In Part 1 of this series, I summarised the decades-long process via which neoliberalism and its offshoot, philanthrocapitalism, have derailed the New Public Health agenda laid out in the World Health Organization’s 1986 Ottawa Charter for Health Promotion.
In Part 2, I’m going to narrow in on the ways in which philanthrocapitalism has directed the global response to SARS-CoV-2, and differentiate this from a response guided by true public health principles.
First, let’s examine the impact of philanthrocapitalism on the response to the emergence and spread of SARS-CoV-2. Remember, philanthrocapitalism is the application of business-like strategies to philanthropy, including harnessing the profit motive in order to achieve social good.
(Side note. Bill Gates is not ‘giving away all his money’. In fact, Gates’ net worth has increased from US$75 billion in March 2016 to a staggering $106.3B today, an over 40% increase in three years. It appears that being a philanthrocapitalist doesn’t harm one’s own bottom line. Between them, Gates, Jeff Bezos and Warren Buffett personally own as much wealth as the bottom half of all U.S.households combined. US billionaire wealth surged $282 billion, or 9.5%, in the 23 days prior to April 10, 2020.)
But who defines ‘social good’? The unelected, unaccountable philanthrocapitalists themselves, of course, presently unabashedly spearheaded by Bill Gates, who, despite having precisely zero credentials in any branch of medicine, is now being described in the mainstream media as a ‘public health expert’.
Gates was even granted an editorial in the world’s top-ranked medical journal, the New England Journal of Medicine. He leveraged this editorial to trumpet his own foundation’s actions in the pandemic, stress the importance of slowing the spread of SARS-CoV-2, and emphasise the centrality of technological solutions in the response to the pandemic, with a particular emphasis on developing vaccines, in which his foundation has heavily invested.
The Bill and Melinda Gates Foundation’s funding priorities are, self-admittedly, “driven by the interests and passions of the Gates family”. The Foundation has been criticised by no less an authority than Richard Horton, editor-in-chief of the world’s second-ranked medical journal, Lancet, for its “whimsical governance”; lack of transparency and accountability; the dramatic mismatch between its grants program and the “burden of disease endured by those in deepest poverty”; the distortion of important health program by its grants; “the alarmingly poor correlation between the Foundation’s funding and childhood disease priorities” reflected in a near-total absence of investment in maternal and child health and nutrition; its complete neglect of chronic diseases; and its lack of investment in health systems and research capacity in low-income countries, which serves to perpetuate both cycles of poverty-related illness and the ‘brain drain’ from such countries.
Horton summarised the Gates Foundation’s highhanded approach to those it claims to be committed to serving with this trenchant comment:
“Although it is driven by the belief that ‘all lives have equal value’, it seems that the Foundation does not believe that every voice has equal value, especially voices from those it seeks most to assist.”
Richard Horton, ‘What has the Gates Foundation done for global health?’
Gates’ continual insistence that the only way that our lives can return to their pre-COVID-19 state is the development and near-universal deployment of one or more vaccines against SARS-CoV-2 – described by him as the ‘final solution‘ to COVID-19 – has been echoed by politicians including NSW Premier Gladys Berejiklian and Canadian Prime Minister Justin Trudeau.
Gates’ single-minded focus on vaccines is hardly new. Over half of the Gates Foundation’s funding is allocated to vaccine development and delivery, with private research organisations, universities, and civil societies in rich countries being the major recipients of Gates Foundation grants.
Gates has “described the key approach to eliminating the main causes of early childhood mortality as ‘the invention of a handful of new vaccines and getting them into widespread usage’.”
Yet in their seminal 1977 paper, ‘The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century’, John B. McKinlay and Sonja M. McKinlay pointed out that
“The introduction of specific medical measures and/or the expansion of medical services are generally not responsible for most of the modern decline in mortality.”
In fact, the McKinlays calculated that at most, 3.5% of the total decline in deaths from influenza, pneumonia, diphtheria, whooping cough, and poliomyelitis between 1900 and 1977 in the US could be ascribed to medical measures (including both treatments and vaccines) introduced for those diseases. So what factors accounted for the remaining 96.5%?
An exhaustive analysis by McKeown, Record and Turner concluded that improvements in nutrition, hygienic measures (including water supply, sewage and garbage disposal, food handling, and safer infant feeding practices) were responsible for the vast majority of the decline in mortality in England and Wales in the twentieth century.
The same declines in mortality occurred in all developed countries in the same time-frame, after adoption of the same suite of public health measures.
Conversely, in regions where these fundamentals of public health have not been implemented (as in many developing countries, including India), infectious diseases are still a major cause of death to this day, despite the introduction of drugs and vaccines and their intensive delivery – largely sponsored by the Gates Foundation – to impoverished populations.
Yet the “technological bias” of the Gates Foundation mitigates against the time-tested public health solution to the scourge of infectious illness such as provision of clean water, sewage and waste disposal.
