More important reads from across the web: Bank Holiday edition

A sobering look at what the pandemic is likely to mean for efforts to control HIV, tuberculosis and malaria in sub-Saharan Africa, by a McGill University communicable disease epidemiologist

A United Nations Development Programme report envisioning the first worldwide decline in the Human Development Index since UNDP started calculating the index in 1990

Human development is facing an unprecedented hit

Source: United Nations Development Programme

University of Warwick researchers point out that including capital gains in estimates of income inequality means that income distribution in the UK is even more unequal than previously thought

A list of heavyweight social scientists argue, rather optimistically, for democratizing work in the post-crisis world

A preview of a new book on the 1965-66 US-backed mass murder carried out in Indonesia by supporters of Suharto

And an intriguing argument by David McCoy, from Queen Mary University London, that in the post-pandemic world ‘we need a manifesto’, not just a coronavirus disease control plan

Superb virus reads from around the Web – 10 May update

A Canadian Broadcasting Corporation news team – yes, a state broadcaster that still does real journalism! – takes a look inside the slaughterhouse that has produce one of Canada’s largest clusters of cases, and the working conditions that virtually guaranteed its spread.

A team of Scottish researchers and Martin McKee point out that the pandemic response itself will have negative health effects, which seems bleedin’ obvious, but for some reason most of the health research community prefers to ignore the point, and indeed much else about the post-pandemic future.   

Naomi Klein points out that big technology firms in the US are using the pandemic as a platform for new systems that will ratchet up inequality, making the billionaires even richer and expanding the precariat.  (The Intercept, where this piece appeared, is proving indispensable for truth-seekers in these times.)

Two articles in The Atlantic, which is making its coronavirus coverage free at the moment, are also valuable.  One offers a succinct description of how South Korea dealt with the virus, and what should be learned from its experience.  The other is a searing examination of the racism revealed in multiple ways by the US response to the pandemic.  For anyone still under the impression that it’s a civilised country, this is a must-read.

Finally, The Times – unfortunately behind a paywall – offers a thoughtful take on the question ‘Supermodeller Neil Ferguson: should we trust his science’?  One might question the description of what the Imperial College crew do as science in the first place, but that’s a topic for another day. 

More in good time.  Meanwhile, stay safe.

Realism versus Monbiot: Thoughts on possible worlds of post-pandemic reconstruction

George Monbiot is only one of many commentators who have argued the need for a post-pandemic programme of economic reconstruction that will address environmental concerns as well as the imperative of restoring and securing the livelihoods of literally hundreds of millions of people. The importance of this latter imperative cannot be overstated. In the US alone, unemployment by the end of April quadrupled to 14.7 percent, with 20.5 million jobs lost.  In the UK, the Bank of England has warned of a doubling of unemployment to nine percent and a shrinkage of the economy’s overall output to a 300-year low.   The UK unemployment figures are less horrific than they otherwise would be because of a massive debt-financed programme of wage and salary compensation that the Chancellor of the Exchequer has correctly characterised as unsustainable. 

Against this background, Monbiot (and I am not picking on him here; he is rather the most articulate and best informed proponent of this perspective, and therefore the most difficult target) argues that ‘[g]overnments should provide financial support to company workers while refashioning the economy to provide new jobs’ outside the automobile, fossil fuel and airline industries.  It is now a commonplace that after the financial crisis of 2008, governments bailed out many of the financial institutions that had caused the crisis – that is, their shareholders, managers and workers – rather than those who bore the worst consequences.  Monbiot argues that: ‘This is our second great chance to do things differently’.  But with government debt and expenditure levels relative to GDP already approaching twentieth-century wartime levels, just to finance short-term remediation, the unavoidable question is:  do things differently with what? And where will the investment necessary for such new jobs, and the financing needed to support workers’ transition to them, come from?

