Professor, Graduate School of Public Health, Seoul National University &
Director, People's Health Institute
Infectious diseases such as COVID-19 are biological, health, and medical incidents, and at the same time, they are social, political, and economic phenomena. Science for prevention and treatment is closely related to who should be prioritised in the distribution of health resources, e.g., ventilators and vaccines. A country's decision to ban the entry of foreigners is bound to consider the international political economy and quarantine effects. Even individual responses of fear and anxiety are not irrelevant to the socioeconomic system or ideologies such as racism, colonialism, and neo-liberalism at the national and global levels. Such non-pharmaceutical measures as “social distancing” are formulated in social, political, economic, and cultural contexts.
An infectious disease’s political economy implicates more than just a political or economic factor that affects or is affected by the disease. For instance, inequality in health and access to health and medical care services is only one aspect of its political economy.
From the outbreak of an infectious disease to the epidemic, spread, responses, consequences, and impacts, the various phenomena and incidents surrounding infectious diseases we encounter are the overall outcomes emerged from the deep structures involving pathogens, humans, non-humans, and society. The political economy can be an ontological and epistemological pursuit to develop a comprehensive explanation of the emergence process.
Frequent Outbreaks of Emerging Infectious Diseases and Zoonoses
COVID-19 is an emerging infectious disease and zoonosis. Here, the word “emerging” means that a pathogen, which used to be of little harm to humans, has caused a new infectious disease and attention should be paid to the reasons for its “emergence” rather than “newness.” It is because something has changed, and new factors are in play, for what was previously harmless to humans has become a new cause of disease. A new infectious disease would break out due to the changes in the conditions surrounding the infection sources (viruses or bacteria), human susceptibility, or the relations between the infection sources and humans.
Going through the Severe Acute Respiratory Syndrome (SARS), the Middle East Respiratory Syndrome (MERS), and COVID-19, we have become familiar with the term zoonosis. It refers to an infectious disease whose pathogen is transmitted from its natural host of animals to humans which then causes infection. In addition, a zoonosis is not necessarily an emerging disease. For a long time, many human infectious diseases have been of this category, and such diseases as smallpox and tuberculosis, which we all know well, are zoonoses by nature. Although they have received renewed attention recently due to the outbreaks of SARS, MERS, and avian flu, zoonoses are frequent in incidence, taking over 60 percent of human infections.
Why have zoonoses - which have coexisted with humanity for so long - increased, especially in the form of emerging diseases? We cannot explain it with one or two reasons, but the most convincing one, “upstream” cause particularly, seems to be the surge of contact between humans and animals.
For example, indiscriminate deforestation and arable land development boost close contact between animals and humans, something that has not existed before. Consequently, pathogens in animals are transmitted to humans with new risks. The Ebola virus, which used to live in wild animals that inhabit dense forests, gets nearer to humans as forests disappear and mutates itself in a new environment before encountering humans.
A study of 27 regions in West Africa where Ebola broke out shows a higher probability of epidemics in the recently deforested areas, supporting the political economy of outbreaks of emerging infectious diseases. The Nipah virus epidemic in Malaysia in 1998-1999, which cost more than 100 human lives, resulted directly from the destruction of forests and the expansion of pig farms.
Eliminating forests, expanding farmlands, and building livestock factories in forests cannot be explained solely by individual economic actors' market behaviours. A global politico-economic structure exists in the deep of those reality changes. Whether the target or domain concerns farming, forestry, raising livestock, or whatever, it is essentially a direct consequence of the unequal international division of production and labour established on a global scale. Robert G. Wallace and Rodrick Wallace, who studied the “systemic” nature of Ebola, even call this emerging infectious disease regime as “neoliberal Ebola.”
Epidemic and Spread of Infectious Diseases
The current capitalist socioeconomic system provides optimal conditions for a small-scale endemic to spread and transform into a global pandemic. Mobility and connectedness, two factors that encompass the entire planet, are particularly notable. While the Influenza A (H1N1) pandemic in 2009 took only nine days to spread across the Pacific, it was several months faster than expected, no matter how it was calculated at the time. The same goes for intra-country movements. When the COVID-19 outbreak began in China, domestic air travel spiked up more than ten times, compared to the SARS outbreak.
Now that no country can surpass these conditions, once incorporated into the globalized economic system, such preventive measures as entry bans and lockdowns are impossible and of no use. This “impossibility” is also the case with the issue of prohibiting the entry into South Korea of those traveling via China, which caused controversy in Korea. If the research results are correct, that there were already COVID-19 cases in several European countries before China reported the outbreak of the disease to the World Health Organization (WHO), blocking cross-border movements would hardly mean more than just lessening the quarantine burden.
Furthermore, implementing the policy is next to impossible. Inbound Koreans coming from China hovered at 13,000 per day before the epidemic and close to 3,000 in early February 2020, even after the spread. Most of them are economic actors who have to travel between the two countries for essential business reasons. Is it possible to ban traveling or to enforce voluntary or involuntary separation of so many individuals once admitted to traveling? It is not the science of quarantine, but more of politics, mainly domestic politics, to demonstrate wills and capacity of the nation-states to prevent the spread of infectious diseases.
