Pandemic futures

There will be another pandemic soon. This is pretty much the consensus among epidemiologists and other public health experts. This should be no surprise since there have already been a number of pandemics this century. Figure 1 lists some of them, but since it was adapted from a paper published in 2021, it is already out of date, since it omits the MPOX pandemic. Luckily, most of these pandemics, including MPOX, were contained rather quickly. AIDS (starting in the Twentieth Century) and COVID-19 have been two recent exceptions. Globally, AIDS is still killing half a million people a year, and COVID-19 killed somewhere between 7 and 20 million people in its first four years. Although the WHO (World Health Organization) and governments have drastically reduced the quality of their reporting since mid-2022, it seems likely that the death rate from COVID-19 has decreased considerably.

As we are writing this, it is unclear whether Bird Flu (Influenza H5N1) is going to become a pandemic among humans and, if so, how bad this pandemic will be. Between April 1 and July 19, 2024, ten human cases were reported in the United States, four of which were among workers exposed to sick dairy cows and six of whom were workers in contact with infected poultry. Serious criticisms have been made of the U.S. surveillance system (as we previously reported) but so far these infections seem not to be easily transmissible from person to person. This could change at any time as flu viruses can evolve rapidly. It is worth remembering that the influenza pandemic that started late in the First World War killed an estimated 50 million people (2.7 percent of the world’s population at the time). AIDS has so far killed about 40 million.

The frequency of pandemics is expected to increase because capitalist development is creating conditions under which pathogens (microorganisms, including but not limited to viruses and bacteria) can readily transmit from animals to people. Capitalist production techniques, particularly for meat, encourage pathogen mutation, and the overuse of antibiotics (particularly in food production) has led many formerly-contained diseases to mutate into forms that medicine can treat only with great difficulty or not at all. Others have described these processes many times, so we will only discuss a few of them.

Capitalism lives on profits, and capitalist nations like (most obviously) the United States, China, and Russia engage in imperialist competition and wars. Forests are cut down to make room for factories, military bases, airports, suburbs, and grazing land to grow meat. As a result, animals (including insects, birds, and rodents) that are hosts to potentially pandemic pathogens migrate to areas where people live, and people move to homes or workplaces near these animals. Soldiers are sent to march through wildlands, again putting them at pathogenic risk. In addition, capitalism leads to climate change, which leads animals such as dengue-carrying mosquitoes to migrate to new areas and their human inhabitants. Production of food, including beef, pork, chicken, duck, dairy products, and eggs, is increasingly carried out in confined mega-sheds or crowded feedlots, which means that infections spread rapidly among the animals being kept in unsanitary conditions, and that pathogens have plenty of opportunity to mutate to spread to workers who tend to them and then the greater society. To make them grow meat more efficiently in terms of inputs, and to speed their growth, animals are given antibiotics, which leads bacteria to mutate beyond the reach of human medicine–and some of these bacteria can be extremely infectious and dangerous.

Once new infectious pathogens reach humans, even if the pathogen is highly infectious and/or virulent (which means destructive to human health), this need not lead to an epidemic, much less a pandemic. If the people who get infected have little contact with other people, as was probably true of villages where some people got infected with HIV or its progenitors in the late 1800s, the pathogen may never get outside that village. With HIV, furthermore, it would likely not spread if none of the infected villagers had sex or shared blood with anyone outside of the village. Even if they did, the probability of their partner getting infected from one or two episodes is far lower than for some other pathogens such as those that cause gonorrhea.

Capitalism, however, has greatly reduced these protections. It has created a need for the transportation of people and products that rely heavily on airplanes which can carry pathogens around the world in a matter of days–as we saw with SARS in the early part of this century and more recently with SARS-CoV-2 (which causes COVID-19), and as we saw when UN “peacekeepers” brought cholera to Haiti a few years later. Capitalism also leads to vast numbers of people–any of whom could be infected–traveling across and between continents. Business travelers do so on behalf of making deals or enhancing production at their company’s plants in other countries. Scientists and others do so when they attend conferences. Vast numbers of soldiers do so in routine movement to bases in foreign lands or in the course of warfare. Mass tourism has become a major profit-maker for many firms, and a mainstay of the economies of many towns and cities around the world. Furthermore, many families live hundreds or thousands of miles apart for jobs or education, which means that vacation seasons and holidays provoke mass travel. We saw how this worked in China in 2019-20 both in terms of spreading COVID-19 across the country and in terms of motivating Chinese officials to keep the potential pandemic secret so as not to disrupt profit-making at a local festival.

