Human solidarity and a global health commons
- July 15, 2020
To protect ourselves against this pandemic, we need to consider health as a global commons, with solidarity as public health’s first line of defense.
Translated from French by Joshua Richeson
The COVID-19 pandemic reminds us of the most fundamental features of the human condition: the solidarity that exists between humans across borders, between humans and all other living beings, as well as between living beings and their environments. This reminder, which obtuse nationalisms and competitive logics are already rushing to hush up, invites us to rethink what a true global political institution should be — what we will here call the “global commons of humanity.”
The lessons from the pandemic also apply to other major problems that confront humanity, starting with global warming and the procession of disasters that are predicted to occur, and for which we are no more prepared than we were to confront the global virus today. In no way do our economic and political institutions arm us to face what lies ahead. It is then more urgent than ever to politically rethink the necessary conditions for the survival of humanity on Earth.
HUMAN SOLIDARITY PROVEN BY THE VIRUS
The virus offers a perfect demonstration for those who would like proof of the solidarity that bind humans to each other and humans to non-humans. The growing interpenetration of societies, with economic exchanges, planetary urbanization and cross-border flows, has considerably accelerated the spread of the epidemic. It has outstripped the states as well as the underfunded health organizations that were unprepared to rise to the occasion.
Infectious phenomena make tangible what sociologists and philosophers at the end of the 19th century called “solidarity.” Durkheim, in his 1893 thesis On the Division of Social Labor, described solidarity as a concept that makes it possible to describe what ties individuals to one another, and to differentiate societies based on the type of solidarity that characterizes them.
Around the same time, the “solidariste” theory — said to have been the philosophy of the Third Republic in France — made solidarity into “the universal law” that should inspire the government’s social policy. The French statesman Léon Bourgeois (1851-1925), spiritual father of the League of Nations and the main author of this current of thought, wrote, “Among each other, people are thus placed and held in bonds of mutual dependence, as are all beings and all bodies, across all space and time. The law of solidarity is universal.” As such, it applied to all areas of life, health, work, thought and feelings.
Against the liberal reading of Darwin, the French solidaristes, relying in particular on Darwin’s writings on cooperation in the human species, made this law of solidarity a law of cohesion and evolution.
Public health theorists then borrowed the concept of solidarity to make it an operational key to public health policy. As the director of Public Assistance and Hygiene in the French Ministry of Interior, Henri Monod (1843-1911), took up the solidariste argument to encourage financial solidarity between rich counties and poor counties, and between rich cities and poor cities:
Public health is perhaps the domain where the social fact of our mutual dependence, of human solidarity, is most clearly evident. At every moment, each one of us unsuspectingly influences the health and the lives of human beings whom we do not know, whom we will never know. Beings whom we will never know, or who have long since disappeared, influence at every moment our health, the health of those we love, and the essential conditions for our happiness.
This solidarity must extend to the whole world, for infectious diseases do not recognize borders: “It is not even enough to say that taking this care is a duty for the citizen, for health solidarity knows no borders.”
Monod’s lucidity as to the international character of public health is still striking today:
Perhaps, as I write, some fault against hygiene, which will one day claim victims in Europe, is being committed on the banks of the Ganges or in one of the ports of India. Perhaps, as I write, another act, this time one of a scientific order which will save thousands and millions from a present-day scourge, is being committed in some distant foreign laboratory. All of humanity can suffer from hygienic crimes just as all of humanity can benefit from the conquests of hygiene. Caring about public health, including the fulfillment of the obligations that come with protecting it, is therefore a duty for every honest person.
We come across the same idea of interdependence proven by infection with Charles Nicolle (1866-1936), a specialist in infectious diseases, who wrote in the 1930s, “Knowledge about infectious diseases teaches humans that they are brothers and sisters in solidarity. We are family because the same danger threatens us, and we are in solidarity because the contagion most often comes to us from our fellow humans.” And speaking of research in medicine, he exclaimed, “What fruitful results when, through their shared efforts, people are united!”
Institutional undertakings accompanied this growing awareness in scientific circles. In 1851, the first international meeting in the fight against plague and cholera was held in Paris, the latter having wreaked havoc between 1830 and 1847. From the end of the 19th century onward, Monod advocated for an international organization that would deal not only with these “classic” epidemics but with all diseases. It was founded in Rome in 1907 as the Office International d’Hygiène Publique.
The internationalization of public health received a new impetus with the creation of the Health Committee of the League of Nations in 1921 and, above all, with the World Health Organization, whose constitution was adopted in 1946, before becoming operational in 1948.
A NATION-STATE LOCKDOWN
Considering this account of the development of the concept of solidarity and the institutionalization of global public health, we may wonder how different countries have responded to the COVID-19 pandemic in 2020.
