Questo vasto lavoro (originariamente pubblicato a marzo da Lucha de Clases in spagnolo) espone chi controlla le risorse economiche e sanitarie del mondo, come possiamo staccarci dal sistema capitalista sfruttatore e irrazionale che sta strangolando la salute pubblica e come possiamo garantire assistenza sanitaria alla classe lavoratrice di tutto il mondo.
Sono passati diversi mesi da quando uno dei mercati umidi più tradizionali di Wuhan – la settima città più grande della Cina – ha visto il primo focolaio di polmonite atipica. Da quando il nuovo virus è stato isolato, sia gli investigatori cinesi che i loro omologhi dell'OMS hanno identificato il nuovo patogeno come appartenente alla famiglia dei coronavirus, che si è ampiamente diffuso in natura e che infetta principalmente gli animali, sebbene alcuni ceppi, in particolare quelli del beta coronavirus genere – fai il salto nell'uomo.
Da allora, come se un terremoto stesse scuotendo il pianeta, l'intero mondo è stato capovolto. Durante la notte, in ogni paese, i regimi borghesi, i loro stati e governi di ogni sorta, affrontano la più grande crisi sanitaria, sociale ed economica nella memoria vivente. Ora, tutti presumono che la prospettiva più favorevole sarebbe uno scenario simile a quello degli anni '30 prima della seconda guerra mondiale, e nella peggiore delle previsioni, potrebbe diventare la crisi più grave nella storia del capitalismo.
L'incapacità di tutti i governi del mondo di affrontare la pandemia di COVID-19 è stata chiara fin dall'inizio, mostrando l'anarchia che caratterizza l'economia di mercato, la sua incapacità di guardare al futuro e la sua stanchezza come un sistema progressivo.
La prima reazione, a partire dal regime cinese, è stata quella di nascondere e minimizzare il rischio che l'epidemia rappresentava. Probabilmente hanno calcolato che l'epidemia potrebbe essere controllata e che, come nel 2003 con la SARS-VOC che causava la cosiddetta sindrome respiratoria acuta grave, la trasmissione non si sarebbe diffusa ampiamente e il virus sarebbe scomparso rapidamente. Questa è stata l'esperienza che hanno avuto con la SARS. In quell'occasione, dal primo caso nel Guangdong nel novembre 2002, l'epidemia si è diffusa in diversi mesi per colpire 29 paesi tra Asia, America ed Europa, totalizzando (secondo l'OMS) 8.403 persone infette e 775 morti. Quindi, l'epidemia è scomparsa e dal dicembre 2003 non sono stati segnalati nuovi casi.
Sfortunatamente, in questa nuova occasione, il virus si è diffuso in modo massiccio perché, tra l'altro, a differenza della SARS, molte persone infette sono asintomatiche. Dopo un mese di negazione delle prove, il governo cinese ha iniziato ad adottare misure drastiche, prima a Wuhan, poi in tutta Hubei, ma a quel punto il virus si era già diffuso nel resto del mondo.
Lungi dall'apprendere gli errori commessi dalla Cina, la maggior parte dei governi delle maggiori potenze mondiali inizialmente ha seguito lo stesso percorso di improvvisazione e minimizzazione del pericolo. Solo quando la crisi raggiunse dimensioni incontrollabili i governi iniziarono a reagire e affermarono che la lotta contro la pandemia doveva essere considerata una guerra mondiale.
Naturalmente, come sempre accade in guerra, la prima vittima è la verità. In ogni paese, la classe dominante e i suoi governi hanno usato lo stato e tutte le risorse a loro disposizione per nascondere l'incapacità del loro sistema di affrontare questa pandemia. Intendono nascondere la loro responsabilità criminale dicendo questo se tutti lottano e che il virus non discrimina tra ricchi e poveri.
Nulla potrebbe essere più lontano dalla verità! Questa lotta, come altre guerre, ha un chiaro carattere di classe, come mostrano i dati oggettivi. Sono i lavoratori e le nostre famiglie a soffrire delle conseguenze più dannose per la salute, economiche e sociali della pandemia. Sono i normali lavoratori che, mettendo a rischio la nostra salute, senza alcun mezzo di protezione, garantiscono che la società possa continuare a funzionare.