It is nice to envision, as a team of luminaries including Nobel laureate economist Joseph Stiglitz and climate economics authority Sir Nicholas Stern has recently argued based on an expert survey, that post-pandemic reconstruction can contribute to reducing climate impacts through investment  in ‘clean physical infrastructure, building efficiency retrofits, investment in education and training, natural capital investment, and clean R&D’, whatever that is.  The authors do not explain where the money will come from, in a world where the estimated US$2.5 trillion annual investment needed to meet the Sustainable Development Goals before the pandemic was nowhere in sight.

It is possible, in theory, to envision mobilising the needed resources by way of income and wealth tax rates that were prevalent after the Second World War, responding to wartime government debt and expenditure levels.  Many of these are now probably infeasible because of the concentration of ultra-wealth in financial instruments and tax haven real estate, and because of possibilities for capital flight that can best be limited through transnational cooperation in a world where a corporate-financed US Congressional candidate has claimed that ‘[f]reedom and democracy are best secured when banking secrecy and tax havens exist’.

If the ultra-rich are probably beyond the reach of national public policy, then the menu of policy options shrinks considerably.  When many dividends have already been cancelled, whose income does Monbiot propose to reduce, whose assets to tax or seize, and how?  What happens to firms that cancel dividend payouts when investors flee their shares, making it impossible for them to raise new capital in response to lockdown-created shortfalls?  How can green jobs be created by seizing foreign oligarchs’ London property holdings, their financial assets having long ago been safely shifted elsewhere?  How many of the Russell Group universities’ 508 senior staff who were paid more than the prime minister in 2018-19 will agree to salary cuts or marginal tax rate increases for the greater good?  Will their response be representative of their broader posh demographic?  Will clinicians who own second homes be content with strongly progressive taxation of their increased value over the years?  What are the legalities of much-needed retrospective wealth taxation?

In short: How are these dreams to be paid for? 

These are not rhetorical questions, and they should be the starting point for conversations that substitute serious consideration of political economy for cheerleading. Even in high-income countries, the post-pandemic menu of policy options is likely to be circumscribed by the International Monetary Fund’s role as a gatekeeper to financial markets – a role that low- and middle-income countries (LMICs) have experienced with often bitter consequences over the past decades, with the impacts compounded by capital flight.  Given the dire situation of LMICs, what justification can the high-income world offer to the world’s majority outside its borders for not taking advantage of fossil fuel prices that have sunk to the pre-1973 levels that enabled today’s rich to get that way, unless its development assistance agencies and investors are willing to increase their commitments by at least an order of magnitude?   Such conversations may have begun, but I am not hearing them. 

Virus reads from around the web

Intriguing looks at the Swedish approach to pandemic response from Vanity Fair and Nature

An argument that the pandemic is revealing varieties of ‘structural violence’ by government including the UK’s neglect of its health services under austerity, by two professors at Queen Mary University London (this is from Counterpunch, which has provided numerous valuable commentaries on the politics of the pandemic)

A debunking of the idea that UK government is ‘following the science’, pointing out that this claim doesn’t even make sense in the uncertain world of public health policy

And a fine, plain-language guide to the wonderful world of World Health Organization decision-making and finance

From tragedy to farce

The Telegraph, whose coverage of the coronavirus pandemic has been consistently excellent, reports today (21 April) that UK firms are shipping millions of pieces of personal protective equipment (PPE) to Europe, while frontline NHS personnel do without; UK firms cannot get a reply to their offers of supplies; individual hospitals are ‘sidestepping the government’s procurement process’ (thank heavens); and central government longingly awaits imports from Turkey.

If accurate, the report confirms that the UK’s response to the pandemic has descended past tragedy into homicidal farce.  Sadly, having now observed British universities for seven years, I can understand what’s probably going on within the similar bureaucracy of NHS procurement: quality is a byproduct, although it may be achieved (and in universities, as on the NHS frontlines, it often is); the real concern is ticking boxes, Following Procedures and not annoying superiors.  Those managing the process have little stake in the outcome.