Medical systems form a potential barrier to a pandemic, although hospitals can also become epicenters for the spread of pathogens. Although capitalism and capitalist societies can have incentives that align with the greater need for a healthier and safer population to be protected, it is always done to protect their profits. This does produce many medical miracles, most recently (with the help of significant government funding) the various vaccines against COVID-19, but it also undercuts medical protections against pandemics. In the decades before COVID-19, economic competition–including competitive and financial pressures for governments to “tighten their belts”–led hospitals to reduce their staffing levels of nurses, doctors, and other personnel to save labor and other costs. Essentially, this led hospitals to have enough capacity to handle slightly over the normal number of patients. When COVID-19 hit, the hospitals were overwhelmed, and they had far too few negative-pressure isolation rooms to keep patients from infecting uninfected patients. The same cost-cutting measures that reduced staffing led to underinvestment in such isolation rooms and even to severe shortages of high-quality face masks and other personal protective equipment for staff. This meant that staff got infected–heightening the labor shortages at hospitals–and also that nurses, room cleaners, and others would carry the virus to infect other people both in and out of the hospital.

Public health agencies and workforces had also been pared back. This meant that contact tracing, which might have slowed or stopped the pandemic spread, had little capacity to do so in many countries. It also meant that outreach workers to spread the word (and supplies) to slow viral spread were few and far between.

These forces continue to operate. This is shown by the failure of most if not all countries to increase the adequacy of staffing at hospitals and public health agencies. In some countries, and perhaps particularly in the United States, many jurisdictions have weakened rather than strengthened public health state of emergency laws, and some jurisdictions are criminalizing mask-wearing. In addition, large movements are organized against vaccines and against masking in many countries, and there is every reason to think that “anti-science” political movements of this kind will arise in the face of future pandemics.

Politics, after all, is a crucial part of capitalism. Much of it takes place within individual nation-states, each of which is dominated by capitalist interests. Different countries make different decisions and policies in different ways, but these decisions are pretty much always decisively shaped by groups of politicians and capitalists discussing and competing with each other. They do so, of course, in contexts that they do not necessarily control. Other forces, both those of other countries and various popular forces such as unions, protest movements, and rebellions, also affect events. The dominating necessities, from the viewpoint of the rulers, are maintaining capitalist rule; maintaining corporate profitability and competitive share in the world; and the survival of the national government against a variety of real and potential imperialist enemies. The health of working people, and the reproduction of a healthy crop of working-class youth to staff businesses for the future, are important insofar as they support these goals. Otherwise, they are secondary. This was amply exemplified by the widespread acceptance of COVID-19 fatalities in nursing homes and prisons in the United States, since their residents, by and large, contribute little to corporate profitability or government survival. (Indeed, their upkeep and medical costs are viewed as a drain on budgets). It has also been exemplified by the early “opening up” of business and other normal activities before the Omicron wave, a variant of COVID that caused mass death and since; and by conscious decisions by the World Health Organization and most if not all governments to degrade the quality and quantity of surveillance statistics on COVID-related hospitalizations and deaths.

This is not to say that individual corporate leaders or politicians are necessarily heartless.  Experience and common sense show that they vary in this. But they are not free to do whatever they like. Their firms and nations are driven by competition toward cutting costs, maximizing profits, and spending money on imperial aims or defense against (other) imperial nations. Within these constraints, many of them probably want most people to stay healthy, although the extent to which they care about different people is usually shaped by racial/ethnic and national loyalties and hatreds, religious biases, elitism, and being part of a socially-cohesive class. And, as discussed in the previous paragraph, their need for social stability means that other groups can influence their decisions to a degree.

