COVID-19 vaccines: The partiality of medicine in United States capitalism

By Vince Montes

February 12, 2021 — Links International Journal of Socialist Renewal — COVID-19 vaccines are meant to function as a panacea for restoring confidence and reestablishing the social order in the capitalist social system. Saving lives is part of the capitalist state’s stated intention, but as we will see it is difficult to take this claim at face value when considering all the lives lost every year to preventable causes. In this way, COVID-19 vaccines will operate like therapeutics for cancer, diabetes, and other diseases because they do not address the social and environmental causes that increase susceptibility to illness, or in this case, COVID-19. In this view, profit-generating enterprises are normalized by the capitalist state's prevailing ideas and its capacity to engage in economic co-optation and coercion (Montes, 2009). Capitalism creates the conditions that lead to social ills and diseases, which produce high susceptibility to viruses such as COVID-19. Similar to how institutions of the state (such as the police, the military, corrections, and the legal system) serve to maintain the social order, so does medicine.

COVID-19 vaccines are an intervention to the dysfunctions of the capitalist social system. Many have realized that inequality is directly related to capitalism; however, they do not see the latent functions (i.e., unintended consequences) of social ills and diseases as connected.  Maybe the best way to view COVID-19 vaccines is to see them as part of the arsenal of mechanisms used to manage capitalism's latent functions. After all, medicine is not part of an effort to detect and eradicate the causes of diseases. To do so would mean being involved in efforts to transform an unequal society (or world) by improving the social and health conditions that can prevent the causes of diseases and social ills. As a result, medicine is partial because it is embedded in the capitalist system. Thereby viewing afflicted individuals as consumers, and in many cases, lifelong consumers of an array of very profitable pharmaceuticals, and as serving a function in maintaining or restoring the system's social order.  In this case, the objective is to restore society to its pre-pandemic days.

There may be much to learn from how capitalist economies are prone to crises and the role medicine plays in the prevention of economic crises. For example, even with exploitation and imperialist expansion and resource usurpation, “profits and capital accumulation are not guaranteed. If there are no profits and accumulation (or even if they are squeezed) then businesses close, people lose jobs, debts are not paid, banks collapse, governments run out of money–in short, there is an economic crisis” (Easterling, 2003). In this context, state institutions and their coordination of corporate interests collaborate to preserve the social order by implementing social reforms, with repressive and facilitative strategies to neutralize and incorporate known dissidents into the system. Medicine can also be seen as mediating the consequences of capitalism by treating workers who have been exposed to harmful materials and products. Lung cancer, mesothelioma, bladder cancer, and leukemia are the most common cancers resulting from occupational exposure to carcinogens (CDC). After all, without a semi-healthy workforce, labor exploitation becomes problematic. 

The COVID-19 pandemic has created conditions similar to economic depressions or slumps for the vast amount of people who survive on wages. For many, the routinization of social life has been severely disrupted. In many states, this has meant school closures, meaning that many parents had to become tutors and multitask between children and working from home. As we know, economic crises also create new market niches and opportunities for corporate mergers and acquisitions.  These periods usually result in some restructuring of the economy. In short, capitalists do not let crises go to waste, they take financial advantage of them, as the current economic crisis is demonstrating. Pharmaceutical corporations are benefiting (e.g., developing pharmaceuticals related to treating COVID-19 patients and producing vaccines). Technology corporations are also benefiting from working from home, and retailers provide lockdown necessities online (e.g., Amazon, Walmart, etc.). In this way, indeed, not everyone is suffering economic hardship during this pandemic. 

The official views that developed out of a highly fragmented bureaucratic capitalist social system are either unable or unwilling to connect medicine with capitalist enterprise as an institution that functions to ensure its continuation. What is missed and obfuscated from ‘public discourse’ is a more critical and holistic analysis that can connect the seemingly unconnected aspects of social problems to larger structures (Mills, 1959), such as to capitalist structure. The system of capitalism is a system in which the state's institutions construct and sustain a reward system with ideologies of conformity. Jeff Schmidt argues that professionals, including scientists, are socialized and disciplined to have politically and intellectually subordinate attitudes; they also develop very narrow views and analyses incapable of analyzing larger structures (2001). Military funding of science, for example, “directs research into military-relevant directions. When scientists put in research proposals to military funders, they anticipate what will be most useful and attractive for military purposes, while maintaining the illusion that they are directing the research” (Martin, 2001).   

