By OSVALDO COGGIOLA*

We become the weakest link in a rotten chain.

The first infections of the new coronavirus were identified at the end of 2019, but it was only on March 11, 2020 that the World Health Organization (WHO) declared that the world was facing a health emergency, raising the classification to the level of a Covid-19 pandemic. . World records indicated 150 people infected and 4,6 lives lost. A year later the global numbers were already at 118 million cases and 2,6 million deaths.

Initially considered a marginal focus, the figures and reality in Brazil have placed the country at the center of international attention. The speed of expansion and mutation of the virus raised the alarm of a threat to global health security, as Brazilian strains spread to other countries (it is no longer possible to enter Argentina and many other countries from Brazil), favoring a new and more lethal wave of the pandemic. To make matters worse, by March 28, only 2,89% of the Brazilian population had received the second dose of the vaccine.

When the first registered case completed one year, Brazil had the highest moving averages of deaths and cases of the entire pandemic. Since the beginning of 2021, the pandemic situation in the country has only worsened, in contrast to the actual results in much of the world. On January 1, in the weekly moving average, Brazil had 5,9% of the cases and 6,3% of the world's deaths (which was already excessive, for a country that has 2,8% of the world's population and has a huge Unified Health System) until we reached, on March 27, an impressive 34,3% of world deaths.

Furthermore, at the current rate of vaccination, it would take two years to vaccinate only the emergency groups established in the National Vaccination Plan. Immunization is only effective if the rate of vaccination is faster than the rate of contamination. Otherwise, it is more likely that new variants will emerge that can make existing vaccines ineffective. The uncontrolled transmission of the virus and the slowness of the vaccination process have opened up space for the emergence of new strains and mutations, such as the P1 variant: Brazil is considered a storehouse of new variants and a threat to the control of Covid-19 throughout the world. world. In Brazil, almost half of health workers worldwide victimized by the pandemic died, according to a survey by the International Council of Nursing.

Maintaining the current speed, Brazil will take about four and a half years, or 1.729 days, until the entire population receives both doses, when Pfizer already warns of the need for a third. There has already been ample insistence, although not enough, on the responsibility of the Bolsonaro government for these results and this tragic perspective. Added to the severity of the pandemic, denialism, the spread of false news and, above all, the lack of vaccines and basic supplies for the care of patients, among others, revealed its absolute mismanagement.

Continuous acts by the federal government have laid bare, since the beginning of the pandemic, a systematic policy that has led Brazil to the calamitous situation we are experiencing: “It is good that deaths are concentrated among the elderly. This will reduce our social security deficit”: these were the words of Solange Vieira, appointed by Bolsonaro as Superintendent of SUSEP (Superintendence of Private Insurance), at the height of the first wave of Covid, in June 2020, at a meeting of the federal government, who celebrated the death of elderly people from the coronavirus because it would improve the performance of the economy, reducing the social security deficit, an accounting idiocy and a premeditated humanitarian crime.

Under the Bolsonaro government, Brazil achieved the most regressive combination in its history: combining the humanitarian catastrophe with the social catastrophe, the environmental crisis and the growing status of an international pariah. However, his mismanagement acted all the more effectively in the spread of the virus, and the resulting disease and death, the more it managed to accomplish this on a structural basis: the systematic destruction, carried out over decades by different governments, of the scientific/technological bases , economic and social, that the country needed and needs to face a calamity of this nature.

Privatization, deindustrialization and economic reprimarization, scrapping higher education and scientific research, budget cuts in vital areas, environmental tragedies (such as Mariana and Brumadinho) and, finally, the current health tragedy, are united by a common thread. Ignore it, don't attack it politically, legitimately focusing attention on the immediate consequences of the current lethal wave, means coming to terms with the present disaster and a dark future, including in the post-pandemic period.

Because these factors are already present in the current health catastrophe. A study on Covid-19 in Brazil showed that regional socioeconomic vulnerabilities affected the course of the pandemic more than the prevalence of risk factors for the disease, such as age and health status. The researchers developed a socioeconomic vulnerability index based on household characteristics and the Human Development Index. The coronavirus was first identified in São Paulo and Rio de Janeiro, but it was in the North and Northeast regions that deaths broke out. The worst situation, as we soon saw, was in the northern states, where the risks typically associated with Covid-19 (advanced age and burden of chronic diseases) do not predominate: what exists is poverty and a shortage of hospital resources.