I miliardari che possiedono e controllano la ricchezza del pianeta e la loro coorte di agenti privilegiati non risparmiano risorse per garantire la propria protezione. Ci dicono che, anche se non ci sono abbastanza mezzi di protezione e la nostra salute è a rischio, la produzione non deve fermarsi. Il loro obiettivo è garantire che i profitti continuino ad arrivare a loro e persino trasformare la pandemia in un'opportunità commerciale.
Questo messaggio che ci ripetono continuamente, che le conseguenze di questo virus ci colpiscono tutti allo stesso modo, è una grande bugia. La realtà è che i lavoratori stanno subendo le conseguenze di questa crisi, sono i nostri futuri e le nostre famiglie a essere a rischio. Per la borghesia, ciò che è veramente importante, come in ogni conflitto passato o futuro, è ottenere i massimi profitti possibili, magari anche trarre profitto direttamente dalla pandemia.
L'imperialismo nel 21 ° secolo, la concentrazione della produzione e il dominio dei monopoli
Nel suo libro L'imperialismo: la fase più alta del capitalismo pubblicato nel maggio del 1916, Lenin concluse che, da un punto di vista economico:
“L'imperialismo è il capitalismo in quella fase di sviluppo in cui si è affermato il dominio dei monopoli e del capitale finanziario; in cui l'esportazione di capitale ha acquisito notevole importanza; in cui è iniziata la divisione del mondo tra i trust internazionali; in cui è stata completata la divisione di tutti i territori del globo tra le maggiori potenze capitaliste ”.
Oggi, analizzando la situazione economica mondiale, la sua tesi non è stata solo confermata dai fatti, ma il processo che ha anticipato ha subito uno sviluppo esponenziale.
Secondo il rapporto Global 500 della rivista americana Fortuna, dall'inizio del 21 ° secolo, i 500 più grandi gruppi di imprese producono e vendono il 40 percento di tutta la ricchezza generata sul pianeta. Nel 2018, le vendite di questi enormi conglomerati capitalisti globali sono ammontate a $ 32,7 trilioni: il 38,12% del PIL globale (stimato a $ 85,7 trilioni), con un utile netto di $ 2,15 trilioni. Nell'ultimo decennio, le vendite del G500 sono aumentate di quasi $ 10 trilioni (da 23 a $ 32,7 trilioni) e gli utili sono cresciuti di $ 650 miliardi. Il numero di lavoratori attualmente impiegati da queste 500 imprese è di 69,3 milioni. Ciò che si esprime in questi dati è che questa enorme concentrazione della produzione è generata da una piccola frazione dei lavoratori del mondo: 69,3 milioni su 3 miliardi – solo il 2,4% della forza lavoro mondiale.
||Totale F 500
|Veicoli a motore e componenti
|Vendite al dettaglio
|Negozi di alimentari e farmacie
|Metallurgia e costruzione
|Cibo, bevande e tabacco
|Aerospaziale e difesa
Tabella 1: 2018 – Distribuzione di F500 per settore. Fonte: Fortuna rivista
Analizzando i dati nella Tabella 1, possiamo vedere che l'assistenza sanitaria è il quinto settore dell'F500 in termini di fatturato e profitti. I 26 gruppi monopolistici che lo compongono hanno incassato oltre $ 2 miliardi di USD nel 2018 e guadagnato $ 112,076,000 USD. Queste grandi multinazionali comprendono assicuratori, fornitori di servizi medici, produttori di apparecchiature mediche e chirurgiche, distributori di apparecchiature mediche e grandi laboratori farmaceutici, con 13 gruppi rappresentati.