Much of the current corporate media coverage and the liberal and conservative political pundits portray medicine and its scientific experts such as Dr. Anthony Fauci and Dr. Deborah L. Birx (members of the US State Department Task Force on COVID-19) as representing objective medical science. However, as we know, in most cases, it is not a matter of an individual’s personality or moral principles: it is their position within a bureaucratic institution that we should concern ourselves with (Mills, 1956).[1] Bureaucratic institutions that the power elite control have an enormous influence on the psychology and values of individuals. According to Robert Merton, we should study the intended outcomes of institutions' actions and their unanticipated latent consequences. To do this, we need to account for the factors that contribute to latent consequences. By analyzing social institutions' functions, we can understand their role in upholding the social order (Merton, 1957).

Since most of our attention focuses on the capitalist system's manifest functions, we often overlook all of its latent functions. In this view, we see the dehumanizing effects of the profit-generating corporations and the state's institutions that act in coordination with them as performing an essential function in maintaining the social system. Included in the manifest functions is institutional socialization. The idea that the economy is natural, self-regulating, and the producer of the conditions for individual freedom, wealth, equality, and democratic institutions is thoroughly instilled within the masses. This, thereby, masks the system of inequality and its skewed distribution of wealth and privilege. 

The latent functions are the consequences of the above capitalist social system and are the following. First, wealth development requires the exploitation of labor, usurpation of land and resources, and the consumption of products, many of which are harmful and toxic, which devastates large sectors of society. Secondly, which is related to the first, this results in these individuals having higher rates of poverty, involvement in the criminal justice system, interpersonal violence, and physical and psychological health issues, [2] which translate into a higher risk of contracting diseases and greater susceptibility to deadly viruses, as we will see below. These diseases also serve a function by generating another market, a spinoff type of industry to treat these diseases. The therapeutic response to COVID-19 is in keeping with an overall medical response to the consequences of the market economy. Talcott Parsons’ (1951a) functionalist theory is tremendously insightful in understanding the role of pharmaceutical corporations and the healthcare industry in capitalist society. [3] Parsons (1951b) viewed illness as potentially disruptive to the social system's equilibrium. In this context, everyone in society is seen as having a role or function. For example, a physician's role is to treat the ‘sick' person, and the role of the ‘sick person’ is to get well so they can return to carrying out their obligations as a functioning member of society. As a result, dysfunctionality and its potential for disruption are remedied. 

Exposure to harmful conditions and toxins have become an integral part of the latent functions of capitalism. From this theoretical framework of intended and unintended consequences of the capitalist social system, we should view diseases, social ills, and deadly viruses. And how medicine – e.g., pharmaceutical corporations and the healthcare industry serves a function in treating the individual so that they can return to carrying out their ‘obligations’ as a functioning member of society. There is precedent to this reasoning. It is not inconsequential that the pathological perspective was linked to Western capitalism (Pfohl, 2009:131). For Stephen Pfohl, 

"Just as the great classificatory project of the nineteenth century gave birth to human sciences, so did it provide an intellectual justification for new strategies of disciplinary control, strategies aimed at correcting, rehabilitating, or curing abnormal types and thereby converting them into an internally motivated supply of labor. In other words, in searching for scientific accounts and cures for abnormality, the human sciences legitimize the power of the capitalist enterprise out of which they are born" (2009:132). 

It was clear to Michel Foucault that the birth of social medicine came to serve three functions: “medical assistance for the poor, control of the health of the labor force, and a general surveying of public health, whereby the wealthy classes would be protected from the greatest dangers” (1994:155). The conversions of these three coexisting medical systems: a welfare medicine designed for the poorest and for workers to be healthy enough to work; an administrative medicine responsible for general problems such as vaccinations for epidemics; and a private medicine that benefits those who could afford it (Foucault, 1994:155-156). It is very apparent that medicine, as an institution, serves a crucial function in maintaining the social system of capitalism. 

COVID-19 pandemic 

George J. Armelagos argues “international travel, global commerce and the accelerating destruction of ecosystems worldwide” has brought about a new era in human illness and “diabolical new diseases,” which were thought to have been eradicated in advanced nations (1998). Historically, industrialization led to a tremendous environmental and social transformation that forced millions of inhabitants into urban settings, who had to contend with industrial wastes and polluted water and air: the slums that developed became the focal point for poverty and the spread of disease (2004:159). There, epidemics of smallpox, typhus, typhoid, diphtheria, measles, and yellow fever became pandemic. For Armelagos, Brown, and Turner, the health indicators of morbidity and life expectancy – i.e., one’s ‘life chances,’ vary inversely with wealth (2004). In short, as capitalism expanded historically and presently, in its efforts to commodify nature, it brings many humans closer to nature, resulting in diseases and deadly viruses.