Brazil, however, is not an exception, but the nerve center of a universal process. Worldwide, some specialists raised the hypothesis that we are just at the beginning of a “pandemic of pandemics”. Camila Malta Romano, a virologist at the Institute of Tropical Medicine at USP, stated that this is not the last pandemic, it would just be a matter of “when”, not “if”, another pandemic will happen: “Pandemics (global level), although less common than epidemics (local level) they do occur from time to time and we have past examples of sporadic situations such as bubonic plague, more than one influenza (Spanish, Asian, swine, etc.

However, it seems that lately the emergence of potentially pandemic agents has been more frequent. For example, the influenza pandemics: 1918 – Spanish flu; 1958- H2N2; 1968 -H3N2; 2009 -H1N1. SARS, caused by a virus very similar to the current SARS-COV-2, caused the first epidemic of the 2003st century (2) and even then, we knew that it would not be the last. So the SARS-COV-XNUMX pandemic will certainly not be the last.”

Amesh Adalja of the Center for Health Security at Johns Hopkins University, an expert in emerging infectious diseases and biosecurity, explained that the world is teeming with microorganisms; it is a simple biological fact that infectious diseases will continue to impact us: “Some of these infections will be able to spread widely due to patterns and times of travel, the rise of megacities and interactions with animals” (SBMT Bulletin, Brazilian Society of Tropical Medicine).

Several studies already point to the responsibility of environmental destruction (another process favored by the current Brazilian government, but not initiated by it) in the “release” of pathogenic agents: “Emerging zoonotic outbreaks will be more frequent due to the systemic increase in triggers for these emergencies, such as deforestation, forest fragmentation and conversion of forests into pastures, mining areas", pointed out Alessandra Nava, from ILMD/Fiocruz Amazônia: "The reduction of biodiversity is a form of occurrence of this rupture due to the alteration of the transmission of pathogens and parasites, which is supposed to have been the cause of the Covid-19 emergency”. For Fernando Aith, from FSP-USP, “the action of human beings on the planet is altering the environmental balance in such a way that new risks to Man's life on Earth will certainly come, whether from nature (viruses, earthquakes, climate change), whether from human ingenuity (medicines, therapies, superbugs, cloning, Brumadinho), or from the new social and work relationships that are installed (telework, social networks, etc.)”.

These concerns about the future seem out of place in a country where many patients have died and are dying, not for lack of adequate medication, but for lack of a basic ingredient: oxygen. But this also ties in with what precedes. The FUP (Federação Único dos Petroleiros) denounced: “While more and more patients with Covid are dying from suffocation due to the lack of oxygen cylinders, amid the collapse of the health system, the Petrobrás Nitrogen Fertilizer Factory in Paraná could be producing 30 thousand cubic meters of oxygen per hour. This would fill 30 small hospital cylinders (per hour!). "

But the factory was closed “by the board of Petrobras a little over a year ago, surprising the 21 workers at the unit, who were summarily dismissed... days”, which passed in white clouds in the great press (and not only in it). The closure of this factory, and others, was due to pressure in favor of the “rationalization” of Petrobras, exerted by the large international investors (funds), holders of shares in the largest Brazilian company on the Wall Street Stock Exchange.

And so, Brazil's historical setback, its growing transformation into a platform for the fictitious valuation of financial capital, driven to a greater or lesser extent by all post-redemocratization governments, resulted in the country's strategic weakening to face the destructive consequences of the world capitalist crisis. What happened in Manaus was certainly a direct result of the genocidal and denialist policy of the Bolsonaro government, even granting a portion of responsibility to the state government of Amazonas and the city hall of the capital.

Denialism left hundreds of people to die and caused the collapse of the Amazonian health system. It was the demonized Venezuela that saved, perhaps, thousands of lives, by dispatching oxygen tank trucks in the face of the transformation of Manaus hospitals, devoid of the input, into involuntary asphyxiation chambers. As is known, however, the Minister of Foreign Affairs, who did not rule out invading and destroying Venezuela, continued in his position, from which he was deposed only when the political radar of the parliamentary “Centrão” registered new winds, national and international, not referring precisely to Venezuela, and imperatively demanded his resignation.

