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Capitalism Breeds Pathogens: An Interview with Epidemiologist Rob Wallace - Left Voice

Ideas & Debates, United States

Capitalism Breeds Pathogens: An Interview with Epidemiologist Rob Wallace

Evolutionary epidemiologist Rob Wallace speaks with Left Voice healthcare workers Mike Pappas, Tre Kwon, and Cliff Willmeng on the origins of Covid and capitalism’s failure to respond to the crisis.

Mike Pappas, Cliff Willmeng and Tre Kwon |
September 7, 2021

Mike Pappas: Where did Covid come from and how did we get here?

I’m an evolutionary epidemiologist by training. I used to take genetic sequences, say the Avian influenza, or H5N1, the first viral rock star of the century, and look at the genetic sequences from the various locales across China and across Eurasia and then build phylogenetic trees. These are evolutionary trees showing how the various strains are related to each other. And because we know the locales where we sample these strains, we can infer through the tree of the previous localities of the strain. So in other words, we can build a map of these different strains just based on the genetic sequences alone. So we did that for H5N1. We identified a southeastern province in China called Guangdong, which seems to be the province of origin for H5N1 before it spilled over into Hong Kong.

The problem is that I made a career mistake. I got curious about something. It’s not always the best career move in science. Much of science is very much attached to establishment presumptions about the nature of capitalism, the nature of empire. And curiosity is very much delineated in specific lanes of exploration and investigation. People are incredibly bright but often work within really restricted boundaries of what is permissible to explore. My curiosity got me into trouble because I wanted to know why H5N1 emerged in Guangdong in 1997. You can’t find the answer in the genetic sequences themselves. So I got into the notions of the history of agriculture in the region, the political economy of global agribusiness, how the different agricultural sectors evolved over time in China and elsewhere, how agribusiness is probably the worst — or the best model — one can come up with for selecting the most deadly pathogens imaginable.

Along the way, you have all these different pathogens that are emerging in real time, almost on an annual basis: you have other avian influenzas; you have the eight, seven, and nine that emerge in 2013; you have the H5N1 that emerged a couple of years later across Europe. In the U.S. you have H5N1 emerge and go on to kill 50 million poultry. But it’s not just the avian influenza. The swine influenza, H1N1, emerged outside Mexico City and in swine before actually becoming a pandemic. You have Zika and SARS. All sorts of pathogens are emerging almost annually. In fact, they’re starting to emerge in parallel. Many of us had our eyes on a virus called African swine fever that originated in Africa among wild hog, but also domestic hog before spilling over into Europe, then more recently through eastern Europe, and then finally to China in 2018, where it killed half the hog population. The hog immune system is very similar to the human one, so at that time, we were very concerned. Anything that’s circulating in domestic hogs could really do quite serious damage to humans.

And so our team, evolutionary biologists, ecologists, geographers, and social scientists of various stripes began to think how and why these viruses are emerging one after another. A lot of the time and attention is put on pathogens and viruses because a lot of focus is on the object of causality, meaning the virus or the vaccine. Clearly the causality extends beyond what’s under the microscope and out into the field and the world. And in such a way that we got into the habit of actually naming some of these pathogens after political movements and even specific politicians.

There’s some aspect of satire about it, but there’s a very serious thing in mind, which is to say that the decisions that governments and broader economies make in terms of how they relate to the world have a profound effect on how pathogens emerge.

So, for instance, we name the H1N1 swine influenza that emerged in 2009 the “NAFTA flu,” after the North American Free Trade Agreement. You have a trade agreement put in place in 1994 that opened up the trade barriers in a way that allowed the multinationals to dump meat on the Mexican domestic market and to destroy the Mexican economy in that sector. Mexican farmers had two choices: either sell off because they couldn’t compete, or consolidate their own farms in a way to make them large enough to compete with the new subsidiaries that were being bought up by American multinationals, among them Smithfield. And it changed Mexican agriculture and hog husbandry in a profound way. The mosaic of small farms across the Mexican landscape now turned into something much more American in style. You can actually track the genetics of the new H1N1 that emerged and find that the influenza genome is segmented. When two different influenzas infect a single host, they can trade their segments like card players on a Saturday night. With the H1N1, a lot of the genetics work shows that some of those segments emerged out of hogs from the U.S. and Canada, and some were from Eurasia. How do those two get together? Unlike avian influenza, you can’t blame the wild waterfowl flying from one continent to another; hogs typically don’t fly, except when they’re exported from one country to the next. And since the industrial livestock revolution in which industrial livestock has been increasingly concentrated, with a loss of diversity — we can get into all that in due course — that went hand in glove with an increase in exports of hog from one side of the world to the other and also transporting their pathogens or influenzas from one side of the world to the other. So in this case, to go back to the NAFTA, which allowed these barriers to be pulled down, allow multinationals to come in, and also influenzas to come in and recombine in a way that a new pathogen emerged outside Mexico City in 2009 before it went human to human and became a pandemic.

