I spoke to scholars Swati Birla & Kuver Sinha for a 2-part interview on ‘vaccine imperialism’ and the complicated politics of India’s Pharmaceutical Capitalism.
This is the conclusion of our conversation, part 1 can be found here.
Asia Art Tours: Something that puzzles me about global Neoliberalism is to what degree the state needs individual capitalists to function? Here is a quote from your Spectre essay on Gates and his role in privatizing the AstraZeneca Vaccine:
Researchers at the Jenner Institute at Oxford University first developed the viral vector technology that underlies the AstraZeneca vaccine; they then founded a spin-out company called Vaccitech Ltd. in 2016 to further develop this technology. The minority stakeholders of Vaccitech Ltd. are a combination of Oxford University and individual researchers; the majority is a web of venture capitalist firms with the biggest one being OSI, an umbrella of further companies like Tencent, Google Ventures, and Sequoia Heritage, as well as charitable foundations like the Wellcome Trust.
Vaccitech Ltd. entered into an exclusive agreement (engineered by Bill Gates) with AstraZeneca in April 2020, for the “international distribution of the vaccine, particularly working to make it available and accessible to low and medium income countries.” AstraZeneca subsequently entered into sub-licenses with several companies in the US, Europe, and Asia – notably the Serum Institute of India.
Looking at this cacophonous list, how relevant are capitalists like Adar Poonawalla (owner of the Serum Institute) or Bill Gates to the function of global Neoliberalism? And how do we defeat such a ‘Many-Headed Hydra’? Can we simply defeat neoliberalism one by one (such as Poonawalla, a Gates or a system like CoWIN) ? Or do we need to reign them in all at once?
Swati Birla: As we watched the Covid trackers we were constantly coming up with the problem of undercounting. As in (for the Indian state) death might be real, the reported numbers didn’t have to be. There were reports filtering from across different regions about the intense measures taken by the Indian state and by BJP functionaries to suppress reports of the disease load and of inaccessibility of treatment. India’s oxygen crisis was well covered. There were also ground reports of police vans accompanying ambulances to enforce isolation and quarantine, to suppress reports of those tested positive, and to ensure that grievances of those denied treatment were not aired.
Given the emphasis on vaccines as the gold standard to counter the viral spread, the overpriced vaccines, delayed distribution timelines, and vindictive withholding of vaccines by the federal government from states where the BJP was not the regional ruling party had created a panic during the second wave. Added to this was the lack of transparency around vaccine production, trials, side-effects, and state contracts with corporations like the Serum Institute of India that enjoyed a near monopolistic hold.
The high morbidity and mortality revealed how profoundly the public health infrastructure had been gutted since the 1980s. People’s experiences of healthcare during this period was traumatic. And so were the experiences of the healthcare workers working at the village level who were made to go from village to village providing care and food supplies while remaining underpaid in many parts for over four months. All the Indian state did was to exacerbate these inequities through the imposition of a new digital divide.
The high morbidity and mortality revealed how profoundly the public health infrastructure had been gutted since the 1980s. People’s experiences of healthcare during this period was traumatic. And so were the experiences of the healthcare workers working at the village level who were made to go from village to village providing care and food supplies while remaining underpaid in many parts for over four months. All the Indian state did was to exacerbate these inequities through the imposition of a new digital divide.
Chart looking at Disability Adjusted Life Years (DALY) attiributable to air pollution & Tobacco in comparison to other disease morbidities in India, 2017. PHOTO CREDIT: Science Direct (Creative Commons).
We also had to account for the specificity of the Indian pharma trajectory. After the exit of European empires in postcolonial nations the government’s capacity to manufacture and distribute medicines and vaccines became an integral aspect of national sovereignty. But since the 1980s vaccine manufacturing in India has become increasingly privatized. Liberalized fiscal policies and patent laws created a terrain that was conducive for scaling up of vaccine manufacture by firms like the Serum Institute of India owned by the Poonawala family. Since the 1990s India has steadily become the manufacturing hub for generic medicines and vaccines, as well as one for clinical trials.
For example, Medécins Sans Frontières’ procures over 75 percent of its antiretroviral drugs from India based manufacturing firms. But the rhetoric of South-South cooperation and anticolonial non-alignment that the Indian state mobilizes effectively masks the corporate interests that propelled the expansion of trading blocs and markets for India’s pharma capital. Capital and modern nation-states have an intimate co-dependent relationship. The Gates foundation, the Wellcome trust, the Poonawallas all made enormous gains during the Covid pandemic by pushing market based solutions.
In short, what we have on one side is the Indian state practice of calculated erasure of people and on the other side the appropriation of health by capital through existing networks, policies, institutional arrangements. The acronym soup reveals the complex entanglements and brokerage economies between venture capitalists, universities, pharmaceutical companies, nation-states, non-governmental organizations, and international institutions. (While we challenged the meta-geographic categories like global South we are working to deepen our investigation so we can begin to address the question you raise: “how do these industries (Tech, Finance, Pharma) keep such exploitation symbiotic under a global crisis like Covid?”)