The Federal Public Ministry concluded that the oxygen crisis in Manaus was caused by the omission of several managers, with emphasis on former military minister Eduardo Pazzuello. According to prosecutors, he acted late and slowly in sending the team to diagnose the new wave of Covid-19 cases. Afterwards, he failed to monitor oxygen demand and adopt measures to avoid shortages. It also took a while to adopt measures to transfer patients who were waiting for beds. It is clear that it is not the function of the Attorney General's Office to bring to the bench the structural conditions that made it possible for the negationist policy to settle down comfortably on the bed of the destruction of productive resources (in all senses) in Brazil, causing a humanitarian catastrophe. What is not possible is to forget that the destruction of the social productive forces is the only resource of capitalism, the world system, to survive, in conditions of crisis and historic decline, and not draw the corresponding political-strategic conclusions from this.

Under these conditions, the largest public health system in the world, SUS, failed to be an efficient barrier against the devastating effects of Covid. The disinvestment and scrapping of public health, the privatization of the sector, led to this result in conditions of a global health crisis: global funds dominate private health plans in Brazil, diagnostic laboratories and hospitals with cutting-edge technology. Focused on maximum profit, they charge more and more and push heavy work to SUS.

The private system, concentrated and monopolized by a few foreign companies (owned by hedge such as BlackRock), was also overcome and had to resort, in desperation, to the weakened public system. In Brazil, the situation not only shows how “populations can still be vulnerable to disaster scenarios just when things seem to be getting better”, in the words of The Atlantic, the famous American “progressive” publication. It shows, above all, how much capitalist “modernization”, in conditions of decline in the mode of production, covers up a destructive process that precipitates the weakest links of the system towards the civilizational abyss.

The Bolsonaro government finds its full reactionary meaning in this decadent framework, it is not the product of a circumstantial combination. Even if the lack of vaccine doses is an impediment to restricting the circulation of the virus, it is not the only one: there are no reasonable explanations for the delay in distributing the few doses that the country already has. In a scenario of scarce supply, the last thing we need is the private sector competing with the SUS; however, that is what the government does, legalizing the purchase and use of vaccines by the “private sector” (capital) and chasing more contracts. But, according to the judges, there would be no such competition because, they say, if the vaccines are not purchased by these entities, the doses would end up going to other countries.

“Healthy competition”, including (and above all) international competition, must prevail over any other consideration, even if it provokes a planned genocide of the poorest, weakest or neediest. Well, what other name can be given to the creation of multiple queues, with young and healthy people being able to get ahead of those at greater risk of dying? The deadly disease has class and race. Those who get infected the most and die the most from Covid-19 in Brazil are black people, who are lagging behind in the vaccination queues. A part of the black population that could be included in the priority groups, for being on the front lines against the pandemic, did not receive the vaccine: in some regions, cleaning and security workers at hospitals did not enter the first stage.

All the links of the semi-colonial chain that binds the country, and of world capitalist decomposition (concentration and monopolization are its only weapons to combat “its” crisis) tied Brazil attacked by the pandemic, causing irreparable damage, quantitatively and qualitatively. This is not a Brazilian process or trend, but a worldwide and universal one, which finds its concentrated expression in Brazil. We have become the weakest link in a rotten chain, this is the ultimate reason for what is apparently inexplicable, or what is intended to be explained by appealing to the mental pathology of the circumstantial occupants of political power, creating the illusion that it would be enough to replace them, electoral or “coup d'état”, by reasonable people, to remedy a situation that has its roots in our history and in the dominant forces of the world economy.

Financial funds promote a private market for the vaccine, which gives them huge profits at the expense of the health of the world's population. The logic of the “direct” supply of vaccines is a monumental private “queue jump”, to create companies with vaccinated personnel, a strategic “comparative advantage”. In the still recent past, National States with capacity manufactured vaccines for diseases that represented a threat to global health, and they did so in cooperation with each other. Neoliberalism, which is not a pathology, but one (only one) of capital's resources in the face of the crisis, saw the outsourcing of research, development and production of vaccines by large pharmaceutical companies, whose enormous profits resulted in the power of the strongest lobby political world, designed to protect and enhance its enormous benefits through patents. The 1995 World Trade Organization (WTO) Treaty on Trade-Related Aspects of Intellectual Property (TRIPS agreement) is an outcome of this lobbying.

Millions of people die each year from lack of access to vaccines, while tens of millions of children around the world still lack access to immunization. The failure of the vaccine market is borne out by the fact that, by 2017, low- and middle-income countries accounted for 79% of the global market's vaccine sales volume, and even then for only 20% of the total real value collected. . The poor simply do not represent a lucrative enough market to drive the necessary investment and production. The Working Group on Intellectual Property stated: “Brazil is completely hostage to the demands made by the private pharmaceutical industry, which is taking advantage of the situation to impose its conditions and concentrate even more power”.