Another example that we named was the West African Ebola that emerged in 2013. We named it the “neoliberal Ebola,” in part because of the structural adjustment programs imposed on the West African nations. So in order to get loans from the World Bank, the IMF, these countries often have to restructure their economies to allow multinationals in and reduce their public outlays for public health and for animal health. And in the case of West Africa, we have increasing integration or movement into the last of the forested areas there to move local peoples away from peasant agroforestry and the emergence of kind of both national and multinational businesses to produce monoculture plantation agriculture in a way that destroys local forests. What does that have to do with Ebola? Well, forests are very complex places. If you ever walk through one, it’s hard to keep track of everything going on. There’s so much complexity, and that complexity does work for us. It happens to be a kind of emergent property that the complexity of the forest and of the ecology is such that any one pathogen in any one host can’t line up a whole bunch of hosts together and really shoot through out of the forest, out into the local landscape, into your local city.

But when you allow multinationals come in, whether it’s plantation agriculture, or logging, or mining, you basically destroy the forest. Most of the host species, natural reservoirs for many pathogens, will die out, but some of them don’t. And a lot of animals, species, they don’t just keel over. They basically are behaviorally plastic. Bats have that kind of behavioral plasticity, and they move right into the monoculture plantations. I mean, what’s not to like — a lot of room to fly from their roosting sites and their foraging sites. There aren’t any competitors or predators. And you have an increasing interface between the locals who have been hired by national companies and multinationals to help run these plantations. And also because of the kind of proletarianization of locals there, they can’t pay all their bills. Many have also migrated into local regional capitals and migrate back during the growing season; there you have your circle, your cycle as it were. Any pathogen and Ebola that spills over from the fruit of your bats or insects or bats spills over into local workers, either tending livestock or the local plantations or loggers or miners, and those workers migrate to the local city.

Public health is in decline because of structural adjustment programs. Any Ebola infection is hard to recognize. And then the virus goes human to human, and you’re off to the races. This is why you have an Ebola that genetically wasn’t very different at all from previous Ebolas that have emerged since the mid-1970s. Ebola would typically spill over into a village or two and take out the village case fatality rates of 90 percent, really terrible. It might take out a gorilla troop, but that’s it. It wouldn’t go any further. But when you streamline that kind of periurban landscape from the deep forest to the city, you have a straight shot out of the local forest right into the local city. Even if the virus itself hasn’t changed, we made the distinction between the object of the virus and the vaccines and the prophylaxis and the field, meaning the larger ecological and sociological relationships between humans and animals, wild animals, their livestock, their crops, and so on. That change in that context is what drove the virus, not the virus itself. The virus causes the outbreak — but it’s also the changing global economy, which has been locally imprinted upon West Africa in a way that allowed this virus to find its legs and go on to infect 35,000 people, kill 11,000 people, leaving bodies in the streets of regional capitals.

Now, what does this have to do with Covid-19? So it’s the circle of production going on between the regional capital through the periurban space all the way into the deep forest and back again. And these different pathogens are emerging in different parts of this circuit of production. So Ebola, as we described, emerges out of the deep forests with the local bats, spilling over into workers, who then by their own migration, take it to the regional capitals. So that emergence is largely at that end of that circuit. And then you have viruses like SARS 2, which causes Covid-19. These are emerging along that entire space. Our research group’s notion of the field hypothesis for Covid-19 is that it emerged in south or central China.