||Sottosettore delle imprese
|Stati Uniti d'America
||UnitedHealth Group – Assicurazioni
|Stati Uniti d'America
||McKesson – Distributore farmaceutico
|Stati Uniti d'America
||CVS Health – Distributore farmaceutico
|Stati Uniti d'America
||Amerisource Bergen – Grossista
|Stati Uniti d'America
||Cardinal Health – Distributore farmaceutico
|Stati Uniti d'America
||Anthem – Assicurazione
||Risorse cinesi – Pharma
|Stati Uniti d'America
||Johnson and Johnson – Pharma
||Roche Group – Pharma
|Stati Uniti d'America
||Centene – Assicurazione
||Sinopharm – Pharma
|Stati Uniti d'America
||Humana – Assicurazione
|Stati Uniti d'America
||Pfizer – Pharma
||Novartis – Pharma
|Stati Uniti d'America
||Cigna – Assicurazione
||Bayer – Pharma
|Stati Uniti d'America
||HCA Healthcare – Strutture mediche
|Stati Uniti d'America
||Merck – Pharma
||SANOFI – Pharma
|G. Gran Bretagna
||GlaxoSmithKline – Pharma
||Fresenius – Strutture mediche
|Stati Uniti d'America
||AbbVie – Pharma
|Stati Uniti d'America
||AbbotLaboratories – Pharma – Materiale medico
||Phoenix Pharma – Pharma
||Medtronic – Forniture mediche
||Medipal Holding – Grossista
Tabella 2: aziende del settore sanitario nell'F500. Fonte: Fortuna rivista
La prima cosa che si distingue per un esame dei dati nella Tabella 2 è la schiacciante predominanza del capitale nordamericano. Le multinazionali con sede negli Stati Uniti comprendono 15 dei 26 maggiori conglomerati del settore, con un guadagno di oltre 1.485 trilioni di dollari, pari al 73,90% del totale, con guadagni di 66.822.000 USD o 59,74%. Gli altri paesi rappresentati sono la Germania con tre società; Cina e Svizzera con due a testa; e Gran Bretagna, Francia, Irlanda e Giappone con una per paese.
La predominanza delle società statunitensi riflette l'enorme dimensione del mercato sanitario nordamericano: 2,93 miliardi di dollari nel 2018, il 17 percento del PIL americano e quasi il 40 percento del mercato mondiale. Il sistema sanitario americano, che dipende dalla gestione e dal controllo privati e difeso dal regime borghese e dalle due parti che lo sostengono, utilizza la maggior parte delle risorse del pianeta. È il terzo più grande pro capite, con $ 9.403 USD a persona, superato solo dalla Svizzera ($ 9.674 USD) e dalla Norvegia ($ 9.522 USD), ed è il più redditizio per il monopolio sanitario internazionale. Paradossalmente, questo enorme flusso di risorse non garantisce l'assistenza sanitaria universale. Solo i settori ricchi della popolazione con il maggior potere d'acquisto sono garantiti assistenza sanitaria di qualità. I lavoratori, se hanno un'assicurazione aziendale o possono pagare una polizza privata, vedono nella migliore delle ipotesi prestazioni sanitarie limitate. Il sistema lascia molte persone che cadono nelle fessure, oltre 30 milioni di persone, senza prestazioni o assicurazione medica.
||Investimento nella sanità
|% del PIL nazionale speso per l'assistenza sanitaria
||Investimento nella sanità
|Stati Uniti d'America
|G. Gran Bretagna
|Corea del Sud
Tabella 3: costi sanitari in miliardi di dollari, percentuale rappresenta il PIL e il costo pro capite nelle principali economie mondiali. Fonte: Espansione
Un altro fattore importante che emerge dall'esame dei dati del settore sanitario è l'importanza dei grandi laboratori farmaceutici, o Big Pharma. In termini sia di numero di gruppi (13, o 50 percento dei 26 nel settore che compongono l'F500) sia di fatturato ($ 624.464.000 USD, o 31,08 percento del totale), è il più grande. I suoi margini di profitto sono $ 71.991.500 USD, il 64,25 percento del totale del settore di $ 112.076.000 USD.
