How to make sense of the Covid-19 crisis and its aftermath?
The Covid-19 crisis is an important source of discontinuities that forces us to rethink our concepts but also that acts as a source of stimulation to put health issues at the center of our research agenda. More precisely, our proposal is not centered on the Coronavirus crisis but the least we can say is that this crisis has confirmed the importance of our research, while forcing us to adjust it.
The crisis of an emergent “anthropogenetic” model of development
From a regulationist perspective, it is possible to interpret the Covid-19 crisis as the crisis of an emergent “anthropogenetic” model of development, which is based on health, education and culture (Boyer, 2020; see also Boyer, 2002, for the concept itself). In the tradition of the Régulation school, crises are the key periods during which it is possible to understand the previous regulation modes and the emerging ones, as it has been done in the 1970s-1980s, with the crisis of the so-called “Fordist” regulation mode.
What is still an open issue is whether the present crisis can be considered as the major outcome of contradictions associated with the emergence of the anthropogenetic model of development, or not. The fact that the health, education and culture industries are among the ones that are facing the most serious difficulties during this crisis is a signal of the possible location of the crisis. It is unexpected for most of the analyses that were focusing on the financial sector, after the 2008-2009 crisis, which has been interpreted as the crisis of a financialized mode of regulation. An exogenous shock, the pandemic caused by the Covid-19 is now at the origin of a crisis, which is much more than a pandemic.
Besides the analysis of this emergent model of development and its contradictions at the origin of the crisis, our aim is to propose a comprehensive analysis of the health sector and its internationalization. We assume that the consequences of the crisis will be long lasting. To this end, our aim is to mobilize the work by Gaudillière (2016, 2014), which offers a rich analysis of the globalization of this industry in all its dimensions from a historical viewpoint. Other contributions from Montalban (e.g. Montalban & Sakinç, 2013) on the financialization of the pharmaceutical industries will be also mobilized in order to set the research agenda of our temporary research team.
Neoliberal globalization and Welfare state
In order to understand the dynamics of the present crisis and its possible solutions, several issues have to be considered. First of all, it cannot be said that the neoliberal nature of globalization is the cause of the globalization of the crisis. Pandemic did not wait for globalization to diffuse and circulate. However, some of the characteristics of the neoliberal globalization have accelerated the speed of diffusion and have made our societies and economies more fragile. A striking example is the localization of the production of masks and some drugs (such as paracetamol) almost exclusively in China. Second, on the side of solutions, it is worth mentioning that the present crisis, like the former ones, has shown the resurgence of the need for the state in its productive function (through nationalization of some companies or industries that have been particularly weakened and that are considered of national interest) and in its reproductive function. The so-called Welfare state, which has been retrenched and dismantled for many years, is now considered by some of its major opponents as the core solution not only of the recovery but of the building of a more resilient society. It requires a specific investigation.
Therefore, although the present crisis is strictly speaking a pandemic and a sanitary crisis, this is in fact a multi-faceted crisis with economic, sociological, anthropological dimensions. More importantly, to us, it should lead to revisiting the relationship between technology and society. Thus, it is a critical moment to re-evaluate our research projects on innovation beyond technology, in focusing more specifically on the recent changes associated with health issues.
Innovation beyond Technology
A first series of remarks concern the responses to the Covid-19 crisis, which has relied a lot on social innovation and much less on technologies. What is indeed absolutely striking in the first responses to the Covid-19 crisis is that the tools central to the policies implemented during the first months of the pandemic have relied on medical and social interventions rather than on technological innovations even if – in China, Taiwan or Singapore digital tracking technologies have played an important role in the early stage of the crisis. In following the recommendations from epidemiologists, the most common answer (but not the only one, as shown in Sweden or South Korea for example) has been a very rude and crude solution: confinement and self-distancing or social isolation at a scale never seen in the past. According to the most common estimates, 2 to 3 billion people have been asked to be confined at the same time worldwide, though with different degrees of strictness, in order to limit the speed of diffusion of the virus. The point here is not to criticize this policy but rather to observe that very few sophisticated, technology-based solutions have been found in the first stage of the crisis. It is all the more impressive that the economic and social costs are and will be enormous.
It is worth underlying that the bottlenecks of most health systems are not so much related to technology but rather to the most basic dimension of hospitals: their ability to welcome patients, to care and to cure them. What is missing is not high-tech but human resources and physical spaces that have been reduced for many years by public policies whose major aims were to curb costs and reduce budgets (Juven et al, 2019).
Of course, in a second stage, medicine and science have been massively mobilized. As it has been said, one can observe a simultaneous and massive effort from the scientific community in order to understand, better characterize the Covid-19 and ultimately to deliver vaccines and chemotherapies. Similar efforts are done in order to scale up PCR tests diagnosis purposes and to develop immunological tests in order to identify the persons who have been contaminated and might protected from a new infection. It is also proposed to mobilize information and communication technologies (ICT) in order to track not only those who are affected by the virus but also their social network. This is done on a mandatory basis in China while the tendency in Europe, with some exceptions, is to use this technology on a voluntary basis.
The lockdown policy choice
The necessity of a generalized lockdown must be understood as the outcome of historical trajectories based on different temporalities, from the decade-long fostering of new public management, the delocalization of major health industries from Europe to China or India, to the low attention European health authorities paid to the recent epidemics of SARS or MERS in Asia.
The lockdown policy actually contrasts the choices made in countries like South Korea where the “test, trace, isolate” strategy has been a crucial factor in controlling the transmission. This extended detection of infected persons in fact led to two types of intervention: 1) reinforced social isolation based on the reconstruction of movements of people who tested positive, through the collection of their personal data and the public dissemination of anonymized versions of this information; 2) the acceleration of clinical care for monitored affected people, facilitated by a hospital infrastructure with a number of beds per inhabitant double that of France (Duddu 2020).
Policy of rights vs policy of essential needs ?
Viewed from such a comparative and international perspective, one of the most striking lessons from the present crisis is the profound discrepancy between the principles, targets and tools in the Covid crisis management and those fostered by global health for more than thirty years, as Beaudevin & Gaudillière (2020) suggest. The Covid-19 pandemic highlights the inadequacy of the global health framework in two important ways. First of all, expertise about the pandemic and the relevant responses is not solely located in Europe and North America and thus cannot be only a matter of transferring knowledge and tools along a North-South gradient. Secondly, response strategies require large-scale implementation of medico-social interventions, conditioned by the state of administrations and health infrastructures, an issue largely ignored in most vertical, one-disease/one technology, programs global health actors have pushed for.
This is indicative of the end of what might be call “the great divide” that is the idea that health governance in the Global North, despite all its limits and imperfections, was based on a policy of rights, on the socialization of costs, on the universalization of beneficiaries, and on the mobilization of science and technology in opposition to a policy of essential needs, dominated by scarcity and triage, considered typical of the Global South. Three decades of intense globalization, of mass urbanization and industrialization, first of all in Asia, explain why such vision of health issues worldwide has not only proved irrelevant but also counter-productive in the handling of Covid-19.