I won’t go into the whole history of China. But just to say, broadly speaking, post-Mao, you have China deciding to go the BRICS route of capitalist development. We won’t argue about whether that was good or bad, but it’s safe to say that millions were pulled out of poverty, and millions were left behind. But for the most part, the Chinese decided to engage in the kind of self-exploitation of using its own resources for its own economic development rather than the old traditional colonial model of the global North merely exploiting the Global South. But in doing so, it encroached on its own forest, as happened in the story of Ebola in Africa. You have the encroachment of traditional livestock on the last of the forests, but also, another sector that’s not only in China but elsewhere, the developing wild-food sector: pangolin, civets, and such, which are increasingly being treated as traditional livestock are, much more integrated into the capitalist food economy. Both those food sectors, both the traditional livestock and monoculture plantation and the more wild food sector, are moving in on China’s south and central forests. Increasing the interface with bats have been documented to be a reservoir for a variety of coronaviruses. SARS 1 emerges in 2002, when pesticide use has been increasing in China even more than in the U.S., so that reduces the insect population and reduces the food for many of these bats, and it increases the area that they need to fly to capture the food they need, which also increases the interface.

I notice, Mike, you did ask me about the field theory hypothesis, in part because I suspect you want to avoid discussing the lab hypothesis, in part because there are so many crazies pushing it. I would say, though, that this might have occurred. In 2013 a Princeton University group put out a report that post-H5N1 and post-9/11, countries around the world started to build Biosafety Labs, biosafety levels (BSL) 3 and 4, that handle the worst and most dangerous pathogens. And they were built in the thousands around the world. And even if a lab leak is rare, a rare event, if given enough chances, bends toward inevitability in such a way that that too is indeed still a hypothesis in play. I mean, it took us 15 years to figure out how SARS 1 emerged, it’s not going to take 19 months to figure out how SARS 2 emerged, so I keep both those possibilities in play, even though I’m very much more a proponent of the field theory because of the chances involved that the various coronaviruses have to experiment with a human immune system. Some of the genetics indicate that in all likelihood, SARS 2 was circulating in human populations for years before it actually exploded in Wuhan, which is very much to the consternation of those who favor the lab leak theory. So that’s how, in our view, Covid-19 emerged out of the field. And it’s fundamentally related to the decisions and governance about how to intervene in terms of public health.

Mike Pappas: Now that more and more people are vaccinated, there’s this rhetoric around solving or escaping the pandemic. “Just get the vaccine, or you’re part of the problem.” Of course, we want people to get the vaccine. But, you’ve talked about how vaccinations in themselves aren’t a magic bullet. Can you elaborate?

First, as we’re finding out right now, the notion that only those who can pay for the vaccines should have access to them is allowing the virus to continue to spread and to evolve, including variants that can escape the vaccine. That doesn’t work. The capitalist model of production of permitting prophylaxis for only those who can pay is a terrible public health approach.

The second thing to understand is that these medical innovations are never enough. Health is an emergent property beyond the individual body. And it’s something that we share in the body politic. And public health is an emergent property of the political economies and models of governance that any country engages in. There are things beyond the scope of human intervention. This is not one of them. Meaning even a pandemic that is everywhere all at once depends on the decisions that governments make around the world. Or in this case, and this is a shock for many people, of even to do anything about it at all. We can speak about the difference between capitalist countries and others, and we should in due course. But it isn’t just a matter of that. It’s the decision of a government to go, “Oh, you know what? The reason why we exist is to help with the public commons and to actually address the needs of the people we ostensibly represent under whatever model of governance.”

You do have countries that engaged in that. China screwed up early on in dealing with Covid’s emergence. But as far as it dealt with its own people, if there’s an outbreak of Covid-19, it floods that local province or local city with thousands of public health workers to engage in the kind of Tetris intervention — testing, tracing, isolation — necessary to track down who’s been infected, isolate them out before they infect anybody else. Make sure that those who are isolated or who are under stay-at-home orders can survive. I remember the early photos of New York City in March 2020 when you had primarily Black and brown workers on subways out and about going to work, whether or not they were so-called essential workers because they had to pay bills. There was no way they can make rent or get food unless they were out and about. That’s how Covid got ahold of them in New York City and exploded because governments didn’t care about that.