Yet, the spread of viruses such as the COVID-19 are being fought with handwashing, social distancing, and following Personal Protective Equipment (PPE) protocols as is recommended by the World Health Organization (WHO) and the Center for Disease and Control (CDC). However, amid this outbreak, what has become more evident is that infections and mortality rates are unevenly distributed across the population. The elderly and people with severe underlying health conditions and comorbidities represent a high percentage of the mortality rates. It is true that with age, the human body experiences degeneration; organs, tissues, and cells lose their function over the natural course of life. However, not all older adults are equal. One could safely speculate with a high degree of certainty that it is the older poor person in nursing homes and other long-term care facilities who experienced higher rates of fatalities from COVID-19. Poor and working-class people are disproportionately likely to have poor health because of physical, psychological, and environmental factors related to their conditions. Also, poor and working-class people tend to have poor diets, live in unhealthy environments, and are over-exposed to toxic products such as tobacco, alcohol, and foods low in nutrients. As a result, they are highly susceptible to dying from a COVID-19 infection. The reason why infection and mortality rates are also high among ethno-racial populations is that they are disproportionately represented in the above categories. 

The prevalence of diseases in society can serve as an indicator. How well society will do appears to depend on it. By all indications, the US has failed to contain a deadly virus such as COVID-19. As of December 21, 2020, according to the John Hopkins University and Medicine, Coronavirus Resource Center reports that the US has over 17 million infection cases and over 318,000 deaths due to COVID-19. It ranks 13th among nations, with a death rate of 97 per 100,000 (Pettersson, Manley and Hernandez, 2020). Except for Peru, all other nations listed with higher rates are either Western or Eastern European (e.g., San Mario, Belgium, Peru, Slovenia, Italy, N. Macedonia, Bosnia, Spain, Andorra, the UK, Montenegro, and the Czech Republic). The one similarity with all of these nations is that they are all fully integrated into the world capitalist system.

Diseases and social ills as precursors to fatal COVID-19 infections

When institutions of the state, which includes large corporations impose market relations over society's needs, they create the conditions for many segments of society to become highly susceptible to various social ills (e.g., crime, murder, suicide, mental illness) and diseases (e.g., heart disease, cancer, high blood pressure, diabetes, depression, anxiety, obesity, and liver disease and cirrhosis). These deaths are due to the normalization of formal bureaucratic rationality, which is driven by economic gain and profit. Consequently, the ordinary citizen has very little defense against the soft drink industry (obesity, diabetes); the alcohol industry (high blood pressure, heart disease, stroke, liver disease; cancer of the breast, mouth, throat, esophagus, liver, and colon); tobacco industry (chronic obstructive pulmonary disease (COPD) and lung cancer); sugar industry (obesity, diabetes); the Big Three US auto industry (pollution that causes lung cancer and respiratory diseases), and the petrochemical industry (various cancers) that kill people at alarming rates every day in the US as well as around the world through the integration in the capitalist global economy. These billion-dollar corporations not only receive government subsidies (i.e., US taxpayer-supported) and generous tax breaks, but they are collectively culpable in the deaths of nearly 2 million people every year. For example, approximately 1,678,456 people died in 2017 (the latest figures available, my computations) from heart diseases, cancer, stroke, respiratory diseases, and diabetes (Leading Causes of Death, 2017). Not listed in the 10 leading causes of death in the US are liver disease and cirrhosis, which also killed 41,743 people (included in the above total figure) (Chronic Liver Disease and Cirrhosis, 2017).

Considering exceptions from genetic predispositions, many of these deaths and injuries were preventable. However, since people live within a state-sanctioned social environment that places profits above human beings, their lives have become expendable for maintaining the social system. Pharma corporations have carved out a lucrative market, providing pharmaceuticals for all the ailments associated with the social system of capitalism. Polanyi (1944), a renowned political sociologist cautioned against the dangers that occur when there is an unembedded market superimposed on society. In this case, the state and corporate elite elevate market relations above nature and human beings' interests. The statistics in this context do not include all of the people diagnosed with the above-listed diseases. The most recent statistics illustrate that there are 1,688,780 new cancer cases in the US, ranked fifth in the world behind Australia, New Zealand, Ireland, and Hungary (Siegel et al., 2017). All these nations have something in common; they are all considered 'high-income' nations (read: capitalist systems), and four out of these five emerged from white-settler states and colonies (however, Northern Ireland remains a colony), with Hungary being the exception, joining the capitalist world after 1989, and received a rapid injection of capitalism. 