With a brief hiatus after the initial shock of panic buying and lockdown, within days the shelves at Tesco and Sainsburys were filling up again: these and other companies, unlike the NHS, have experience with doing logistics on the fly.  As hard as it is for a committed social democrat to say this, it is hard to avoid the conclusion that turning PPE procurement over to private sector logistics contractors, with RAF aircraft at their disposal if necessary, would have produced a superior outcome and saved lives.*  The government will have to try this route if it is to have any hope of protecting professionals and the public as a step towards a lockdown exit strategy, before the economy collapses beyond hope of repair. 

And on that note Prof. Carl Heneghan of Oxford, one of British medicine’s most conspicuous overachievers, was quoted yesterday as having told BBC Radio 4 that ‘the damaging effect now of lockdown is going to outweigh the damaging effect of coronavirus’.  Indeed, the social science tells us precisely that.  The question now is who will listen.

* Update: The Times reported on 22 April, unfortunately behind a paywall, that the NHS has in fact simplified its PPE supply chain to involve both the armed forces ‘and Clipper Logistics, a private contractor’, but that the military are ‘appalled’ by continuing inability to procure PPE and deliver it where it is needed. Clearly managers cannot get even the simplified logistics right … the fatal farce continues.

Testing and tracing – not here

So, here we are into week four of a lockdown that threatens to turn the UK into a Third World economy.  There is widespread agreement among those knowledgeable about public health that intensive testing and contact tracing are the least unsafe routes out of the lockdown.  In its 18 April issue, The Economist reports that to carry this out effectively in the US, more than 260,000 people would need to be trained and hired to do a job that is not especially demanding – “anyone with a secondary-school education can be trained in a day”.  It further reports an estimate that paying the first 100,000 hires paid for a year, after the costs of training, would cost US$3.6 billion – ‘a rounding error on the cost of shutting down the American economy’.

I’ve done a simple transposition of these numbers to the UK context.  The UK’s population is about one-fifth that of the United States, so the need is for 52,000 contact tracers, with an initial tranche of 10,000 – a small fraction of the number of people with requisite qualifications who have been idled by the mandated economic shutdown.  Assuming comparable wage costs, after training this first tranche would cost less than £600 million – again, a rounding error in the costs lockdown is now inflicting on the UK economy.

There is no indication whatsoever that the UK government is contemplating the basic measures that, on the best available evidence, would provide a safe route out of lockdown.  Instead, we get reports that: ‘A Department of Health spokesman said the UK was “one of the most prepared countries in the world for pandemics”’ – meaning only that anyone with an official connection to central government is lying, which we already knew. 

The lack of any semblance of preparation lends itself to one of three explanations:

1.  The government is incompetent and has no idea of what it is doing – troubling, since constitutionally it is almost impossible to replace for four years.

2.  The government is well aware of what it should be doing, but also aware that despite the sweeping powers it has granted itself, it lacks the administrative and logistics capacity in Whitehall and perhaps the basic intelligence at senior levels to organise tasks such as repurposing idled industrial capacity to produce protective equipment and setting up training programmes using existing educational institutions.  A government run by normally intelligent grownups would have started on these tasks weeks ago, bringing in private sector expertise as needed.

3.  The government’s objective is to create conditions under which current lockdown conditions will be extended for many months, using public health as a justification – meanwhile, distracting attention from all its earlier failures to take measures that would avoided the continuing crisis.

Take your choice – and if you are fortunate enough to have the choice, organise your own ‘exit strategy’ from what may become an unlivable jurisdiction if and when the lockdown ends.

Unemployment and the dark future of the post-pandemic world

I have previously mentioned Andrew Sorkin’s DealBook blog, which I regard as indispensable.  Here’s an example: The first paragraphs of today’s (16 April) update about the situation in the United States:

Think about the short- and long-term health implications of that last figure, and the situation in many other countries, which will no doubt be comparable.  If you take the social determinants of health inequalities at all seriously, you can’t ignore them, even though too many of my colleagues would prefer to do so.