Le vendite globali di medicinali nel 2017 rappresentavano tra il 20 e il 25 percento della spesa sanitaria globale, 1,1 miliardi di dollari, distribuiti come segue:
- Nord America (Stati Uniti e Canada): 37 percento
- Pacifico / Asia: 22 percento
- Europa: 20 percento
- Resto del mondo: 21 percento
Nello stesso anno, i 50 più grandi laboratori del pianeta hanno registrato vendite per $ 642.478.000 USD e hanno guadagnato $ 121.259.000 USD, con un tasso di ritorno sulle vendite del 19%.
L'origine dei brevetti e il loro significato oggi
Non a caso, l'aspetto e la regolamentazione legale dei brevetti – vale a dire, il diritto concesso dai governi a un inventore dell'uso esclusivo della sua invenzione, mantenendolo off-limits per l'uso degli altri per un determinato periodo di tempo – è strettamente legato a le origini stesse del capitalismo. La prima legge sui brevetti registrata è stata approvata nella Repubblica Serena di Venezia nel 1474. Stabilì un termine di 10 anni. Successivamente, dopo il trionfo della rivoluzione borghese americana nel 1787, una Costituzione relativa ai brevetti fu inclusa nella Costituzione americana (articolo 1, sezione 8, paragrafo 8), che autorizzava il Congresso degli Stati Uniti “a promuovere il progresso della scienza e l'utile arti, garantendo a autori e inventori per un periodo limitato il diritto esclusivo sui rispettivi scritti e scoperte. “
La lotta per ottenere nuovi brevetti per nuove terapie, lungi dal promuovere la conoscenza e rafforzare la lotta contro le malattie, cerca solo di garantire prezzi elevati e profitti monopolistici / Immagine: WTO, Flickr
Uno schema accettato a livello internazionale di regolamentazione legale dei brevetti era fondamentale, specialmente dopo la fine della seconda guerra mondiale, quando il commercio internazionale divenne essenziale per l'intera economia capitalista. Pertanto, l'accordo con cui l'Organizzazione mondiale del commercio (OMC) è stato creato nel 1995 ha stabilito nel suo allegato 1-C l'accordo sugli aspetti della proprietà intellettuale attinenti al commercio (TRIPS). Descrive in dettaglio i principi di base della proprietà intellettuale volti ad armonizzare i sistemi di diritto dei brevetti tra i paesi firmatari e nelle loro relazioni con il commercio mondiale.
I brevetti per medicinali negli Stati Uniti sono regolati da diverse leggi, incluso l'Hatch Waxman Act del 1984. Questa legge stabilisce un termine di brevetto di 20 anni dalla data della domanda, rinnovabile per altri cinque anni dalla data di scadenza del brevetto. In Europa, a partire dal 2004, la produzione di farmaci generici può essere richiesta otto anni dopo l'autorizzazione del farmaco originale. Questi farmaci generici possono essere venduti dopo 10 anni.
Nell'infanzia del capitalismo, i brevetti hanno contribuito a favorire la concorrenza tra la borghesia, guidando nuove invenzioni e applicazioni tecnologiche, che hanno rivoluzionato in modo permanente lo sviluppo della tecnica e delle forze produttive. Tuttavia, questa situazione divenne rapidamente il suo contrario e la chiusura del mercato a società meno competitive promosse la concentrazione della produzione in imprese sempre più grandi. Questi si sono fusi l'uno con l'altro e con un'intensa e rapida concentrazione di capitale finanziario, ha creato un monopolio.
Oggi, nell'industria farmaceutica, la lotta per ottenere nuovi brevetti per nuove terapie, lungi dal promuovere la conoscenza e rafforzare la lotta contro le malattie, cerca solo di garantire prezzi elevati e profitti monopolistici.
Brevetti, ricerca e sviluppo e prezzi dei medicinali
Nel gergo del marketing farmaceutico, le medicine sono divise in due gruppi principali:
- “Essential Health”: farmaci già testati e in uso diffuso. I brevetti sono scaduti su questi farmaci, quindi chiunque può sintetizzarli dai loro principi attivi o produrre farmaci biosimilari a un costo inferiore.
- “Blockbusters”: nuovi medicinali il cui sviluppo e protezione brevettuale garantiscono il controllo monopolistico durante il periodo di diritti esclusivi di produzione e commercializzazione.