Capitalism is not simply an economic system. It is a whole way of life. Capitalist culture varies from country to country, of course, but certain commonalities do exist. Based in part on its economic theory and on fierce competition in labor markets, it is deeply individualistic, with a focus on the “me” rather than on the community. This is reflected in the fact that health education and public health theories focus much more on self-protection rather than on protecting others. Thus, although various forms of mutual aid groups sprang up in most countries during the early stage of the COVID-19 pandemic, as well as in the early and some later stages of the AIDS pandemic, few if any public health agencies supported these activities. Instead, they focused on health messaging telling people to wear condoms or to wear masks to protect themselves from being infected by “others.” Indeed, throughout the AIDS pandemic, the U.S. Centers for Disease Control and Prevention and other agencies around the world have insisted that community organizations they fund to conduct disease prevention use “data-based interventions,” which sounds sensible until you realize that their research model is to see what interventions with individuals reduce the likelihood that those individuals become infected. Research of this sort is unable to certify that interventions of a more collective sort–such as those that work in terms of preventing infected people from passing their disease on to others–are effective.

Capitalist societies also are in many ways irrational or anti-rational. In this, they are not unique, of course. For example, pre-capitalist Europe fought wars and destabilized kingdoms if their leaders had “heretical” religious beliefs, and the intellectual movement known as the Enlightenment is lauded by many because it fought for and in many ways succeeded in creating ways of thought based on scientific method and calculative rationality. Nonetheless, capitalism produces irrationalist and strands of anti-scientific thought, particularly during periods when its self-destructive contradictions come to a head.

To some degree, antiscience is due to conscious planning on the part of the powerful. Corporations have funded coordinated attacks on scientific research that might threaten their profitability. The best-known example of this is tobacco companies’ attacks on research about the unhealthy effects of smoking. Other examples include fossil fuel producers and users attacking climate science, and corporate-funded groups such as the Family Values Council in the United States attacking AIDS research projects. During the COVID-19 pandemic, many members of the capitalist class funded both astroturf and grass-roots movements against vaccines and masking. Corporate leaders’ motivations in doing so have not been definitively studied, but probably include a general desire to “open up” and de-emphasize the pandemic so their businesses could go back to normal and a more specific political motive to support right-wing mobilizations that, if politically successful, would help restrain political and labor activities that might reduce their profits, social standing, or competitiveness.

Another source of irrational thinking is the unpredictability of life in a society in crisis. For example, many of the older people in the world grew up expecting their children and grandchildren to have better lives than they did. In many countries, with China a partial exception, this has not worked out in terms of living standards for the working classes or other non-elite classes. For many young adults in the United States, expectations that education would lead to economic security have proven untrue. And for everybody in the world, the expectation that scientific and technological advancements, including the development of a global economy, run in accord with the findings of economic science, would lead to better times for the world has also not come true. These prime examples of scientific and rational thought in action have instead produced climate change, the economic crash of 2008 and the slow growth that followed it, renewed inter-imperialist rivalry and war threats among the United States, Russia, and China, and a years-long pandemic. This is one force that has led, in our opinion, to a growth in apocalyptic religious beliefs and forms of right-wing nationalism built around racist, conspiracist, and sexist irrationality.

In summary, capitalism’s inability to make its many crises go away, and the political struggles this creates within ruling classes and parties, make it harder to deal with pandemics. The uncertainties these crises foster in the working class and other people can feed irrational responses. All of this means that the system and the human race become less able to deal with pandemics. And of course, these difficulties can all be increased by uncertainties and conflicts created by pandemics.

Pandemics have different modes of transmission, and this leads to different forms of prevention and political responses

Generals are always accused of fighting the last war. We cannot assume the next pandemic will be airborne like COVID. After all, HIV/AIDS transmission was primarily via sex and injection (particularly drugs and Factor VIII), which meant that masks were irrelevant to reducing HIV transmission whereas condoms and sterile syringes were crucial. It also meant that anyone who was in a room with an infectious person with SARS CoV-2 was at risk but that HIV transmission is concentrated in groups who engaged in certain behaviors to a degree, although heterosexual transmission has been far more prevalent in certain areas than others.