So it’s really remarkable coming out of Trump, a total buffoon, total disaster, they put a lot of money into developing vaccines. It is remarkable. I mean, I didn’t think they would do it. Usually vaccines take no earlier than years to develop, and there hadn’t been a coronavirus vaccine ever developed, so they did deliver. But it’s not a sterilizing vaccination, meaning that those who are vaccinated can still pass on the virus. It provides disease immunity, however. It will largely keep you from getting killed or being hospitalized. And in June, 99 percent of those who were killed by Covid-19 in the U.S. were unvaccinated. But it’s not enough. Because the failure to follow through with the nonpharmaceutical interventions that we talked about, the stay-at-home orders, the need to isolate people who are sick, we weren’t able to do that at all. We refused to do that. We’ve lost even the very notion of the concept of public health, that you would hire hundreds of thousands, if not millions of public health workers, community health workers to go hit the street, to go out there and reach out to people. You would do what other countries did, which is to pay people to stay home rather than forcing working people to go out to pay their bills. It’s ridiculous. Those countries (New Zealand, Vietnam, Taiwan, Iceland for example) took care of business in four months. Here we are in month 17, and we still don’t have a handle on a pandemic here. You’ve lost touch with even notions of what public health interventions are. And that comes from the insistence on commoditizing medical interventions, both the actual medicine and its delivery. So every minute in the ER or in the doctor’s office is billable. That’s not public health.

You have to match the scale of the outbreak with the scale of the intervention, and underfunded hospitals are not the scale at which Covid-19 operates. It operates way more at a level that requires community interventions out and abroad, and not just at the point of medical intervention. So if you don’t have the apparatus involved in delivering nonpharmaceutical interventions that countries like little Vietnam actually was able to engage in in short order and keep the outbreak from going–when the richest country in humanity can’t do even that, then that public health apparatus is still not available here, but you still need it to deliver your vaccines to get people out and about.

But we have individualized public health. And this is not just a Trump thing, Biden has done it as well. In fact, his vaccine intervention said, “It’s on your head, if you don’t get the vaccine because we all want to do our cookouts by July 4, and you’re going to ruin everything.” He also said, “Oh, those of you who are vaccinated, you can take your mask off because you’re not going to infect anybody else,” when even then many of us knew that that wasn’t true. Both those things sent a signal to the entirety of the country, whether you were vaccinated or not, that you can take off your mask. It basically threw masks under the bus as a means of intervening. Nonpharmaceutical interventions were basically thrust aside at a time when we needed to continue to develop trust in them so that you would engage in all the interventions at once.

There’s something called a Swiss cheese model of public health intervention. Vaccines, they do a lot, but they’re not keeping people necessarily from being infected. So there’s holes in that slice of cheese. So that’s why you had to put another slice of cheese on top of it. It may have holes as well, but they’re in different parts of the cheese. So once you build several layers of cheese, then all the holes are filled by virtue of a kind of holistic mode of intervention where you do multiple means by filtering out influenza, keeping it from spreading out in the community, vaccination testing, tracing isolation, paying people to stay home, food trucks on the ground to feed people, municipalizing restaurants, as it were. You pay restaurants to cook food for local people. That’s a government program. But that’s rejected as a violation of the kind of capitalist ideology that requires all interventions to make a buck.

Mike Pappas: In countries where we see really high vaccination rates, even ones that were held up as examples, like Israel, we’re now seeing case numbers and hospitalizations go up again. And I wanted to ask you about that because I‘ve seen a bunch of different theories of why that might be happening. Anything from immune-escape, versus possibly waning immunity, versus antibody dependent enhancement (ADE) theories and those types of things. And I‘m just wondering your thoughts on that and what we’re seeing in those countries.

I would say all of those things are in play. If you go back to pointing the finger, the liberals like to dunk on Trump and the anti-vaxxers for not doing this. And there’s an element of, “Well, you should go die,” which is ridiculous because as horrible as we might consider people’s politics, there really has to be a notion of shared fate and the understanding that the health and well-being of my neighbor is fundamentally tied to mine. Pathogens are weird because they’re both too small to be seen and too big to be seen because the waves of epidemics extend across whole states and countries. And it’s hard for us to see that in real time. So the well-being of people we don’t like is fundamentally, integrally related with our own well-being. It’s not an ethical thing on my part, because I don’t like Nazis and I don’t like Trumpists and I have my own feelings about their fate. However, the well-being in public health terms extends beyond that, and we have to see that even those who don’t take vaccines are indeed our epidemiological brothers and sisters, and their well-being is tied into ours.