One can only imagine all the new heart disease cases, diabetes, and liver disease. In these figures, one sees how many individuals develop compromised immune systems and high comorbidity rates and who, over time with age, are incapable of fighting the COVID-19 virus. According to the CDC, which estimates from 2010-11 to 2019-20, 12,000 to 61,000 people died in this period due to the annual influenza season. In the flu season 2017-18, approximately 61,000 people died. According to the CDC, the following people are at high risk for developing influenza-related complications: adults 65 years of age and older; pregnant women; residents of nursing homes and other long-term care facilities; and Black, Latino, and Native Americans or Alaskan Native persons. In addition, people who have to underline medical conditions including Asthma; Neurological and neurodevelopmental conditions; chronic lung disease (COPD and cystic fibrosis); heart disease; blood disorders (such as sickle cell disease); endocrine disorders; kidney disorders; liver disorders; metabolic disorders; weakened immune system due to diseases or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids), and people who are morbidly obese. Oddly, susceptibility to a fatal outcome of influenza is roughly the same for COVID-19. 

The most prominent indicator for COVID-19, influenza, and one must assume other lethal viruses is the presence of comorbidities. According to a new study conducted by FAIR Health, about half (51.71 %) of all patients who were diagnosed with COVID-19 had preexisting comorbidity; the remainder (48.29 %) did not (see chart below). But although the two groups are roughly 

evenly divided among patients diagnosed with COVID-19, their outcomes were vastly different among COVID-19 patients who died. Of deceased COVID-19 patients, 83.29 % had preexisting comorbidity, while 16.71 % did not. As we will see below, one could argue that disease and social ills are precursors to fatal COVID-19 infection outcomes. Consequently, one should not be surprised to discover that the US, the wealthiest nation in the world—and for some in the US, “the world’s shining beacon”—has the highest cases and deaths from COVID-19, with 4% of the population and approximately 25% of all cases. The question is and should be what is it about the US capitalist social system that makes large segments of their people so vulnerable to deadly viruses. Looking at the latest Organization for Economic Cooperation and Development (OECD) poverty rates of 2015–2019, the US has 17.4% of its people living in poverty, making it one of four nations of the 37 OECD member nations with the highest rates of poverty (Poverty Rate, 2015-2019). Looking at the Measles virus, even with the availability of a vaccine, it is still common in many third world nations, particularly in parts of Africa and Asia. Inequality within and among nations remains a problem in containing deadly viruses. The overwhelming majority (more than 95%) of measles deaths are occurring in countries with low per capita incomes and weak health infrastructures. The telling fact of the matter is that viruses tend to strike the poor the hardest. 

Moreover, the US is plagued with social problems. Consider a population of about 323 million people; there are approximately 15,000 murders every year (U.S. Department of Justice, 2016). This figure grows to 66,500 (2017) deaths when you include suicide (CDC, 2017). Murder is high in the US compared to similar high-income nations in the OECD (Grinshteyn and Hemenway, 2016). For example, in a study that compared the US' violent death rate with that of other high-income OECD nations, it was found that men in the US are approximately nine times more likely to be homicide victims than their male counterparts. American women are four times more likely to be a victim of murder than their respective counterparts. The US total homicide rate was 5.3 per 100,000 compared to other high-income nations in the OECD, with the Czech Republic at 2.6 and Finland at 1.9, at second and third place. Even more disturbing is a look at the FBI UCR statistics from 2016, which reported 1,248,185 victims of murder and violent crimes such as rape, robbery, and aggravated assault for that year (U.S. Department of Justice, 2016). It is challenging for many to look beyond the individual as a unit of analysis and examine the social system in which these behaviors occur. 

The US capitalist state can socialize its ideology of the individual exercising their free will in society. However, a political-economic system that only benefits a small number of individuals at the expense of the many will find it extremely difficult to reverse course. Wikinson and Pickett’s (2010) research illustrates how poor health and violence are more common in more unequal societies. Almost all social problems that are “more common at the bottom of the social ladder are more common in more unequal societies” (ibid, 18). Among 23 wealthy nations, the US has the highest health and social problems. These factors were operationalized as the following: low levels of trust; high rates of mental illness (including drug and alcohol dependency); low rates of life expectancy and high rates of infant mortality; high rates of obesity; low rates of educational performance in children; high rates of teenage births; high rates of homicides; and high rates of imprisonment (ibid., 18-19).

This inequality translates into poor health and social ills that make many people in the US highly susceptible to diseases and viruses such as COVID-19. The despair that grows alongside such an unequal society creates fertile grounds for frustration, rage, alienation, anomie, and many psychological difficulties. By all accounts, these conditions constitute a state crime of omission (Barak, 2011) because the state and its government have failed to protect the rights, health, and economic security of everyone's needs within its given territory. What is clear is the connection between high levels of disease and social ills, related to social inequality, serving as precursors to the COVID-19 virus infections and fatalities. 