In fact, the capacity of the public sector to deliver such services is undermined by philanthrocapitalism, as Linsey McGoey, Professor of Sociology at the University of Essex, UK, and author of No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy explains:
“The new ‘philanthrocapitalism’ threatens democracy by increasing the power of the corporate sector at the expense of the public sector organizations, which increasingly face budget squeezes, in part by excessively remunerating for-profit organizations to deliver public services that could be delivered more cheaply without private sector involvement.”
The authors of a detailed analysis of the Gates Foundation’s grant-making program characterise the dichotomy between the philanthrocapitalist and public health approaches:
“Thus, rather than viewing the hundreds of thousands of child deaths from rotavirus infection as a clinical problem that needs a vaccine solution, a better approach might be to view it as a public health problem that needs a social, economic, or political intervention to ensure universal access to clean water and sanitation.”
The Bill & Melinda Gates Foundation’s grant-making programme for global health, McCoy et al
Philanthrocapitalism is not just undermining the application of fundamental public health principles in developing countries; it is also doing so in developed countries, by diverting attention from the social determinants of health. As a recent editorial in The New England Journal of Medicine pointed out:
“The most consequential question in the new normal for the future of US and global health is this: Will leaders and the public now at last commit to a firm, generous, and durable social and economic safety net? That would accomplish more for human health and well-being than any vaccine or miracle drug ever can.”
Choices for the “New Normal”, D. M. Berwick
While the eyes of Bill Gates, politicians, and the mainstream media are fixed firmly on the development of a vaccine as our only possible salvation, little bandwidth is given to concerns that a rushed SARS-CoV-2 vaccine may be unsafe or ineffective due to viral mutations.
But there is also mounting evidence that by the time it’s developed and tested, it will be unnecessary.
The virus has been spreading, largely silently, through various populations including Los Angeles, New York, Chicago, Iran, Japan and Germany.
And it has been doing so for far longer than initially believed, as revealed by the recent identification of France’s first retrospectively-diagnosed COVID-19 case.
A man treated in hospital for a flu-like illness tested negative for influenza on December 27 2019, but his reanalysed blood sample was found to be positive for SARS-CoV-2 – nearly a month before France declared its first case. Since the man had no history of travel to a COVID-affected area, he must have contracted the virus from someone with whom he had come in contact while conducting his everyday business, indicating that there has already been widespread community transmission in France.
Meanwhile, Sweden now appears to be on track to achieve herd immunity – a state in which a sufficiently large percentage of the population has encountered the virus and developed natural immunity to it to halt viral transmission and thereby protect the vulnerable – by sometime in May. And all without significant damage to its economy or to public life.
The approach taken by health authorities in Sweden illustrates the difference between the technological and public health approaches to infectious disease outbreaks. The Swedes have exhorted their citizens to self-isolate if they fall ill or are over 70, taken measures to protect the elderly and vulnerable, and prohibited gatherings of more than 50 people while keeping schools, bars and restaurants open.
Remember the definition of public health given by the US Centers for Disease Control? Here it is again:
“Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases.
Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world.
Public health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research—in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured. Public health also works to limit health disparities. A large part of public health is promoting healthcare equity, quality and accessibility.”
Dr David Katz – who, not coincidentally, holds a Master of Public Health – has laid out a strategy for responding to SARS-CoV-2 that is guided by public health principles.
The strategy, which he describes as “Total Harm Minimization”, emphasises protecting all members of society from the threats from which they are most at risk.
In the case of the frail elderly and younger people with comorbidities that increase the risk of developing severe outcomes of infection, the greatest threat is exposure to the virus. Closing nursing homes to visitors and ramping up testing of the staff of these institutions, along with providing additional services to community-dwelling at-risk individuals so they don’t have to go out in public until the crisis is over but are still fed and cared for, are sensible protective measures for this risk group.
How well is Australia protecting its frail elderly?
26 of the 97 deaths attributed to COVID-19 in Australia so far have occurred in nursing homes, which were clearly not adequately guarded from the beginning of the epidemic, despite clear evidence that elderly people were most at risk of serious and fatal outcomes:
In the case of young, healthy people and the more robust elderly, the greatest threat is disruption and even destruction of the entire fabric of their lives by the closure of schools and businesses, draconian restrictions on freedom of movement, assembly and even speech (as Internet censorship ramps up) that have been inflicted on them in the name of ‘flattening the curve’.
“Public health is the science of protecting and improving the health of people and their communities.”
The health of people and their communities is intimately linked to their financial status. As of 6 May 2020, 1 million Australians had lost their jobs entirely, over 5 million were on the JobKeeper payment (a wage-subsidy program that will cost $130 billion), and a further 1 million had been forced to dip into their retirement savings to support themselves and their families, due to the forced shutdown of businesses.