The New York Times had an article in which a survey was done. It’s not just yahoo anti-vaxxers, it’s entirely class divided. Many people below a certain income level are not being vaccinated. Those who are not getting enough food, those who are having a problem with rent. I mean, this is foundationally related, and it really speaks to the failure of governance both at the state and the federal level to go out there, speak to people, find them. And that requires community health workers in the legion of tens of thousands to go out there to do that. And the Biden administration failed to do that. That’s on their head. That’s not just a Trump thing. It’s a capitalist government thing.

It’s our obligation to reach out to people, and it takes hard work, it’s ridiculous. That’s why you are hiring community health workers in the thousands and tens of thousands, they will walk around their neighborhoods, often where they live and talk to people. And you got to work on people. On the weekly and even the monthly or even the daily to get them to think through what the vaccine is, listening to people. It’s not just about talking to your doctor, that is not enough. It’s about talking, as yourself, to people who are your neighbors. And if someone keeps showing up and they are kind to you and respectful, you can have that conversation in a way that will move people to understand that the vaccine makes sense.

About the vaccines themselves. Yeah, I mean, all that you describe is ongoing, so you have the Delta variant, among other variants, emerging in a way that that data coming in even a few months ago indicated that the various vaccines, whatever company, Pfizer, Moderna or any of them, they’re starting to slowly fall out of the sky. We learned first in England that one shot for Pfizer wasn’t enough, so the two shots now. Now they’re talking about booster shots because the variants are evolving out from underneath the efficaciousness of the virus. This is an evolving moment, and the pathogens are evolving. And the more you allow viruses to spread around the world, the more you allow the variants to emerge and defeat your vaccines.

This goes back to the kind of liberal interventions. If you’re going to tut-tut the Trumpist anti-vaxxers for not taking the vaccine, what the hell are you doing supporting the Gates Foundation’s efforts to block the efforts to allow open medicine? The Gates Foundation and the pharmaceutical companies basically told the WHO, You’re not going to do it that way. So COVAX, which was trying to vaccinate 20 percent of populations in low-income countries with discounted vaccines, has largely failed, in part because of these intellectual property rights that are keeping vaccines from being produced around the world.

If you let most of the world go unvaccinated, then you in essence, turn over millions of experiments to the virus to figure out how to evolve to the various things that we throw at it. So it is entirely self-defeating. That’s what capitalism does. It’s in the business of making money. They are perfectly fine continuing along in ways that destroy the earth, whether it’s climate change or these pandemics, as long as some billionaires continue to make a bunch of money.

The pharmaceutical companies have really steered global public health in a direction that meant that it can continue to produce boosters for those who can pay, rather than engaging in the shared public health intervention, global governance that would say, “The health of my neighbors is important to me, we’re going to vaccinate the entire world and do our best to drive Covid down to a point where it’s not going to run wild for many years.”

Early models I saw in March 2020 were predicting that, under worst-case scenarios, the outbreak would continue to 2024. There are now people talking about 2025. You are in the health business, think about how exhausting only a year and a half has been. There could be multiple waves a year because those in power have refused to take this seriously enough.

Millions of people have died, but it’s only a 1 to 2 percent mortality rate. What’s going to happen if we have the annual emergence of viruses with case fatality rates of 5 percent, 25 percent, 30 percent? This, in essence, was something of a softball for a global governance system. And many of the countries failed at it because they’re beholden to a capitalist class.

Mike Pappas: Beyond the pharmaceutical companies, how have various sectors of the capitalist class tried to exploit the pandemic for their own benefit?