Per quanto riguarda i “successi”, i grandi laboratori investono principalmente nella ricerca e sviluppo sulle malattie che considerano più redditizie, in particolare oncologia, HIV, epatite, malattie autoimmuni e disturbi cronici.
Secondo le stime del settore, l'investimento medio in ricerca e sviluppo necessario per soddisfare i requisiti legali necessari, registrare il brevetto e commercializzare una nuova medicina chimica o biologica è compreso tra uno e due miliardi di dollari.
I maggiori investimenti monopolistici sono dedicati alla produzione di cosiddette medicine biologiche. A differenza delle droghe chimiche, non sono prodotte da un processo di sintesi chimica, ma sono molecole molto più complesse derivate da organismi viventi. Sono proteine come ormoni o anticorpi che l'uomo produce in condizioni normali. Quando le persone si ammalano, non producono queste sostanze nelle quantità richieste, specialmente nel caso di gravi malattie croniche come cancro, diabete, asma e malattie infiammatorie intestinali.
A differenza delle droghe chimiche, le droghe biologiche non sono prodotte sotto forma di pillola; la maggior parte sono disponibili solo come iniettabili. Alcuni esempi dei più noti biofarmaci sono gli ormoni della crescita, l'insulina e quelli utilizzati per i pazienti chemioterapici per aumentare i livelli dei globuli rossi e bianchi: EPO per i globuli rossi e G-CSF per stimolare le colonie di granulociti dei globuli bianchi. Questi farmaci sono fondamentali per il trattamento di molte malattie gravi e l'accesso ad esse è vitale per i malati e le loro famiglie.
Nel corso del tempo, i medicinali biologici sono diventati la principale fonte di reddito dell'industria farmaceutica per diversi motivi. Innanzitutto, i prezzi che possono essere richiesti durante la vita dei brevetti applicabili sono astronomici. Secondo uno studio dell'Associazione nordamericana “Patients for Affordable Drugs”, i farmaci per il trattamento del cancro sono tra i più costosi negli Stati Uniti e negli ultimi 15 anni i loro prezzi sono aumentati di dieci volte.
Un altro fattore che aiuta le aziende a massimizzare i profitti su questi farmaci è che sono complessi, rendendoli costosi e difficili da copiare. A partire dal 2006 in Europa e nel 2015 negli Stati Uniti, qualsiasi laboratorio può produrre legalmente un medicinale biosimilare a un altro il cui brevetto è scaduto. Tuttavia, anche se undici laboratori hanno sviluppato versioni biosimilari più economiche per anni, gli esempi sono ancora molto limitati.
Lo sviluppo di un medicinale biosimilare è molto più costoso in termini di tempo e denaro rispetto alla sintesi del generico di un farmaco chimico. Per produrre un farmaco generico, l'investimento medio varia da $ 600.000 a $ 4.000.000 di dollari e il tempo necessario per il suo sviluppo è di circa tre anni. Nel caso di un biosimilare, l'investimento sale a un intervallo compreso tra $ 100 e $ 300 milioni di USD e il suo sviluppo richiede in media dai sei ai sette anni. Di conseguenza, le medie imprese spesso sviluppano e producono droghe nei paesi in via di sviluppo: ad esempio, il 26 percento dei generici consumati in Europa e il 24 percento di quelli venduti negli Stati Uniti sono prodotti in India. Nel mercato biosimilare, la guerra è condotta tra i grandi monopoli del settore.
I profitti in gioco in questo mercato sono così grandi che la grande industria farmaceutica stanzia centinaia di milioni di dollari per finanziare conferenze e articoli medici su riviste specializzate, semplicemente per mettere in dubbio la sicurezza dei biosimilari. Mettono in discussione i criteri degli esperti delle autorità sanitarie, che affermano che il farmaco biosimilare ha gli stessi effetti terapeutici del farmaco originale. Sostengono che, se il trattamento inizia con una medicina biologica originale, sarebbe pericoloso continuare a trattare il paziente con un biosimilare più economico. L'obiettivo è generare incertezza e paura tra i malati e le loro famiglie. I media e l'arsenale legale di Big Pharma mirano a garantire che, dopo la fine del brevetto, la concorrenza con i biosimilari sia il più minima possibile, mantenendo così gli alti tassi di profitto garantiti dai prezzi di monopolio.