The current strain of bird flu (H5N1), if it becomes an outbreak among humans, will probably primarily be airborne, perhaps somewhat aerosolized, and probably with fomite transmission. If it is highly aerosolized, as was COVID-19, many of the same prevention and political issues are likely to come to the fore, and the need to clean food and other goods that might have been exposed to the virus may be more important even than was thought to be true at the beginning of COVID-19. Some pathogens are “vector borne” by insects or other animals. For example, malaria and Dengue are transmitted by mosquitoes, hantavirus by rodents, and Lyme disease by deer ticks These diseases do not spread directly from person to person, so much of their related prevention and politics focus on reducing human contact with the animals that carry them or eradicating the animals. On the other hand, although Ebola is sometimes transmitted from animals to humans, when it becomes epidemic or pandemic, this is based on human-to-human transmission through contact with other people’s bodies, liquids from other people, or via fomite transmission (for example, through contact with infected bed sheets.) Cholera and its mutations are water-borne. As such, they are primarily a threat of becoming major pandemics in places where water is not adequately treated or where many people lack access to safe drinking water. Unfortunately, a large but hard-to-estimate proportion of humanity lives in such conditions. These include a great many farming and forestry locations and large swathes of the mega-slums in which billions of people now live. They also include many war zones, such as Gaza in 2024 (and indeed before), and the unhoused in cities where the stably housed have access to good water. The cholera outbreak in Haiti in and after 2010, which began after a massive earthquake where UN peacekeepers then brought cholera for the first time ever to the island, has infected over a million people and killed about 10,000, according to the U.S. CDC.

When a pandemic first emerges, there is enormous uncertainty about how it is transmitted, the full range of its effects on human bodies, and of course how to respond

The beginning of a pandemic can take many forms. In some ways, the periods when HIV spread through a large number of human bodies and when SARS-CoV-2 did so were extremely different. Given the long period of “silent infection” in HIV disease, which lasts for years before infected people develop AIDS, we have documented the spread of HIV in New York City beginning in approximately 1975, although medical science did not notice it and make it public until 1981, a gap of six years. Although full recognition of the threat that SARS-CoV-2 posed was delayed for a month or so by the Chinese government’s decisions, the period between the beginning of widespread viral transmission among humans and recognition of the pandemic can be measured in weeks rather than years.

In other ways, the emergence of these two pandemics was very similar. To begin with, public health agencies, doctors, and researchers knew almost nothing about the new disease. Errors get made. Some are excusable, since no one knows the answers, and people rely on analogies to prior epidemics. With AIDS, it was not originally clear to scientists that it was an infectious disease rather than a condition provoked among gay men (and later people who inject drugs) by aspects of unhealthy living conditions or drug use. (Nonetheless, for both gay men and people who inject drugs, a plethora of evidence exists that many members of these groups were engaging in protective behavioral changes even before science “discovered” the new disease.) With COVID-19, public health authorities drew upon analogies with influenza and thus emphasized hand washing, cleaning of fomites, and maintaining physical distance from the sick since they speculated that coughs and other respiration with the infection would only travel about six feet before falling to the ground. In addition, with a new disease, it takes some time to develop tests to determine who is and who is not infected, although scientific advance seems to have shortened this time considerably since 1981.

Other errors are inexcusable. One of the most visible with COVID-19 was the incompetence of U.S. public health officials in making diagnostic tests available, which was followed by many additional errors. For both pandemics, most scientists and public health agencies failed to recognize the need to measure, much less prevent, the racial/ethnic and class inequities that developed. To some extent, as Arthur Caplan has argued, COVID-19 was an occupational disease concentrated heavily among racially oppressed, poor, and immigrant workers, and, through them, their families and communities. AIDS also was heavily concentrated among the racially oppressed and poor people, although the exact pathways by which this took place are still being discussed and debated. In both diseases, in addition, medications and vaccines were slow to reach the non-elite residents of the poorer countries of the world. One useful way to look at these similarities, as discussed earlier in this paper, is that the ruling classes and politicians of the world emphasize profitability, competitiveness, and imperial strategies, and that these interests lead to similar groups of people being treated as disposable time after time, even when the pathogens are transmitted through very different ways such as sex and injections versus through the air.

Implications for action

Since capitalism creates climate change, economic processes that lead humans and pathogen-bearing animals to interact, and travel patterns that lead to the rapid diffusion of new disease outbreaks around the world in a matter of hours, and thus is bringing pandemics upon us, it is urgent to end capitalism. Furthermore, as we have discussed, capitalism also produces political systems and cultures which make it hard to stop pandemics once they start and it incentivizes people to ignore the suffering of “disposable population groups,” which is another reason to end capitalism and replace it with something better. We discuss some ideas about how to end capitalism in the final section of this paper, but before doing that, we want to discuss some ways to provide some protection before we can end capitalism.