I have been looking at the agricultural sector, as you know. I got into agriculture because I realized that you can’t just handle outbreaks once a virus goes human to human. The horse has left the barn. I mean, we talked about all the ways in which a proper public health intervention would minimize the damage and allow us to emerge more unscathed, or relatively less scathed, in a way that we can return to some life that doesn’t involve a pandemic. And I realized that in order to do that, we have to change our agricultural practices and intervene at that level to minimize the possibility that new pathogens would emerge out of livestock and poultry. So, I have been keeping an eye on the agricultural sector. And now here in the U.S. there was the now infamous intervention, Trump’s Defense Production Act (DPA), which did not produce more personal protection equipment (PPE), which was needed by the nurses and doctors and people working on the public. But to allow the various poultry and livestock processing plants to continue as thousands of plant workers got infected and died. And that’s the most obvious thing, the willingness to keep those rolling. Ostensibly it was to feed America, but that wasn’t the case at all. I mean, there is a decline in meat eating among Americans, and there was plenty on hand. It had more to do with fulfilling the demand abroad. The Chinese had suffered a decline in swine production by virtue of the African swine fever. Even though American meat eating had declined, the floorspace built for processing it was increasing in the millions of square feet, across many multiple states. So Trump’s intervention was more about servicing markets abroad than any nationalistic appeal to an American food supply. And, of course, in other words, there was an aspect of denial on the part of the meat sector about the danger of this. And the Trump administration allowed the processing plants to speed up their operations in such a way that it forced workers on the line to actually bunch up closer to each other, and that increased the likelihood of spreading infection. So in other words, the entire sector was devoted to engaging in practices that spread the virus around.

Now comes the hypocrisy that once the vaccine is brought about, the food sector demands that its workers in the factory get vaccinated first. And they should be, but it does speak to the utter hypocrisy on the part of the meat sector to try to vaccinate workers they had thrown under the bus in the first year of the outbreak. So a dangerous infection spread out from these rural meatpacking plants, out into the local community, infecting thousands of people who ostensibly were not anywhere near some of the coastal cities where the outbreak began here in the U.S. Because of the kind of industrialized and globalized nature of the meat supply line, you have some counties that were further out in the most hinterland parts, the most rural parts of the country that were being hit rather hard by outbreaks, even though they weren’t connected to any local cities. So, it has to do with the ways and means by which rural communities have been treated as sacrifice zones in which industrial agriculture wipes out not just the landscape but the capacity of local farmers and meat processors to control the decision-making that goes into what goes on in their community.

Cliff Willmeng: How does the scientific community perceive your work and how you’re discussing this?

I was at the University of Minnesota for a little bit in geography. I wasn’t there very long. I spoke out when H1N1 emerged. I spoke out about the flu, but Minnesota is a company town, it’s an agribusiness state. And I mean, they don’t leave the head of a pig at the end of your bed. It’s not like that, it’s much more Minnesota-style. Calls aren’t returned, your contract was not renewed, and things like that. So that’s how they’re operating. But the filtering process is real. And the capitalist realism is very real. Something that imbues deep into the very fabric of scientific practice, down into the mathematical formalisms. A lot of the scientific–modeling, the susceptible, infectious, recovered modeling in epidemiology– is so focused on the individuals infected and the virus itself that it leaves out the stochastic terms that determine whether a pandemic explodes or contracts.

So, in other words, everything we just described here in very political terms, in terms of political economy and world history, is fundamental to how scientists approach the problem, but they also undergird their development as scientists to begin with, how they’re educated right from the start. Take Richard Lewontin, the famous dialectical biologist, an evolutionary geneticist of great renown who worked with Richard Levins for many years. He’s not the only one who said this, but I remember his version of it along the lines that scientists are part of society before they ever become scientists. So they’re imbued with the instincts of their social class and taught those instincts while becoming part of what are often elite institutions that teach not only the specifics of molecular biology or evolutionary computations, but also how to maneuver through working life. Who pays for science, at the government level, NIH and NSF, those funding numbers are in decline. The average age of those who are rewarded grants has skyrocketed up. So, yeah, young faculty are subject to labor discipline. State universities are increasingly underfunded. So they have to turn to the private sector for R&D funding. So the land grant universities here in the Midwest turn toward agribusiness to supply the money to keep them running. All science isn’t just a method. It’s not just “Oh, I have a question. I’m going to take data and test and see if I can reject the hypothesis or the Bayesian version of assigning posterior probabilities to each of these hypotheses” and all that. You have a lot of bright minds put to the task of hunting for answers to questions not of their making.

So when a pandemic arrives at your shore, you don’t know what the fuck to do because you spent billions of dollars answering questions that had nothing to do with it or answering questions about how to monetize this thing. These are institutional failures. This is what our research group calls failures of institutional cognition. What you see here is the rotting of the American ruling class, a political class that extends out into science. When you’re confronted with a problem that requires various units of governance and society to interact and work through, cogitate through the nature of the problem and cogitate through answers to it, you have to have a well-oiled machine that is open to understanding the true nature of things.