La propaganda dei lobbisti dell'industria farmaceutica mette in discussione il ruolo della ricerca e dello sviluppo privati nello sviluppo di farmaci come un modo per giustificare i loro colossali margini di profitto. Tuttavia, la realtà, secondo la maggior parte degli studi finanziati con fondi pubblici, è che almeno il 60 percento della ricerca di base e lo sviluppo di nuovi farmaci sono effettivamente realizzati in università e istituti di ricerca pubblici. Naturalmente, quando esiste una molecola che può essere utilizzata in una droga redditizia, Big Pharma acquista i diritti di sfruttamento su di essa e continua con la sua ricerca e sviluppo. Se il processo termina, il laboratorio che ha acquistato l'idea vende il nuovo farmaco al settore pubblico a qualunque prezzo il mercato sosterrà. Attraverso questo circolo vizioso, il monopolio raccoglie margini di profitto di svariati milioni di dollari.
||Miliardi di vendite ($)
||Utili / Vendite
||Stati Uniti d'America
|* Prevnar13 5.718
|* Lyrica 4.966
|* Gleevec 3.323
|* Gilenya 3.109
|* Rituxan 7.410
|* Avastin 6.885
|* Herceptin 6.884
||Stati Uniti d'America
|* Januvia 3.908
|* Zetia 2.560
|* Lantus 6.322
||Stati Uniti d'America
||Johnson & Johnson
|* Remicade 6.184
|* Stelara 3.232
|* Xarelto 2.288
||Stati Uniti d'America
|* Harvoni 9.081
|* Sovald 4.001
||G. Gran Bretagna
|* Advair 5.625
||Stati Uniti d'America
|* Humira 16.078
||Stati Uniti d'America
|* Enbrel 5.965
|* Neulasta 4.648
||G. Gran Bretagna
|* Crestor 3.401
|* Symbicort 2.989
||Stati Uniti d'America
|* Botox 2.786
|* Copaxone 4.223
||Stati Uniti d'America
|* Opdivo 3.774
|* Eliquis 3.343
||Stati Uniti d'America
|* Humalog 2.769
|* Cialis 2.456
|* Alimta 2.283
|* Xarelto 2.698
|* Eylea 1.798
|* Victoza 2.979
|* NovoRapid 2.964
|* Levemir 2.539
|* Spiriva 3.314
|* Pradaxa 1.532
|* Entyvio 1.307
|* Velcade 1.033
||Stati Uniti d'America
|* Revlimid 6.974
Tabella 4: le 20 maggiori aziende farmaceutiche del mondo nel 2017, profitti in milioni di dollari e in percentuale sulle vendite, fatturato in milioni di dollari delle principali marche di medicina commerciale. Fonte: vendite sul mercato delle prescrizioni PMFarma-Dirigente farmaceutico
In questa tabella, vediamo che ciò si riflette in modo concreto la quota del leone delle vendite e dei profitti del settore sono concentrati in pochissime marche di farmaci.
Ad esempio, la società svizzera Roche, la terza più grande azienda farmaceutica al mondo, ha guadagnato 8.717 milioni di dollari nel 2017 con i suoi soli tre farmaci più venduti, Rituxan, Avastin ed Herceptin, tutti utilizzati per il trattamento del cancro (per rettale, tumori del colon e del seno) e quell'anno ha registrato un fatturato di $ 21.179 milioni, il 53,55 percento del totale.
Questo processo raggiunge i suoi livelli più estremi in alcuni dei grandi laboratori degli Stati Uniti. Prendiamo il caso di Abbvie, dove le vendite di un singolo farmaco, Humira – destinato al trattamento di patologie del sistema immunitario come la colite ulcerosa, l'artrite reumatoide o l'artrite della psoriasi – sono ammontate nel 2017 a $ 16.078 milioni, il 63,55 percento del suo fatturato. Solo nella prima metà del 2018, le sue vendite hanno raggiunto $ 13.960 milioni. La stessa situazione è evidente nel caso di Celgene con vendite di Revlimid – implicate nel trattamento dei tumori ematologici come mieloma e linfomi – che nel 2017 ammontavano a $ 6.974 milioni contro un fatturato di $ 11.114 milioni, il 62,75 percento del totale.