Latent functions: the COVID-19 vaccines 

By analyzing the institutions' functions, we see that the institutions of the state are following the blueprint of the functionalist perspective. These institutions attempt to restore order to the social system's equilibrium by developing and administering COVID-19 vaccines. Interestingly enough, like Parsons’ description of the physician's role and the role of the 'sick person,' the COVID-19 infected person must be treated with medicine – e.g., pharmaceuticals so that he or she can return to carrying out their obligations as a functioning member of society. However, with this disruption to the system, the reduction of a public sector (the result of the implementation of neoliberal policies), the US state relies on giant corporations, and in this case, pharma corporations. As a result, Pfizer, Moderna, BioNTech, GlaxoSmithKline, Johnson & Johnson, Merck, Moderna, Novavax, Sanofi, and AstraZeneca have received millions of US government dollars in their efforts to develop vaccines. This effort is called Operation Warp Speed, which includes a collaboration with the Department of Health and Human Services (HHS), the CDC, the National Institutes of Health (NIH), the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense (DoD). We should also mention that Johnson & Johnson, Merck, and Pfizer are three of the top five pharma corporations in the Fortune 500 club (2019).  

Understanding the role state institutions (i.e., the executive branch, HHS, CDC, NIH, BARDA, and DoD) and their coordination with pharma corporations reveal that their collective aim is to restore the social order, as was established in the pre-era period. It stands to reason that similar to how the producers of diseases and social ills have immunity from liability, the pharma corporations such as Pfizer and Moderna should also have immunity from liability if something unintentionally goes wrong with their vaccines. 

It is not just that the concept of a public health system is problematic because its function is not in the interest of the public's well-being, but because it functions to ensure the continuation of the system. Yes, in this continuation the objective is to develop new and improve pharmaceuticals to manage the latent functions and thereby not address the causes of diseases but to gain consumers of the new products. If we are willing to grasp this, we can understand medicine and healthcare in US society. It is not that society has been made too reliant on the private sector for not only essential equipment and services (such as PPE, testing, ventilators, and vaccines), which certainly is a problem. And that the health care systems operate like a capitalist enterprise (see Montes 2020), which seems to be more of a reality. It is that we are oblivious to the latent functions of capitalism. It makes perfect sense that the latent functions would ensure that the poor and the worker are healthy enough to fulfill their tasks. And that disruptive pandemics would be mediated with vaccines or other measures, and that quality health care is provided for those who can afford it. It is also clear that the capitalist system, a very resilient system, would develop enormous spinoff industries that would amass astronomical profits for treating with pharmaceuticals, the very people it made sick in the first place. 

Some implications 

To understand the logic behind the capitalist social system, one needs to realize that there are many latent functions to its manifest functions. Most importantly, the state's institutions and its corporate sector are committed to its manifest intentions, and will ensure that its latent functions also serve their collective interests. And in so doing, they are already quite versed at accepting the human and environmental costs of capitalism, as was illustrated with the various social ills and diseases listed above. The most vulnerable segments of the population, the worker, and the ethno-racially oppressed (disproportionately working-class and poor), have little or no defense against the state-sponsored peddlers of toxic products, exploitation, and polluted environments, making them highly susceptible to the COVID-19 virus. And as long as there is more profit to be made from treating people with pharmaceuticals than in enacting public policies that address the etiology of diseases and social ills (such as raising the health and immunity of all people within a society), the role of the institutions and corporations will remain the same. When one considers this critical interpretation of the functionalist framework, we should understand how social institutions of the state and medicine all function to uphold the capitalist social system. 

Vince Montes is a lecturer in sociology at California State University - East Bay. He earned a PhD in sociology and historical studies at the Graduate Faculty of the New School for Social Research, New York, NY. His research includes the U.S. state, capitalism, and political control.

Notes

[1] Careerism is not reserved for the business world and this point is nothing new. Most scientists and professors research questions, research design and findings funded uphold the ideology of social order (see Jeff Schmidt, 2001).

[2] Jeffrey Reiman and Paul Leighton argue that poverty is a source of crime because poverty contributes to creating need; in contrast, at the other end of the spectrum, wealth can contribute to crime by unleashing greed (especially in white-collar crime) (2013:31). 

[3] Although Parsons’ theory was not a critique of capitalism, his theoretical framework does explain how the capitalist system maintains its social order.  

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