The Chinese did their version, the Kiwis did it, their versions were slightly different from each other, but their institutional cognition kicked in. They came to some answers. They enacted them. What is the U.S. doing? Nothing but dithering around, can’t come up with an answer or returning back to the very answer that was wrong. So in January 2020, Covid-19 is emerging in China. We in the U.S. pretend nothing’s happening, it comes to our shores, we pretend nothing’s happening, all right, so we lost that gamble. We were wrong. What happened January 2021? You have the Delta variant emerging. What do we do? We go back. Oh, we get the vaccines. We’re going to strip the mask off. We’re going to go back to doing exactly the type one error of pretending nothing’s going to happen to us should a danger arrive. We emerge at the same thing, in part because our political class can only identify itself in the mirror of its presumptions. The notion of investing in public commons is completely off the table. You are structurally cornered. All the politicians, whatever party comes up, are incapable, strictly speaking, of thinking through solutions. And that goes for our scientists as well, thinking solutions that require profound shifts in the political nature of our society.

Someone says, “Rob, we should have you in power, man. You be the public health guy. If you could run things, what would you do?” And I’d be like, well, I can give you chapter and verse, but that requires an entirely different society to arrive at a moment that Rob Wallace or anybody else much smarter than me can be in a position to make these decisions. Coming out of the 1960s, you had a bunch of radical scientists in a variety of fields, natural science, touches of Latin American social medicine in the U.S., of all places. Jack Geiger, Levins, and Lewontin, those people were all swept out. And it’s often said that science progresses one funeral at a time. But in this case, not to say that all was well back in the 1970s, but at least there was a still a sense of connection with a social turn. By the time the neoliberal program arrived at universities, those people were all stripped out. They were fired. They were neutered. So people like me, we find our ways on the margins because we get filtered out too. On the other hand, the problem is, the world’s confronted by problems whose solutions radicals have a lot to offer. So when H5N1 emerged, the Food and Agriculture Organization, which for many farmers is like the Death Star, but they all of a sudden had a bunch of money given to them. So I was hired on a contract basis to do some work on H5N1. I was able to make some interventions that, at least at the level of the science, had some interesting steps forward. But then H5N1 was politically solved even as it is still a problem in terms of epidemiology.

That’s the problem. When you solve something politically, meaning it’s a nice way of saying sweep it under the rug, the problem remains. New pathogens emerge, and you keep rolling the dice year after year, or now we’re rolling it a couple of times a year. You have to return to our first question. You have so many different types of new pathogens emerging. Then invariably one hits the sweet spot of being infectious and virulent, and it gets onto the increasing global traffic, much more integrated global traffic, both in trade and travel, which I think should have been part of that model of the circuits of production. Once you reach the regional capital, you get on a plane, and in a couple of hours this virus is having martinis on Miami Beach. There’s no friction to stop it. This is why it’s so incredibly important to gravitate toward new models of human solidarity, if only because the production models and our civilizational model have gotten us to a spot where a pathogen emerged in the most hinterlands area you can imagine and can get to the other side of the world in short order.

The competing brothers — that’s what Marx called capitalists — work together to enforce labor discipline or even commit mass murder to protect their interests. But they are profoundly divorced from what we all share. In terms of that, we are very much still part of the ecological matrix upon which our entire species depends. When you see a forest, that’s not just something to strip down for logging. It’s working as a buffer from pathogens, but it also provides clean water, produces air, produces the entire ecological matrix upon which we depend, all the animals and insects and plants and diversity. This is ultimately why it’s ecosocialism or barbarism.

Cliff Willmeng: What would your message be to the health care workers specifically? And what would be a better decision-making model in health care?

