘Was that the situation at the weekend as the UK was plunged into what’s rapidly become its worst crisis since World War II (and certainly the worst self-induced one), just ahead of Christmas? No, this was the precise situation FIVE MONTHS AGO, when I wrote about Spike D614G, a mutant variant of coronavirus that we were told could be up to NINE TIMES more contagious. You may not remember because that mutant strain turned out to be a total nothing burger. So why would this one be any different?’

Read here (RT, Dec 21, 2020)

The institutional crisis and Covid-19

‘This is what an institutional crisis looks like. The most extreme claims of corruption become readily embraced by one faction and condemned by another. The belief that the presidency is corrupt becomes the framework of political life.

‘This goes beyond the political. I have written about the crisis of expertise, of experts who know their own field brilliantly but cannot comprehend the consequences of their actions beyond that field. The American government after World War II was built on the sanctity of expertise. That principle has since come under challenge in many areas, where the myopia of the experts undermined its depth.

‘The COVID-19 pandemic drove the point home. There were those who invoked the authority of medical experts as paramount. There were those who argued that, absent a cure, the solution the experts submitted – masks and social distancing – was only marginally effective and ignored the devastating economic and social consequences of the solution. There was no clear institutional authority that could strike a reasonable balance.’

Read here (Other News, Dec 8, 2020)

The governance of Covid-19: Anthropogenic risk, evolutionary learning, and the future of the social state

‘We consider the implications of the Covid-19 crisis for the theory and practice of governance. We define ‘governance’ as the process through which, in the case of a given entity or polity, resources are allocated, decisions made and policies implemented, with a view to ensuring the effectiveness of its operations in the face of risks in its environment. Core to this, we argue, is the organisation of knowledge through public institutions, including the legal system. Covid-19 poses a particular type of ‘Anthropogenic’ risk, which arises when organised human activity triggers feedback effects from the natural environment. As such it requires the concerted mobilisation of knowledge and a directed response from governments and international agencies. 

‘In this context, neoliberal theories and practices, which emphasise the self-adjusting properties of systems of governance in response to external shocks, are going to be put to the test. In states’ varied responses to Covid-19 to date, it is already possible to observe some trends. One of them is the widespread mischaracterisation of the measures taken to address the epidemic at the point of its emergence in the Chinese city of Wuhan in January and February 2020. 

‘Public health measures of this kind, rather than constituting a ‘state of exception’ in which legality is set aside, are informed by practices which originated in the welfare or social states of industrialised countries, and which were successful in achieving a ‘mortality revolution’ in the course of the nineteenth and twentieth centuries. Relearning this history would seem to be essential for the future control of pandemics and other Anthropogenic risks.’

Read here (NCBI, Dec 4, 2020)

Unconventional measures for extraordinary times no excuse for more abuse

‘...There are widespread concerns that bolder expansionary fiscal policies are likely to be abused by typically short-termist governments of the day, tempted by macroeconomic (ethno-)populism, and unconcerned about the medium- and long-term consequences of increased spending, borrowing and debt. 

‘Only much better governance, transparency and accountability can minimise harm due to likely ‘leakages’ and abuses associated with increased government borrowing and spending. Such fiscal policies typically involve governments borrowing, especially by selling bonds and other securities, including to central banks. 

‘Publics often presume that governments tax first in order to spend. In fact, they usually spend first, and then tax. Poorly accountable governments often take advantage of real, exaggerated or imagined crises to pursue more populist macroeconomic policies to secure regime survival and benefit the politically well-connected.’

Read here (ksjomo.org, Dec 3, 2020)

Human Rights Watch: “Whoever finds the vaccine must share it” — Strengthening human rights and transparency around Covid-19 vaccines

‘The Covid-19 pandemic has shown that the fates of people all over the world are interconnected: protecting one country’s people and its economy from the impacts a deadly infectious disease is impossible unless the people of other countries are also protected. Governments have a critical role to play in funding efforts to develop safe and effective vaccines. But no amount of funding will guarantee equitable access without decisive collective action and global cooperation to challenge the profit-driven and opaque systems that have determined access to lifesaving treatments and vaccines in the past.

‘Governments should continue to fund Covid-19 vaccines, especially to ensure access for low- and middle-income countries. While doing so, they should take all possible measures, including directing and conditioning funds in ways that are aligned with their human rights obligations to share the benefits of scientific knowledge and its applications widely, and ensure participation, transparency, and accountability in vaccine research, development, and manufacturing.’

Read here (Human Rights Watch, Oct 29, 2020)

Cate Blanchett: ‘Covid-19 has ravaged the whole idea of small government’

In this extract from her essay collection Upturn, the actor considers the disruptions of the pandemic and the renewed fervour for social and economic justice...

‘For the arts, I fear the good old days of root and soil porous gateway-ism are a thing of the past. The relationship between artist and audience has changed fundamentally. The tools of the future on hand today, from selfies to Zoom, are just awkward attempts to grab back the surface appearance of connectivity. Real connectivity will need to find a new way. The good news is, it will – and it will be fascinating and illuminating and confronting.’

Read here (The Guardian, Oct 29, 2020)

A world in disorder

On September 14th 2020, the GPMB released its second report titled, A World in Disorder. In this report, the GPMB provides a harsh assessment of the global COVID-19 response, warning that the world cannot afford to be unprepared again when the next pandemic hits. The Board called for five urgent actions to be taken to bring order out of the catastrophe and chaos currently facing the world: responsible leadership; engaged citizenship; strong and agile systems for health security; sustained investment; and robust global governance of preparedness.

The Global Preparedness Monitoring Board (GPMB) is an independent monitoring and accountability body to ensure preparedness for global health crises. Comprised of political leaders, agency principals and world-class experts, the Board provides an independent and comprehensive appraisal for policy makers and the world about progress towards increased preparedness and response capacity for disease outbreaks and other emergencies with health consequences. In short, the work of the GPMB will be to chart a roadmap for a safer world.

Download here (Global Preparedness Monitoring Board, Sept 14, 2020)

Meet the philosopher who is trying to explain the pandemic: Giorgio Agamben criticises the “techno-medical despotism” of quarantines and closing

‘In a society that respects science, expertise confers power. That has good results, but it brings a terrible problem: Illegitimate political power can be disguised as expertise. This was an idea of the French philosopher Michel Foucault, who used it to explain how experts had expanded definitions of criminality and sexual deviancy. One of Italy’s most celebrated thinkers, Giorgio Agamben, has recently applied similar insights to the coronavirus, at the risk of turning himself into a national pariah...

‘Mr. Agamben’s name may ring a bell for some Americans. He was the professor who in 2004, at the height of the “war on terror,” was so alarmed by the new U.S. fingerprinting requirements for foreign visitors that he gave up a post at New York University rather than submit to them. He warned that such data collection was only passing itself off as an emergency measure; it would inevitably become a normal part of peacetime life.

‘His argument about the coronavirus runs along similar lines: The emergency declared by public-health experts replaces the discredited narrative of “national security experts” as a pretext for withdrawing rights and privacy from citizens. “Biosecurity” now serves as a reason for governments to rule in terms of “worst-case scenarios.” This means there is no level of cases or deaths below which locking down an entire nation of 60 million becomes unreasonable. Many European governments, including Italy’s, have developed national contact tracing apps that allow them to track their citizens using cellphones.’

Read here (New York Times, August 21, 2020)