Against Covid-19 fetishism, and other musings

Herewith a few equity- and policy-oriented musings about the latest state of the pandemic world.

1.  Media, and many researchers who should know better, seem obsessed with the number of deaths from Covid-19, or associated with Covid-19.  Good reasons exist to want to know this over the short term, for purposes of tracking the spread of the virus, but apart from the fact that in most countries the current chaos makes it impossible accurately to determine this number, it is largely irrelevant in terms of the overall health impacts of the pandemic.

The most basic indicator that matters is the all-cause mortality rate (age-adjusted or not, and both figures should be presented), and the inequalities in this indicator amongst various age, class, gender, race/ethnicity and regional demographics. Over time, all-cause mortality rates will reflect not only the short-term health system dislocations and dysfunctions associated with the pandemic, but also the longer-term impacts on social determinants of health of the depression that will follow the lockdown. In a few years, those of us still alive will be able to compare the effectiveness of various national responses … and to restate a point it is all-cause mortality, and not the number of deaths directly attributable to Covid-19 or among people tested positive, that matters. Dead is dead, whatever the cause.

2.  In the UK, I continue to be baffled by the utter lack of comprehension among people professing a concern for equity of what economic downturns of the magnitude now apparently envisioned by Treasury – and of course these anticipations are all dependent on the assumed length of the lockdown, the nature of the exit strategy, and the economy’s subsequent response – will mean for everyday life and for the economic substrates of health inequalities.  The cynical me suspects that most people in a position to prognosticate with anyone paying attention have gardens and can comfortably work from home, unlike much of the rest of the population.

Let me suggest just one example of probable impacts:

Concern about the fate of high street commerce has long been unmatched by meaningful policy response.  Mr. and Mrs. Range Rover, who matter most in political terms, usually shop online or in the suburbs.   Post-pandemic, for hard financial reasons, it is likely that local authorities will simply cease providing services to low-occupancy commercial high streets, and utilities will be released from whatever obligations they have to provide services in those areas.  There will be few users, and fewer still who are able to pay their bills or council taxes. 

A fantasy?  Not at all.  A variant of this policy was partially adopted as “planned shrinkage” in New York City in the 1980s, and much more recently in post-bankruptcy Detroit.  There will be no-go high street wastelands of abandonment, at least until some far distant future when they will become attractive for reinvestment (beyond the lifetimes of many of us).

Alternatives can be imagined, in abundance (and will be the topic of a future post), but it is hard to think that any UK government will pursue them in the near future, especially as the country’s post-pandemic economic policy may well be managed jointly by the International Monetary Fund, as gatekeeper, and China, as the only external actor with the resources necessary to provide direct investment on the scale necessary.

3.  Even if the UK’s post-Brexit departure from the single market and customs union is delayed, as it should be, the full scope of the dislocations will become clear at the start of next winter, when it becomes clear how many Britons simply cannot afford to heat their homes.  Watch the all-cause mortality rate carefully as that happens. 

This post was updated on 15 April.

Power and pandemics: A thought experiment

Imagine you’re a far-right government bent on a particular political project, whose lead minister for domestic affairs is on record as saying governments are not responsible for poverty, and you have to respond to a fast-moving contagious disease, after a decade of austerity has left the national health system overstretched even under normal circumstances and eviscerated local authorities’ ability to respond to public health crises. 

You are also committed to leaving the customs union whose members buy almost half your exports and supply about 30 percent of the nation’s food, in nine months, with or without a replacement set of arrangements[1] and despite the social and economic disruption that may ensue, including disruption of food supply chains whose precariousness the epidemic is already demonstrating. 

What might your sharpest-minded strategists do? 

Well, one approach would start by playing down the seriousness of the epidemic.  The Prime Minister might urge people to minimise social contact, whilst sometimes ignoring his own advice.  As the scale and speed of the epidemic became clearer, you might go ‘evidence-based,’ relying on a particularly apocalyptic set of model predictions that ignore the possible benefits of basic public health measures such as contact tracing, clinical observation, and testingperhaps to avoid drawing attention to austerity’s effects on the country’s ability to carry those out. 