I don’t want to just come off as Dr. Doom, right? Because we are in some heavy shit. I’m not going to deny that. Tracing all that is an important contribution because it says, “Oh, this is the scope of things, this is serious business. Now we have to draw attention on this.” I’m not in the medical field. I’m not a nurse or doctor. I cede the field to those who know much more along these lines. I would say a couple of things, however. And the first, if I were to draw an analogy to what’s happening in agriculture, I spoke about the problem of robbing farmers and rural communities of the right to make decisions locally. That leads to an extractivist model that destroys local communities that are sending all the money by pipeline to, say, Monsanto headquarters in St. Louis or something like that. That aspect of local control is incredibly important. And it doesn’t matter what model, if you’re an anarchistic model or a socialist model or central planning communist model — there has to be some aspect of local control in decision-making because local people know what’s going on in a way that is incredibly important, even as we also need to engage in the kind of solidarity building across communities from one county to another to the other side of the world. So nurses and some doctors have been very much the lead on this. When the CDC put its mask mandate out in May, they said if you’re vaccinated, you don’t need your mask. And it’s remarkable to deans of public health, who as a species tend to be quite cowardly, but they were so aghast by this that they wrote a scathing op-ed. And my hat’s off to them. But clearly, many nurses’ unions were very much on point with this. Some of the national unions were adamant that this is bullshit and gave chapter and verse on why. Nurses have a certain moral standing among many community members.

I would say back a program that is much more than just about the vaccines. Clearly, many people need to get vaccinated, but it isn’t merely a matter of talking to someone in a clinic or an examination room. If you really want to get us to move forward, we really need to push in a very pragmatic way the notion of the community health worker and get thousands and tens of thousands of people who can go visit people where they are checking on how they are, what their needs are. Even people who would fundamentally disagree and not like to see such a worker. That repeat visit would actually develop the trust necessary to have those difficult conversations.

In the end, I could argue for overthrowing capitalism. And that’s a good place to start. But as a pragmatic first step, along the lines of fighting Covid-19 from the hospital floor, which is where nurses operate, the public health effort has to extend out into the community so you can reduce the community infection level so that the hospitals aren’t overrun. And that requires forcing politicians in various jurisdictions to fund the kind of Tetris interventions that have been largely abandoned or were never taken up. And it involves hiring a lot of people at good wages and benefits in a way, because it’s not easy work or at the necessary scale.

This extends to the question, How do we stop these pathogens from emerging in the first place? The medical sector needs to intervene in the agricultural sector. You don’t want to have to go through this again. So that means intervening and saying we can’t do agriculture in this way anymore, and we have to do it in a new way that promotes rural health on an individual and community level. It returns the locus of control to people. That’s a very long history in terms of the public health benefits of community control. And because the community health damage and the agricultural sector are fundamentally integrated.

And the thing is, other countries have this all worked out. There was a recent outbreak in a Chinese city, and they sent 70,000 public health workers, and they rushed to the area. And they’re very much about relating what happens in the hospitals, what happens out in the community. And it’s not part of the American instinct at this point, because here you want to quash things early on so that you don’t have to do that. There was talk about flattening the curve and all that. Have you heard any of that lately? No. That’s all gone. We failed at it. We just want to open business up. Get your fucking vaccines. If you don’t, it’s your fault. And if you die, tough luck, man. And, you know, serve the economy, man.

How would a hospital under a corporate model ever adopt a community health workers model? What are they going to do? Are you going to slap a bill on someone you meet in the street and say, “Hey, you should take a vaccine. By the way, here’s this bill.” So that is profitless work. If you’re going to go, “We’re not going to do anything with profit and let the government pay for that.” And then governments say, “We don’t do that” because either “Our tax base in decline” or “We don’t want to, we want to run our government like a corporation” or all that ideology, then it means that the hospitals by definition can’t do that. There are community nurses. There are, as I understand it, people who do go out and do that stuff. But how do you make that a much more profound part of it? I know the Cuban model is along those lines, and their notion of health extends out into where people live and not just their house. It’s not just about house visits. It’s about seeing community health as fundamentally integrated with intervening at all levels. Whether there’s a hurricane that sweeps through or there’s an outbreak. And also about supporting self-organizing so that institutional cognition can extend into community life, the community’s capacity to decide about what to do and how to intervene. I think I wrote it in Dead Epidemiologists. When I got diagnosed with Covid, there was no community health worker. Nobody knocked on my door. I got diagnosed online by a nurse who didn’t see tonsil or nare of me. And that was not the nurse’s fault. That has to do with a societal decision to handle a dangerous outbreak, at a time when we knew nothing about Covid, by telemedicine and nothing else. That is profoundly disturbing. It really, really underscored the state of public health in the country for me on a very personal level.