Urbanization is another critical factor in promoting the diffusion and epidemic of infectious diseases. An exemplary case is the city of Wuhan, China, where COVID-19 emerged for the first time and subsequently spread to other places. The urbanized Wuhan does not merely mean the planar urban feature of a dense concentration of people. It is an industrial production base and regional transportation and educational centre, with various characteristics that makeup a globalized city.
It was not a coincidence that over five million Wuhan dwellers left for other areas before its blockade in time for the Chinese New Year holidays, which was a critical contributor to the spread and epidemic of the disease. Numerous migrant workers have scattered to other regions and countries, becoming the sources of infection everywhere. Fully integrated into China's socioeconomic system and further, the global capitalist system, the megacity, has the optimal conditions for the spread of infection worldwide.
The political economy of the epidemic and the spread of infectious diseases is integrated into quarantine means and technologies. To take an example, the so-called “social distancing” is one of the powerful ways to contain cluster infections in local communities, but its applicability and extent vary depending on the society's socioeconomic circumstances.
In a typical capitalist market economy, it is relatively easy to adopt social distancing measures for schools, religious organizations, and leisure activities. However, production activities and workers engaged in them would find it quite challenging to practice social distancing at the individual level. It is because the issue of “power” intervenes in terms of who is to bear the cost of halting labour, in addition to the sustainability of economic activities. A large number of workers in the United States cannot afford to take time off from work, because they are hired part-time or have no paid leave; therefore, social distancing, that is, staying away from work, can hardly be a viable quarantine measure for them.
System Crisis and Transformation Possibility
From the outbreak to the epidemic and spread; responses; consequences; and long- and short-term impacts; the COVID-19 pandemic has revealed our socioeconomic system as its condition and basis. The manifestation will continue to unravel in the coming months and years. Border closure, shortage of hospital beds and equipment, racial inequality, and the impossibility of practicing social distancing are only a few facets of the related phenomena. Most countries have responded to the pandemic mainly as nation-states, while shutting down borders and prohibiting transborder movements. It is fully reflective of the vulnerability of global health governance.
Most countries, including South Korea, have attempted predictions on what a “post-pandemic” era will be like and speculated on the “new normal.” It illustrates that they are well aware of the “systemic impossibility,” i.e., that the current system is too inadequate to respond effectively to the outbreaks of infectious diseases. For instance, the quarantine authorities' “recommendation” for workers to take sick leave when they are ill is a roundabout technical statement on the need for a new labour system. In a similar context, countries that have refrained from spending on health and medical care under a fiscal austerity policy vow belatedly to strengthen or restore the “publicness” of healthcare services.
From the perspective of power dynamics, the necessity for systemic transformation does not automatically turn around as a possibility. It is questionable whether we could consider the current situation with the system becoming unstable due to the impact of an external factor (a pandemic) as a “crisis.” But we should not forget that the possibility of sustaining or transforming the existing system is almost entirely the outcome of power relations.
If the current arrangement could be regarded as a “morbid state” of crisis in Antonio Gramsci’s notion, existing power groups will continuously struggle to go back to the “old normal.” Unless alternative powers manage to formulate a new equilibrium, “resilience” would probably end up only meaning regression to the old normal.
The same is true for the microsystem. Claiming that “K-quarantine” has already made a success, the Korean government (state power) defines biotechnologies, ICT, and public-private partnerships as primary success factors. It perfectly matches the politico-economic interests of the new growth engine policy that has been put forth in full swing since the 2000s and corresponds to the capital accumulation model pursued by Korean capitalism. In comparison, the power to promote an alternative system, including strengthened public healthcare, seems unsure in its magnitude and foundation.
Although forecasts say that vaccines and treatments will be the key to fundamentally resolving the COVID-19 crisis, without changing the old system, the solution is very likely to benefit only a limited number of groups. The political and economic interests concerning the development of vaccines and treatments are already well-known, thus do not need a long and detailed explanation.
Like other vaccines and the treatments for neglected diseases, vaccines and treatments for emerging infectious diseases such as COVID-19 often have a small market and low profitability. As the pandemic subsides and enters a stable phase, the momentum for their development will weaken inevitably. Even if vaccines are developed soon as everyone hopes, the situation is unlikely to get much better. The firm structure and mechanisms of the between- and within-country inequalities will continue to play on in the distribution of such limited resources as vaccines.
Nation-state-centered responses to the pandemic are highly likely to reveal their contradictions and implausibility more apparently. Not only can the strictest travel ban stop the spread of infection, but even if it is possible, a country’s social and economic isolation can hardly last beyond a specified period. Moreover, it should not be overlooked that the epidemic of an infectious disease in a particular country affects others indirectly in the current global economic system with production and consumption connected with all countries in the world.
The coronavirus pandemic, literally, will not end until it finally ends in every country. That is why global and regional cooperation and solidarity are acutely called for even now. The question is, though, how to construct a new collaboration system now that the existing global governance has revealed its total incompetence and weaknesses. It seems somewhat too early to predict, but at least one thing is clear, the principles of a new global system must be based on the lessons we have learned from the COVID-19 pandemic and our responses.
Perhaps the new relation system should go beyond the international relations composed of nation-states and be anchored as a new global governance based mainly on civic solidarity and cooperation of greater breadth, depth, and strength. In my view, the core principle should be democratic publicness that all global citizens should put into action.