Alastair Cartwright explains how the current economic system is prone to failure and what needs to be done to change it
A system beyond repair
Announcing his botched interpretation of lockdown on Monday evening, Boris Johnson told the public that ‘without a huge national effort to halt the growth of this virus, there will come a moment where no health service in the world could possibly cope because there won’t be enough ventilators, enough intensive care beds, enough doctors and nurses.’
A huge effort on a national and international scale is indeed necessary. But let’s examine the second part of that sentence: the idea that such a massive and unprecedented crisis would push any health care system to the point of crisis. According to Johnson’s statement, this is regardless of the 17,230 NHS care beds removed from service over the last decade. It is regardless also of prior warnings given during major outbreaks in the recent past.
In addressing the nation, Johnson not only dared to insert a sly apology for the role of his party in depriving hospitals of essential resources but also looked to bury the fact that these cuts were initiated by the very same Conservative ministers who a year earlier were warning the then Labour government about the underprepared state of the NHS.
A catastrophe foretold
Do the following words, spoken in Parliament, sound familiar to anyone?
'We have not previously raised this in detail with Ministers, because it seemed premature to do so, but given what the Imperial college modelling suggests about the impact of the virus, I think it is appropriate to do so now… I hope that the Minister of State will be able to tell us what measures the Government has taken to support additional critical care capacity – for example, ensuring additional ventilators are available.
The latest data on adult critical care services in a number of the most developed health economies… sets out the number of adult intensive beds per 100,000 people – that is the relative measure… The House will note the apparent substantial disparity in the availability of critical care capacity in this country and in many other countries. Anyone who has visited critical care units recently will know that they are generally full. The ethical and prioritisation impacts of a pandemic are therefore likely to be encountered rather faster in this country than in many others.’
The date was 14 May 2009, in the middle of the Swine Flu pandemic, and the speaker was Conservative MP Andrew Lansley, addressing himself to the Labour Health Secretary. When the Coalition government came to power a year later, Lansley in his new role as Health Secretary became the architect of the 2012 Health and Social Care Act, which radically opened up the NHS to privatisation in an effort to find billions of pounds worth of ‘efficiency savings’.
Right now, London hospitals are saying their intensive care units can barely cope with any more patients. In Italy on Tuesday, 743 people died from Covid-19. Italy is estimated to have upwards of 70% more critical care beds per head of population than the UK, yet its health system buckled under the weight of numbers hospitalised by the virus. There is a desperate need for more ventilators, as well as infusion pumps, specialist drugs, protective equipment, and, fundamentally, staff.
Governments were warned about this, and not only the UK. The Washington Post has revealed how a leading US manufacturer of surgical masks wrote to President Trump three years ago warning that the country’s protective mask supply ‘could - and most likely would - be disrupted… in the event of a pandemic’. The same company had already raised the alarm during Obama’s presidency in 2010.
Masks, ventilators and other equipment are running dangerously low. On Amazon today you can buy a box of 50 surgical masks for £29. Manufacturers would usually sell the equivalent volume for about £5. The WHO estimates that since the start of the COVID-19 outbreak, prices for surgical masks have seen a sixfold increase, N95 respirators have trebled in price and gowns have doubled.
The Sun and the Daily Mail have shamed individual ‘hoarders’ for panic buying. What they never mention is the total inadequacy of a system based on profit and competition when faced with a human crisis, and the criminal negligence of the British government in ignoring early warning signs more than ten years ago.
Blocked, broken, incapacitated
The medical equipment and pharmaceuticals industry form a complex supply network that has proven vulnerable to the Chinese lockdown. Checkpoints and quarantine stations in the Hubei exclusion zone have led to empty shipping containers stacking up in Chinese ports.
For the same reason that Apple outsources its iPhone production to Foxconn, medical equipment suppliers have come to rely on cheap, globalised labour. Low-profit margins on basic items like masks offer little incentive to manufacturers in countries where the industry has shrunk in favour of financial and other services. According to a 2014 briefing by the U.S. Department of Health and Human Services, up to 95% of US surgical masks are made overseas, in places like China and Mexico.
Quite naturally, China is meanwhile buying up supplies to protect its own people. The country has signed a $2 million contract with a US-based firm to produce 5,000 goggles and 5,000 face shields per day (10 times the firm’s normal output). So while the richer nations of the West outsource production to China, China itself is block-booking production in the US.
At the same time, EU countries are bickering over export bans on protective equipment, leaving Italy to fend for itself – or look to Russia and China for help.
An upset in the global division of labour has left the system incapacitated. Similar irrationalities govern the actual rhythm of production and distribution. The Atlantic magazine has highlighted how today’s ‘just-in-time’ distribution methods, which only keep 15-30 days worth of products in stock, have exacerbated the problem. The supplies manager at The Medical University of South Carolina put it like this: “I guess we’ve done a good enough job within the health-care supply chain of getting pricing down to the point that the vendors don’t have a lot of extra margin or slack to play with.”
In the case of the NHS, part of the problem lies with the private companies contracted to manage hospitals’ distribution networks. In an effort to cut spending, the NHS last year switched from DHL to Unipart, despite concerns that the latter – which subcontracts part of its service to a US logistics company – lacked experience and capacity.
The more health is treated as a commodity, the more the production and distribution of essential medical equipment become keyed to the fluctuations of the market. One of neoliberalism’s favourite catchphrases even finds its way into an official NHS emergency response framework: ‘just in time’ contracts with suppliers will be activated in the event of a pandemic.
Dither vs the People
In the middle of a disastrous global backlog, governments are scrambling for solutions. Yesterday’s unthinkable has become today’s necessity. Yet the current response is tentative when measured against the magnitude of the crisis. Johnson’s dithering shows signs of pressure from both the left and the right but his government remains wedded to a corporate-friendly approach.
The UK’s Department for Business, Energy and Industrial Strategy, for example, has approached firms such as JCB and Rolls Royce about producing extra ventilators. But negotiating licenses from the big players in medical technology like Philips and General Electric – so that other companies can roll out their products – slows down the process. Shouldn’t copyrighted designs for these products simply be released as open-source blueprints?
On the PPE front, things are also moving. After 3,963 NHS workers signed a letter in the Sunday Times decrying the lack of protective equipment, Health Secretary Matt Hancock drafted in the army to ship millions of units of PPE from the national stockpile. As with most decisions this government takes, there has been little transparency about why these stocks were withheld until now, or how long they are expected to last.
The Covid-19 crisis exposes structural problems in the whole nature of global capitalism. But it also highlights the indispensable role of nurses, doctors, carers, cleaners, warehouse technicians, logistics administrators, lorry drivers, and dock workers. These and so many more are today’s key workers, and the crisis only emphasises their potential power. Strikes by Amazon workers in Italy and France have shone a spotlight on unsafe working conditions. New York teachers forced the closure of schools by announcing a collective sick day. And although many medical workers will find it difficult or impossible to walk out, their voices can have incredible weight in the current circumstances, to the extent that even the threat of discontent can alter the direction of politics.
It’s our job to do everything we can to support the various forms of collective action that are emerging, spreading and radicalising every demand that can save lives and steer the outcome of this crisis in a progressive direction.
Alistair Cartwright is an activist with the Stop the War Coalition and a member of Counterfire.
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