(1): Reforms while we work to end capitalism

Some reforms may be able to mitigate or stop pandemics while capitalism exists. After all, humanity has survived many horrible plagues in the past. This is no guarantee for the future, however, particularly given the massive rapid travel for profit-making, imperial, scientific and other purposes that are unique to present times. We shudder to think what could happen if mutation creates an aerosol-borne pathogen (perhaps a coronavirus) as deadly as the flu pandemic of the earliest twentieth century, but with a latency period of months or years before active disease develops, that gets widely dispersed through modern transportation.

Useful reforms and approaches, in addition to those obvious from the list above (such as re-building rather than cutting back upon public health, medical staffing, medical research budgets, ending factory farming, etc.), include:

Developing community-based and workplace-based mutual aid organizations and train them in contact-tracing, disease detection, and building local solidarity. Workplace mutual aid organizing should take forms compatible with activist democratic unionism–which also will be essential to force employers to take action to reduce transmission at work and in some countries to ensure that sick workers can access health care.

Mandate that all places of employment have worker committees to promote workplace health. Empower these committees legally to shut down workplaces during epidemics.

To increase the probability of early detection and response to potential pandemics, develop a worldwide set of “canary in the coal mine” sociomedical labs to collect biological specimens from “high risk/canary populations” and to monitor hospital data appropriately. Wastewater monitoring should become universal and should be supported by the rapid development of assays to detect emerging pathogens in wastewater. Such labs should have community guidance boards of “canary” populations to ensure ethical and effective procedures and community trust. Ensure these labs have access to high-up authorities locally and globally and to mass media locally and globally.

We need to develop high-quality educational programs about the causes and processes of pandemics, and use them as the basis for both school-based and mass media education. Such education should include a discussion of how egoistic individualism can get in the way of solidarity and of community collective defense against pandemics.

Relatedly, after COVID and AIDS, we can pretty much predict that the tendencies in capitalism toward irrational thinking will generate political and grassroots opposition to any “inconvenient” public health measures. It may be possible to reduce this if public health moves away from egoistic individualistic assumptions (based on capitalist individualism and its extreme formulations during the neoliberal decades) and towards encouraging people to act to protect others on the basis of solidarity and love.

(2): Ending capitalism and replacing it with something better

It is easy to say that we need to end capitalism before it ends humanity and a huge number of other species by an interlinked combination of climate change, pandemics, and perhaps nuclear world war. But to see the need is not to see the solution. The various parts of the global Left have discussed and fought about how to do this for at least a century and a half. Further, there is no agreement on the Left about what a post-capitalist society should or could look like.

The authors of this paper have a number of disagreements on these issues, and we will not discuss them at any length. We all agree we need to replace capitalism with a social order that is sustainable, that no longer provokes pandemics, and that is able to survive the difficulties that capitalism will have passed down to us such as continuing global climate change and its residue of pandemics.

We all also agree that such a society will need to be run initially by the working class, although one implication of ending capitalism is that relations of production will change and thus over time the working class as “workers” will cease to exist and be replaced by some form of freely associated labor.

We can also agree that such a society will undergo continuing conflict over how to meet its goals, and that people will have to devise new forms of democratic organization to make decisions and implement them. Unfortunately, even though the process of workers taking over the running of society will require a degree of improvement in how people of different genders, races/ethnicities, and nationalities relate to each other, there are likely to be remaining issues around inequalities and power and economic dominations that will still need to be worked out, and these may lead to various forms of social struggle.

To the extent that these struggles succeed, and we are able to produce reasonably democratic forms of making and implementing decisions, we think we should be able to build a society of international solidarity that is devoid of racial/ethnic and gender oppression and that can mitigate and, increasingly, prevent pandemics and provide decent health care for all.

Although our authorship team agrees on these points, we cannot agree upon how to organize to make the ending of capitalism and the creation of the new society actually happen.  Even without such agreement–which has eluded the Left for generations–we do all agree that it is essential to try, and that taking part in such efforts is perhaps the most important task people can take on.

Featured Image credit: Gopu.Ramya; modified by Tempest.
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