Now invoking wartime imagery, you would close schools and most businesses and public facilities countrywide.  Within a few days, enabled by a hapless simpering Parliamentary opposition that did not oppose, you would enact a 348-page piece of legislation that centralises almost all power in the hands of the political executive for at least two years, and among many other extraordinary measures gives police the authority to use roadblocks and drones to prevent non-essential travel, indeed to define it, with criminal prosecution as a backstop. You would also, quite understandably, commit to massive borrowing and spending in order partially to compensate for lost jobs and business revenues, and to keep the economy from collapsing completely.

Oh, wait – the UK has such a government, and it just did all that.  Lancet editor Richard Horton has written that ‘basic principles of public health and infectious disease control were ignored, for reasons that remain opaque’; the following day, former Conservative Secretary of State Jeremy Hunt made a similar point, noting – about countries that tested early and intensively – that ‘[t]he restaurants are open in South Korea. You can go shopping in Taiwan. Offices are open in Singapore’. Abundant evidence now shows that permissible movements are now determined only by police acting on their interpretation of the orders of the political executive. When the other shoe drops, in the form of post-pandemic, post-Brexit austerity that will solemnly be defended on grounds of fiscal prudence, resistance may be difficult if not dangerous.  Methinks that far from blundering, the Conservative response to the pandemic has been extremely calculating and politically sophisticated.  I desperately hope I’m wrong.


[1]   Thanks to the US, the World Trade Organization now is nothing more than a talking shop, but that’s another story.

This post was updated on 31 March

Snapshots and casualties from the pandemic

On the morning of 18 March, Andrew Ross Sorkin’s indispensable Dealbook blog asked ‘what a “wartime” economy looks like’, pointing to the roughly US$2.5 billion in stimulus spending that the United States, the UK, France, Germany and Spain had offered as of yesterday; warning that it might not be enough; and calling the ‘spending plans unlike anything seen during peacetime’.

Actually he’s not quite correct on that last point.  The Bank of England pointed out in 2009 that in response to the financial crisis, the US and UK governments quickly mobilised an estimated US$14 trillion in cash and credit guarantees to rescue financial institutions, ‘equivalent to about 50% of annual GDP in those economies, although that does not equate to losses as in some cases these obligations were offset by holdings of assets’.  It is becoming clearer by the day that a commitment of that magnitude, if not larger, will be needed to avoid a depression.  And the blog points out that during the Second World War, the UK and the US ran budget deficits equivalent to more than a fifth of their respective GDPs.  By 20 March, The Economist was citing a figure of US$7.4 trillion (about 23 percent of GDP) as the combined commitment from the US, the UK, Germany, France and Italy; warning that conventional fiscal policy is likely to have limited impact; and observing that ‘new financial tools need to be deployed, and fast’. An optimistic view is that Green New Deals may achieve a breadth of political support unimaginable two weeks ago.

On the other hand, Toronto’s Globe and Mail offered an important commentary pointing out that many people already living paycheque to paycheque and now facing the probability of job losses cannot afford to stockpile a fortnight’s worth of food and will probably have trouble keeping a roof over their heads – an obvious point that seems to have escaped most of the mainstream media.  Both the New York Times, whose epidemic coverage is now out from behind its paywall, and the Guardian offered ominous frontline accounts calling into question the National Health Service’s ability to cope with increased caseloads after a decade of austerity-induced fragility. Similar accounts are now emerging from (among other places) the United States and Italy. And outspoken Lancet editor Richard Horton excoriated the British response as ‘a collective failure among politicians and perhaps even government experts to recognise the signals’ emanating from China and India.  He concluded that ‘when we have suppressed this epidemic, when life returns to some semblance of normality, difficult questions will have to be asked and answered’. 

We must now confront the possibility that, if economic policy is mismanaged and some health services collapse, that return might take, not a few years, but a generation.

This post was updated on 20 March