And it’s going to get even worse: Treasury has predicted unemployment will double to 10 per cent in the June quarter, the highest level in 26 years.
The economic shutdown is costing the national economy A$4 billion per week, with Gross Domestic Product predicted to plummet by 10 per cent in the June quarter, effectively wiping $50 billion off the economy.
The severe economic downturn will affect every government-funded service that Australians rely upon – schools, infrastructure, social services and, yes, the health system – for years to come.
The reduction in public services and increased taxation to service ballooning national debt will impact primarily on those currently of working age and those who are now still too young to vote, but whose education – and therefore future employment prospects – is currently being severely disrupted.
“Overall, public health is concerned with protecting the health of entire populations.”
One glance at the government’s summary of COVID-19 statistics reveals the failure of its strategy to achieve this end.
While people aged 20-29 are the most likely to contract SARS-CoV-2,
they are not at risk of dying from it:
and, as noted above, 30% of COVID-19-associated deaths have occurred in residents of nursing homes and recipients of in-home care, who clearly were not adequately protected.
Furthermore, the epidemic self-evidently peaked in late March, before lockdown measures were implemented,
yet millions of Australians were effectively placed under house arrest, deprived of social contact, employment and recreation for all of April.
Furthermore, the healthcare system is not now, and has never been throughout the SARS-CoV-2 epidemic, under significant strain:
yet treatments deemed ‘non-essential’ were cancelled, resulting in disruption to continuity of care and significant unnecessary suffering – everything from delayed dental treatments and IVF procedures to cancellation of reconstructive surgery.
On top of all these woes, reports of domestic violence, child abuse and neglect have spiked – again, iniquities that primarily impact on population groups that are at minimal risk of serious illness from SARS-CoV-2, but who are now being confined with their abusers without the prospect of escape to work, school or friends’ homes.
Calls to suicide hotlines have also spiked, as people facing financial crisis and the stress of isolation, compounded by the constant stream of fear-porn emanating from mainstream media, spiral into anxiety and depression.
Two points in the pledge made by participants in the First International Conference on Health Promotion in Ottawa are particularly noteworthy in the light of the global response to the emergence of SARS-CoV-2:
“to acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health, living conditions and well-being;
The Ottawa Charter for Health Promotion, World health organization, 1986
to reorient health services and their resources towards the promotion of health; and to share power with other sectors, other disciplines and, most importantly, with people themselves.”
This is the essence of the public health approach: empowering people and communities with the information and resources (financial, social and personal) they need in order to maximise their health potential, while respecting their right to make their own risk assessments and the decisions about how to live their lives that flow from these risk assessments.
Sweden’s success in pursuing a public health-oriented approach to COVID-19 stands in stark contrast to outcomes in countries which have pursued the authoritarian approach favoured by Gates as the mouthpiece of philanthrocapitalism. The graph below clearly demonstrates that locked-down Belgium, Spain, France, UK, Italy, Switzerland and Netherlands have fared worse than Sweden, with death rates continuing to climb in several of these countries while Sweden’s steadily declines.
Professor Isaac Ben-Israel’s analysis of international data indicates that SARS-CoV-2 has a “shelf-life” of “about eight weeks” regardless of the approach taken to it; Professor Knut Wittkowski asserts that the virus will burn itself out even faster due to the development of natural herd immunity.
As Johan Giesecke, one of the world’s most senior epidemiologists and advisor to the Swedish government has pointed out, it is not Sweden that is conducting a dangerous experiment in novel infection control methods on its population; it’s the rest of the world. And that world-wide experiment is levying an unacceptably high toll on young, healthy people and on the institutions and norms of democratic societies.
An article published in the Journal of the American Medical Association highlights the tension between public health and individual rights:
“Achieving a careful balance between public health and individual rights requires adherence to 6 key principles: (1) interventions should be evidence-based and grounded in scientific knowledge, not political considerations; (2) health officials should make individualized risk assessments demonstrating a significant risk to the public; (3) coercive measures should be proportionate to the threat faced; (4) there should be no less restrictive alternatives to accomplish public health objectives; (5) individuals subject to deprivation of liberty should be afforded due process, including impartial hearings; and (6) government should ensure fair and equal treatment, avoiding stigma or discrimination against individuals or groups.”
Presidential Powers and Response to COVID-19
Our Federal and State governments have failed to achieve this balance, apparently having fallen under the sway of philanthrocapitalism’s proffered technocratic solutions – temperature-sensing drones, de facto house arrest enforced by heavy-handed policing, and an intrusive and insecure surveillance app. The restoration of an appropriate balance depends on how loudly the public demands it.
Remember, taking good care of your health is even more important than usual due to the high levels of stress generated by the world’s response to COVID-19, and the fact that people with pre-existing chronic disease, as well as smokers and people with obesity, are at higher risk of serious complications of infection.
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