During the pandemic most arguments and policy pieces such as the one co-authored by Joseph Stiglitz, Jayati Ghosh, et al were echoing the convenient messaging of “vaccine imperialism.” What role does the idea of the ‘South’ play within this progressive critique of legal regimes such as intellectual property rights? South here is configured in some form of stable geography of “developing” versus “developed” world. It is in keeping with the growing convention (since 2000s) of using “global south” as a meta-geographic category to understand socio-economic marginality of peoples but also hierarchical powers of nation-states. This tendency to lump the historical trajectories of Haiti, Laos, Guadeloupe, India, and China into one bin is conceptually weak.
But there is an additional danger of slippage here since the Indian state clearly supports big pharma in opposition to its citizens. These pieces do the work of directing anger and centering preoccupation with patents, TRIPs waivers but the vaccine and pandemic politics is more complicated than that. But the north/south divide recoded the question of “free access to vaccines” as a question of “health sovereignty” over distribution). To be clear, the failure of the Indian state did not lie in its inability to secure the health of its people but a callous refusal to do so, in collusion with the interests of the capital class.
Writing against vaccine imperialism in a piece by a friend on the situation in Iran was very illuminating: “It’s similar to the economic sanctions, yes external inequalities and imperial powers play major influence, but the economy and the health care was already being destroyed/fully militarized prior to the sanctions.” Critiques of our Iranian comrades were really helpful in clarifying the language on failures of the Indian state. Similarly Kaushik Sunder Rajan’s book “Pharmocracy: Value, Politics, and Knowledge in Global Medicine” was also very insightful to understand the links between biomedicine, capital, and state. It situated the Indian pharma capital within global histories.
What we are facing is at once a conceptual and a political problem. The structure of the pandemic crisis is diagnostic of the workings of global capitalism in the health sector, its ability to transgress geographic boundaries. The violent exclusion of people (death and lifelong disability) are not consequences but the conditions of its possibility. And then the question that arises is the political.
As you ask: “how do we move to defeat such a ‘Many-Headed Hydra’? Can we simply reign in one industry or capitalist (such as Poonawalla or a system like CoWIN) ? Or due to their intertwined nature, do we need to reign them in all at once and all?” My response to this will be to create a series of linked and sustained movements that not only resist and disrupt the state and capital but also think creatively about what it means for us to survive and reproduce social life.
Since the 1990s India has steadily become the manufacturing hub for generic medicines and vaccines, as well as one for clinical trials. For example, Medécins Sans Frontières’ procures over 75 percent of its antiretroviral drugs from India based manufacturing firms. But the rhetoric of South-South cooperation and anticolonial non-alignment that the Indian state mobilizes effectively masks the corporate interests that propelled the expansion of trading blocs and markets for India’s pharma capital.
The Bill & Melinda Gates Foundation Visitor’s Center. PHOTO CREDIT: Wikipedia
Asia Art Tours: Why has it been important important for you to shift the narrative away from one of ‘Western vaccine imperialism’ to one of Global Vaccine Capitalism?
And do you see your critique of ‘vaccine imperialism’ related to the ‘anti-imperialism of fools’ critique? That any ‘enemy’ of the US is a friend of liberation, regardless of how cruel, carceral or authoritarian their governance is over their own citizens?
Kuver Sinha: For me, the classical Leninist framework of imperialism continues to be relevant, if for no other reason than the fact that communists in India operate firmly within this framework (here I’m thinking of the entire spectrum of Marxist-Leninist parties in India, as well as the Indian Maoists).
Historically, the characterization of the Indian State (for example, understanding whether it is semi-colonial and semi-feudal) and ideological debates on the nature of imperialism (the contradiction between imperialism and the oppressed nations; the contradiction between the bourgeoisie and the working class in imperialist countries; and the relationship between imperialist nations and monopoly-capital entities) has guided not only the splits, but also the synthesis of various communist groups in India. The question, for me, therefore isn’t what “Western white leftists” are thinking about this, but whether and how the Leninist framework can be made useful for communists who are leading struggles and are under severe State repression in India.
One of the things that I hope our analysis made clear was that the North-South divide, at least as far as vaccine capital is concerned, is a mechanistic application of the Leninist framework, perhaps even a caricature of it. The extent to which trans-national capital is embedded in every aspect of vaccines is astounding: from research to manufacture to delivery. Understanding and confronting vaccine capital in every sphere that it operates in is important. Marxists are of course generally cognizant of the international nature of trade, capital flows, and the division of labor, and how this blurs the neat division of the world into nation states.
The question is: where should the emphasis of struggle be at a given conjuncture? For Covid, the fact that the vaccine drought inflicted by the Indian State, the extractive pricing gouged by Indian vaccine capital, and the government’s disastrous vaccine rollout have not evoked enormous popular anger (even as it is estimated that this has been one of India’s biggest disasters, with over 3 million dead) indicates that perhaps the Left’s strategy has not been entirely correct.