I profitti del monopolio e il monopolio dell'assistenza sanitaria si fondono con lo stato
Big Pharma non ci pensa due volte a mettere a rischio la salute e la vita di milioni di malati / Immagine: Pxfuel
La produzione di merci è inerente al capitalismo. È orientato al mercato e mira a raggiungere il più alto tasso di profitto possibile. Questo è un tema corrente in ogni settore produttivo. Non si occupa di soddisfare i bisogni di base o sociali dell'umanità, né si preoccupa di migliorare o prendersi cura della salute umana.
In un articolo pubblicato lo scorso anno, Laura Marcos, della Right to Health Association, specifica quanto segue: nove imprese su dieci in Europa che hanno ricevuto il maggior numero di sussidi per progetti sanitari tra il 2010 e il 2016 erano grandi prodotti farmaceutici. Tuttavia, il 75 percento dei nuovi farmaci approvati in Europa nel 2015 non ha contribuito affatto al mercato o esisteva accanto a migliori alternative terapeutiche. Siamo ora a un punto in cui le stime hanno dimostrato che lo spreco di ricerca e sviluppo nel settore sanitario potrebbe rappresentare fino all'85% del finanziamento totale.
Nel perseguimento del massimo profitto, Big Pharma non ci pensa due volte a mettere a rischio la salute e la vita di milioni di malati. È in grado di contare su enti governativi di controllo sanitario che chiudono un occhio sull'intera vicenda e sono apertamente complici delle attività del monopolio.
Bayer e gli effetti collaterali di Xarelto
Bayer, la società farmaceutica multinazionale tedesca, ha lanciato sul mercato la prima molecola di rivaroxaban sintetizzata nel 2008 con grande successo da parte delle autorità tedesche ed europee di sanità pubblica. Questo farmaco viene utilizzato per diluire il sangue e prevenire i coaguli, che potrebbero causare ictus. Mirava a sostituire due anticoagulanti che erano già sul mercato da anni: Sintrom, con acenocumarolo come ingrediente attivo; e Aldocumar, un composto derivato dal warfarin. Il farmaco è stato commercializzato con il marchio Xarelto e Bayer ha raggiunto un accordo con Janssen, la divisione sanitaria di Johnson & Johnson, per distribuire il farmaco in Nord America.
Attraverso una campagna di marketing aggressiva, è rapidamente arrivata a dominare il mercato. Nel 2017, il farmaco è stato prescritto a 42 milioni di pazienti e quest'anno le vendite hanno portato a $ 2,669 miliardi per Bayer e $ 2,288 miliardi per la multinazionale farmaceutica nordamericana.
Tuttavia, non sono stati in grado di avvertire il pubblico di un particolare effetto collaterale: l'uso di rivaroxaban può causare gravi emorragie in alcuni pazienti. I casi di pazienti che soffrono dell'effetto collaterale hanno iniziato ad apparire non appena sono stati resi disponibili sul mercato e migliaia di loro hanno sofferto di gravi sequele o sono morti a causa delle emorragie. 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.
The opioid crisis made death by overdose the biggest killer of adults in the U.S. / Image: Mark R. W. Orders-Woempner
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 per 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.
Pfizer's crimes are numerous and shocking / Image: Lauri Silvennoinen
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 Inviare 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.
Dozens of pharma firms are hunting for the COVID-19 vaccine: but their priority is profit, not curing people / Image: Pixabay
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.
||Hong Kong flu
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.
Epidemics have plagued humanity since ancient times / Image: public domain
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.
It is estimated that in Europe between 24 and 48 million people died of the Black Death, from 30 percent to 60 percent of the population, with 75 to 200 million deaths worldwide / Image: public domain
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.
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 / Image: Europe Asia Foundation
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.