The big pharmaceutical industry (Big Pharma) only invests in vaccines and research and development of therapeutic treatment for diseases that are more prevalent in richer countries or require continuous treatment. These drugs are often very expensive and limited to those with private health services or to those public sector hospitals where Nation States can afford it.

The race for access to coronavirus vaccines has again demonstrated the inequality (i.e. oppression of the weakest by the strongest) between nations in the pharmaceutical market. In addition to Covid-19, the problem manifests itself in the underfunding of research on tropical diseases; in the intellectual property rights system that excludes “peripheral” countries from search results; and in the squandering of the research and production capacities of the poorest countries.

In the words of Maíra Mathias, in a text published on the website Other words, “one of the best-known arms of this complex – the pharmaceutical industry – crosses not only Brazil and the SUS, but other countries and health systems. In recent decades, there has been an intense process of acquisitions and mergers, which has left a few large companies at the forefront of this sector. In the area of ​​vaccines, the bottleneck was even greater, with four North American and European economic groups concentrating 90% of the market. Vaccines account for the fifth largest billing of products in the pharmaceutical area. With the pandemic, they must be catapulted into the second most profitable niche, behind only oncology products. Revenue from the market as a whole is about a trillion dollars, with cancer drugs accounting for $150 billion of that amount. Calculating the price of the 8,6 billion doses of immunizations against the new coronavirus promised for 2021 in the world, an additional revenue of 40 billion dollars is projected for vaccines, in a total of 80 billion. This phenomenon has created distortions that have cost national health systems dearly and taken away innovation efforts from the needs of most of the world's population. 80% of global revenues from immunization sales come from rich countries, although these nations only represent 20% of the annual volume of doses supplied in the world”.

After the accumulation of vaccines by a handful of countries, a new complaint reveals Pfizer's pressure against several states in the periphery: “The pharmaceutical company Pfizer, based in the United States, is demanding guarantees from countries, interfering in their legislation and even demanding bases military". This was classified as a “terrorist” act. Through bilateral agreements with the laboratories, Western governments have reserved the first billion doses against Covid 19. Despite postures and rhetoric about global public goods, leaders of rich countries maintain their preference for options that preserve the financial architecture and sanitary, in which the search for profit occupies the center of the global sanitary system.

Wrote Riccardo Petrella, “Suspending enforcement of patent rules on vaccines would 'disturb' collaboration with pharmaceutical companies. What else can we say? It is clear that the current rulers will never give in to the principle of patent privacy. It is up to citizens to oblige elected representatives to respect the right to life of all inhabitants of the Earth”. Or promote political changes that do not leave us at the mercy of “elected representatives” with the means of big capital, to carry out, during long and deadly periods, the mischief necessary to preserve and increase the profits of its true voters/controllers. But this, true democracy, requires a social revolution.

As the ultimate efficacy of the vaccine remains unknown, uncertainty heightened by the emergence of new strains, global vaccination faces a crisis. We are in the midst of a global supply shortage of Covid-19 vaccines, which does not affect everyone equally. We are reliving, in an incremental way, what happened at the beginning of the pandemic, when each country fought for its own goal. Very quickly, a struggle of interests was unleashed for a huge health market and a struggle for political hegemony that comes hand in hand with the productive and commercial monopoly. This includes an arsenal of products, from syringes and respirators, through the vaccines themselves, to ultra-cold refrigerators. The fight against the pandemic is, above all, social and political in nature. Even within the capitalist class and the imperialist order: laboratories are under the crosshairs of all European powers, because of the disruption of their supply contracts.

Priorities for vaccine delivery by international laboratories are a closely guarded secret. So far vaccines have only reached about 50 countries, most of them high-income, and 75% of doses are concentrated in just ten nations. The survival of the world's great investment funds, which control the great laboratories, demands helplessness and death for the majority of the population. The declaration of all vaccines as a public good, the abolition of patent law and the right of all countries to access their formulas and manufacturing procedures is a crucial struggle to end the barbarism that States and health monopolies are perpetrating. against the populations of the whole world, but especially of the countries in a subordinated condition by the world system (imperialist) of dominion of financial capital. The means put into action for this struggle must be in line with what is at stake and the worldwide strength of the merchants of death.

*Osvaldo Coggiola He is a professor at the Department of History at USP. Author, among other books, of History and Revolution (Shaman)