To put it briefly, the economic, political and scientific response has proven to be disastrous in many ways. First and foremost by revealing how disarmed we were by decades of health care policies guided by austerity and profitability. But also, we cannot overlook the almost absolute prevalence of nation-state logic in the response to the health crisis. Each state responded to the problems posed by the global health crisis as if it were an island: each one able to deal with the crisis in its own way and independently of others.
We very quickly witnessed the closure of borders, the strictly national definitions of the respective strategies to be followed, the mobilization and requisitioning of resources — sometimes to the detriment of other countries — and even the occasional denigration or denunciation of measures taken elsewhere.
Along with this general political cacophony, which has demonstrated the general crisis of “multilateralism” on the health front, we are witnessing the greatest scientific and administrative confusion, both at the national and international levels. Even in the European Union, the national drug agencies have each played their own game, with no coordination of methodologies and each country, each laboratory, each industry trying to outpace the others.
How can it be that the great lessons of the solidarity movement from the late 19th and early 20th centuries have been forgotten so quickly? How can we understand the spasm that has seized our governments, to the point that for too long the gravity of the situation has, purely and simply, been denied? There are many factors, but we will focus on two of them, one at the national level, the other at the global level.
CIVIC RESPONSIBILITY, SELF-INTEREST AND STATE COERCION
In the face of a pandemic caused by a highly contagious virus such as COVID-19, the only solution, according to epidemiologists, is to cut all possible chains of human-to-human transmission. That is, to call upon the collective responsibility of each individual. This does not mean that each individual should merely protect themselves, but a mutual protection that each one grants to the other in a relationship of reciprocity.
When we talk about “public health,” we too often fail to realize that, in this expression, “public” absolutely cannot be reduced to “the state.” Here, “public” refers not only to the state, but to the whole collectivity as constituted by all its citizens. However, governments have generally been unable to grasp that the main asset in a fight against such a contagious disease lies in what can be called civic, or collective, responsibility.
Deeply misguided by decades of utilitarian dogmas, neoliberal norms and individualistic demands, government discourse often failed to find the necessary words to say that social solidarity is the first line of defense against the epidemic — that the feeling and awareness that the fate of all of us is in hands of each of us is the only vaccine currently available.
Instead, these governments had only the most inadequate words: talking about the obvious self-interest of each of us, or talking about the individual responsibility each of us bears in the face of risk. Governments acted as if society were a jumble of isolated atoms, as if each individual had to protect themselves from the others. It was “for oneself” that one had to keep one’s distance, mask oneself, wash one’s hands — not to protect the community as a whole.
If our governments have been unable to clearly state and encourage the co-responsibility of each of us in our collective fate, it is probably because they find it very difficult to imagine other relationships between individuals than ones of rivalry, competition and confrontation of interests.
“THE WORLD IS NOT PREPARED”
States have responded with an “everyone for themselves” approach and the WHO has not been able to effectively coordinate efforts. The most convincing analysis of this powerlessness was provided by pandemic expert Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva: “The crisis we are experiencing shows how enduring the principle of statist sovereignty is in world affairs.”
The WHO, however, cannot be blamed for not having perfectly anticipated the risk. The Global Preparedness Monitoring Board, an office linked to the WHO and more specifically responsible for responding to pandemics, had warned the world a few months before the virus appeared: “If it is true to say ‘what’s past is prologue,’ then there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5 percent of the world’s economy. A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared.”
The Global Preparedness Monitoring Board released this report in September 2019.
FOR THE GLOBAL HEALTH COMMONS
Should the consequence of this crisis be the “return of the nation state” and the “rebirth of state sovereignty,” then we will be dealing with one of the most serious misunderstandings in history. The only possible way forward is to consider health as a global commons.
What does this mean?
What is common is what a collective decision “makes common.” To make common is to make a resource, a service or a space accessible to a community, based on the recognition of a right of persons. A vaccine is a “common good” based on the link that is politically established between it and a fundamental right to health for every human being. But this is not enough to define a global commons, for it is immediately apparent that the institutional conditions still need to be created for this decision to be adopted and implemented.
We need a different type of political organization for global health than the WHO. Its double dependence on states and private funds does not give it the authority and means it should have to fulfill its task of cooperation. It is therefore necessary to imagine a world health institution whose deliberations and decisions will constitute imperative world standards.
This cosmopolitical (read: not “interstatist”) institution would federate all national, regional and local non-profit health institutions and would mobilize researchers from all countries. It would have the same information, notification and cooperation missions that are officially attributed to the WHO today, but unlike the WHO, it would have authority nationally and locally to mobilize the means necessary to meet populations’ fundamental right to health.
The question that these consequences of globalization open up is whether future humanity will be able to establish new institutions that will give it the means to face the risks that predatory capitalism will have left behind. The global health commons is part of that.