Global Health Tears the World a New One

The Felicific Calculus used by international institutions and global media has decreed that all the bad things in the world, whomever or whatever may have been blamed for them in the past, are now almost entirely accounted for by Covid-19. The world of ordinary people knows that the calculus is a hoax, and that poverty, sickness, disability, economic and environmental collapse, anything that is getting worse since the pandemic started, are a result of the response to it, not the pandemic. 

The English Guardian churns out another clickbait article, deeply concerned about the effects of Covid-19, seemingly oblivious to the fact that every item ticked off in their spreadsheet predates the virus by decades, even centuries. Other media have jumped in with organ trafficking, persecution of people with HIV, family planning provision, availability of sanitary pads, teen pregnancy, child abuse, domestic abuse, female genital mutilation (sic), child marriage, orphans and much else, striving to update their advocacy with the latest hashtags. 

And the universal solution to all these problems is technology! There are vaccines, masks, hand sanitizers, handheld computers and anything else that can be sold to people who have lived their whole lives without access to running water, an adequate and varied diet, in environments that have been depleted, to a large extent, by the same countries that produce all the technology and the purported solutions and their array of placebo suppositories. 

For the Guardian, decades of progress on extreme poverty is now in reverse due to Covid, so the title goes. But much of the ‘evidence’ for this is from a World Bank wonk, who pours out the usual sanctimonious spiel about all the great things that have been achieved, but that are now threatened by a pandemic. They are not threatened by a pandemic, they are threatened by the response to it. 

Bear in mind, this is the institution to which almost every poor country is in debt. Much of those countries’ annual earnings is sent to repay loans they have been persuaded to take over a period of several decades. A handful of international institutions have pushed poor countries to reduce public sector employment, spending on health, education, infrastructure and social services. Indeed, they have ensured the destruction of the very things that they now claim are vital to address Covid-19: hospitals, schools, infrastructure and social services. 

Poor countries are arm-twisted by such international institutions into handing over all resources that are of value to multinationals. Multinationals are not content to rip out everything they can get their hands on, but will happily destroy environments, communities, water supplies, economies and anything else, and leave behind an enormous tab for the host to pay. The very means to survive for most people, fertile land, water, food, employment, agriculture, etc., are denied to those countries in the name of modernization and development. 

The World Bank knows more than most about the conditions in poor countries, because they have spent so long reducing struggling economies to rubble. Countries that had anything worth exploiting were, effectively, colonized by poverty profiteers, people who were paid to take what they wanted, and often took a lot more. Media, like the Guardian, dutifully cover ‘disasters’ as if the damage they wreak on increasingly vulnerable populations is entirely unforeseen, unpredictable, an ‘act of God’. 

Since when has the World Bank been the go-to source of ideas for reducing poverty, or for improving the conditions that most people in the world live in? The countries that have followed their ideologies, as they gradually moved from the vile and despotic policies of 40 years ago to the most comprehensive and widespread enslavement and subjugation of people living in poor countries that we see today, are the ones suffering the most now. 

The only thing more disgusting than promulgating this kind of poverty porn is the pretence that the English Guardian, the World Bank or any of the other big players in the media, international financial institutions and the development industry have the slightest sympathy for those who suffer most from the conditions that underlie this veneer of humanitarianism and philanthropy.  

If these prognostications from the media are correct, and many things really have improved over the past 30-40 years, then we must return to where we were before the pandemic, and identify what we were doing right, and do more of that. Many things will need to be done differently, and the big players of the past will be reluctant to do anything not in their interest. But these lockdowns are a disaster and must be ended before the damage they are doing becomes irreversible. 

To those who herald in the ‘new normal’, there’s nothing new about poverty, disease, food shortages, droughts and disasters. Lockdowns exacerbate and further institutionalize phenomena that have been around for as long as people in poor countries can remember. There's nothing new about authoritarianism, but we have been happy to overlook it when it was imposed on distant countries. It now threatens everyone and it's not something to be encouraged. 

In Memory of Dr Joseph Sonnabend, 6 Jan 1933–24 Jan 2021

Dr Joseph Sonnabend’s first concern was always the welfare of his patients, their families and the people they loved. Before HIV was identified as the virus that caused Aids, Dr Sonnabend was treating people suffering from the shocking illnesses that he and others were discovering among their patients in New York, mostly gay men. Many people infected in the 1980s died. But some survived because of the work of professionals such as Joseph. He pioneered safe sex as a response to HIV and Aids among gay men, and gave his patients the undivided attention that few others were prepared to give.  

Joseph set up and ran several institutions to address the epidemic, care for sick people and research the disease. But when some of his colleagues joined with other parties to create a myth about an imminent ‘heterosexual Aids’ pandemic in order to raise funding, he left. Joseph was branded a ‘denialist’ by those who didn’t wish to deal with any of the numerous concerns that he raised. However, Joseph continued to insist that you cannot understand the spread of a disease if you fail to identify the most important circumstances surrounding its transmission. He still held his ‘multi-factorial’ view of HIV a few months ago, in a discussion about the history of the pandemic with Sean Strub and Dr. Stuart Schlossman. When Schlossman claimed that no one held such a view any longer, Joseph disagreed, but did not have the opportunity to defend his position at that time.

Joseph told me later that his ‘multi-factorial’ view of disease transmission is a characterization of epidemiology as the study of pathogen, host and environment, and not an idiosyncratic theory of his own. He said that most people he worked with in immunology and epidemiology held a similar view, and did not reduce the explanation of HIV infection and the development of Aids to an account of the pathogen, alone, independent of host and environment factors. That’s why the multi-factorial view of HIV explains a lot more than its sexual transmission among men who have sex with men. The theory can also be used to understand the extraordinary outbreaks of HIV transmission among people who are neither male, gay, intravenous drug users, nor even sex workers. The worst of these outbreaks are all to be found in a few countries in southern and eastern Africa, including Zimbabwe and South Africa, where Joseph spent several decades of his life.

Joseph confirmed my belief that HIV is not ‘all about sex’ in high prevalence countries, and that the worst epidemics cannot be accounted for by alleged ‘unsafe’ sexual behavior among African people. He often asked how women can transmit HIV to men via sexual intercourse, saying he knew of no causal mechanism to explain it. Something about the host and the environment, African people and the conditions they live in, the experiences they have, the diseases they suffer, their crumbling healthcare facilities, their poverty and their position as former possessions of European powers could turn out to be a part of a credible explanation of the highest rates of HIV transmission in the world.

Joseph was concerned about the way people lived, their welfare, their “complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO’s definition of health, not necessarily exemplified by their activities). He was not content with vaccines and cures, treatment regimens and medications, alone. In fact, Joseph was opposed to what he saw as the rapidly increasing ‘medicalization’ of healthcare, and disgusted by the systematic humiliation of African people, who were blamed for their own sickness and told to quietly accept what they were given.

Many people have learned a great deal from Joseph, and benefited from his work. He distanced himself from those who saw HIV and Aids as a launchpad for their own careers and ambitions, and he refused to get involved in the more lucrative side of the pandemic. He will be much missed.