For Covid, the fact that the vaccine drought inflicted by the Indian State, the extractive pricing gouged by Indian vaccine capital, and the government’s disastrous vaccine rollout have not evoked enormous popular anger (even as it is estimated that this has been one of India’s biggest disasters, with over 3 million dead) indicates that perhaps the Left’s strategy has not been entirely correct.
Communist hammer-and-sickle near Darasuram, Tamil Nadu state, India. PHOTO CREDIT: Wikipedia
Understanding the main contradictions is important. For example, certain Marxists in India have argued that the reason behind the Indian State’s parsimonious fiscal response to the pandemic is US imperialism, as expressed through the incipient threat of a credit ratings downgrade and capital outflows if the government responds in a pro-people manner. There may be a strong case to be made that this is indeed the case. But is this the main contradiction right now, and does this diagnosis open the path for political action? I think a much more thorough understanding of the imperialist framework under pandemic capitalism is needed.
That said, there is also the danger, I feel, of throwing the baby out with the bathwater: in trying to sharpen my understanding of the Leninist framework and in trying to open avenues for political action, there is the danger of abandoning the framework altogether or altering it beyond recognition. For example, grading nation states along an axis of liberal democracy instead of extraction of labour power, or not grading nation states altogether (“all are imperialist”), may, I feel, be dangerous. As dangerous as the opposite extreme, which is a mechanical application of imperialism into the North-South framework, which also negates the possibility of political action.
I feel that it is important not to make sweeping generalizations, for example, along the lines of “any enemy of the US is a friend of liberation, no matter what they do to their own citizens”. One can take the example of China. Several measures indicate that China is a semi-peripheral nation: it maintains exploitative relationships with South Asia and Africa, but it transfers a greater amount of surplus value to the core than it receives from the periphery [Minqi Li, China and the Twenty-first Century Crisis (New York: Pluto Press, 2016)]. Other measures – for example weighted average per capita gross national product – also indicate that China occupies a position in the semi-periphery of Arrighi’s “organic core”.
On the other hand, the diagnosis of Indian Maoists is much harsher. If one looks at their 2017 Central Committee study, China after Mao is characterized as a “modern social-imperial power” and “an integral part of the capitalist-imperialist system”. The document states: “People are struggling against Chinese imperialism in myriad ways, and the contradictions between social-imperialism and the oppressed peoples are heightening, just as that between the bourgeoisie and the working class in China is heightening.” It should be noted, in passing, that these critiques of China by Indian Maoists are not stemming from a broader critique of Stalinism, as they often do in the US. The Indian Maoists recognize the USSR as a bona fide socialist state till 1956.
Going a bit further, there is some level of agreement between both these views: one which places China in the semi-periphery, the other that places it squarely as an imperial power. Both acknowledge, for example, a contiguous middle tier between the organic core and the periphery; both acknowledge that the trajectory of China is towards imperialism. The question is: what does one do with such a characterization of China? How does one open up the scope for political action?
In the case of India, too, I feel that the total destruction wrought by the pandemic makes it critical for us to understand the nature of imperialism more clearly. For example, as we have shown in our Spectre article, Vaccitech – the startup behind the Oxford-AstraZeneca vaccine – is a conglomerate of various venture capitalist firms, like Tencent, Google Ventures, etc. If you look at distribution, SII was part of the original consortium with Vaccitech, and AstraZeneca was involved at a later stage, with SII ultimately becoming a sub-licensee.
If you look at vaccine pricing by SII, it is at a level equal to pricing by AstraZeneca in the EU in direct dollar terms, although manufacturing costs are a fraction, and highly subsidized by the government. I think a mechanical application on the North-South divide in this scenario misses these nerve points where an actual peoples movement can be built up. If the Left focuses on IP laws, moratorium on debt payments, or getting reserve assets from the IMF – if the Left argues that the main reason behind the immiseration of the Indian people is the threat of international banks in the face of which the current government is helpless, leading to the anemic fiscal response – does that open the way for a mass movement in India?
Several million people have died in a year. The Indian people are facing devastation at a scale unprecedented since colonial times – the only equivalent I can think of are the famines perpetrated by British policies during those times, which also killed similar numbers of people in such short timescales. The Left has to correctly assess imperialism. At least that’s where I see our article playing a role.
Several million people have died in a year. The Indian people are facing devastation at a scale unprecedented since colonial times – the only equivalent I can think of are the famines perpetrated by British policies during those times, which also killed similar numbers of people in such short timescales. The Left has to correctly assess imperialism. At least that’s where I see our article playing a role.
Naxal (Maoist) activity within India, 2018. PHOTO CREDIT: Wikipedia
Please follow Swati Birla for more updates on her work on Twitter: @SwatiBirla4.
The essay by Kuver Sinha & Swati Birla which inspired this interview series can be found on Spectre Magazine