Revolutionary Marxists have often been ridiculed by bourgeois commentators for “predicting the apocalypse*”, or even eagerly awaiting it, as if, somehow, we are meant to think that the “complete collapse of the existing social order” will necessarily be followed by the dawning of a new, socialist nirvana. Of course, this is far from the truth. There may be a tiny handful of “Marxists”, who adhere to the notion that refusing donations to charities promotes absolute capitalist degradation, and thereby hastens The Revolution, but such ultra-left views are largely irrelevant writes Phil Ward.
For our critics, the apocalypse of “Marxist determinism” is fundamentally economic in nature: the “inevitable” victory of the working class follows the economic crisis of capitalism. History shows this to be false: the working class must act as a conscious agent to overthrow capitalism, without any foregone conclusion.
Working class defeat, in a period of profound crisis, heralds the real apocalypse: (nuclear) war and/or fascism and all the death and destruction that accompany them. Such events occur within the system, in no sense as part of a transition. And, of course, these occurrences are not welcomed by Marxists at all. They do, however, illustrate the depths to which the system is capable of descending, thereby serving as a warning to those who might be complacent about the capitalist future.
This then raises the question: what apocalypses does capitalism have in store for us? I’ve mentioned war and fascism, developments which depend on the outcome of future class struggles. Further extension of starvation is also a possibility. This, too, depends on coming struggles, perhaps particularly over climate change, which the system seems unable to combat.
It’s a bug’s life
Over the last weeks, another apocalypse has entered the public discourse: antibiotic-resistant bacteria. As much as any of the above issues, the tale of this potential disaster illustrates perfectly why it is necessary to take up the cudgels and fight the capitalist system.
In many ways, Professor Dame Sally Davies, the Chief Medical Officer for England, has written this article for me. She says there is a “market failure”, there has been no new class of antibiotics developed since the 1980’s: “we haven’t as a society globally incentivised making antibiotics”.
The result is an “apocalyptic scenario”, a “ticking time bomb” and we could end up back in the 19th century, when routine operations often killed and cancer treatments would have been impossible. New Scientist magazine tells of the US medical authorities also describing the threat as apocalyptic, although the author says the situation is worse than that (Armageddon – which is a battle within the apocalypse?) They go on to describe the spread of carbapenem-resistant Enterobacteriaceae (CRE): 40% of infections result in death, with no new antibiotics near “the market”. The UK has more infections than the US, 799 (up from 17 in 2008). Meanwhile, MRSA, the most common hospital-acquired infection, is killing 18,000 people a year in the US, and gonorrhoea is becoming very difficult to treat.
Levels of such infections in countries where antibiotic sales are uncontrolled, such as India and China, are unknown.
Of course, the most severe effects of antimicrobial resistance are likely to be felt in the Global South, both due to the absence of regulation of drugs and to poor hygiene. This is particularly the case with tuberculosis (TB): in Africa and Asia, 80% of the population carries the latent form of this disease, of whom 10% will develop symptoms in their lifetime. There are over 9 million symptomatic cases per year, resulting in 1.7 million deaths. Steadily, over the years, resistance to TB medication has been growing, as evidenced by the terms used: “multi-drug-”, “extensively-drug-” and “totally-drug-resistant” TB, the latter being nine cases in South Africa, reported in the March 2013 edition of Emerging Infectious Diseases. Drug resistance is far more prevalent in people who have been treated previously for the disease, indicating that the infection was not initially eradicated.
When your household cleaner says it eliminates 99.9% of all household germs, what it is doing is making space for the 0.1% that survive. This simple point illustrates how important it is for antibiotics to be used where they are absolutely necessary and are effective.
The bugs won’t budge
This state of affairs is neither accidental, nor the result of scientific ignorance. Here is what Alexander Fleming said in his Nobel Prize speech in 1945, less than two years after the development of penicillin on an industrial scale:
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Fleming’s warning describes exactly what has been happening with antibiotics ever since their development. By 1955, 13% of staphylococcus aureus infections were resistant to penicillin and now it is over 90%. It is accepted that resistance will develop naturally: there is continuous need to develop new treatments, or possibly to phase drugs in and out of circulation in a planned and regulated manner. This is something governments have signally failed to do.
The process is accelerated by the over-prescription and failure to complete courses. Public health authorities have contributed to the problem by failing, both to educate people about these risks and to counteract the “pill for every illness” culture promoted by the drug companies.
Agribusiness bears a huge responsibility for antibiotic resistance. It first started using the drugs routinely in 1946, to promote growth in livestock and to prevent infections in filthy, overcrowded conditions. Now, antibiotics are used on such a scale, in livestock, poultry and fish, that, in the USA, this constitutes 80% of the market. The antibiotic residues enter the water supply and our food chain, while resistant bacteria can be transmitted directly from farm animals’ manure to people, or indirectly by insects etc.
Preventative use of antibiotics in farms is now meant to be banned in the EU, as are their use for growth promotion and over-the-counter sales to people. However, the situation is complex, with different drug controlled for different animals and it seems that there is poor understanding of the details of the controls.
In a sense, that doesn’t matter, in the absence of meaningful controls in other countries, as bugs don’t recognise national boundaries – even when they are UKIP members. But the controls are also such that the rules are probably routinely flouted in the EU, both regarding animal and human use, according to Peet Tüll, a Swedish former World Health Organisation (WHO) official.
Tüll mentions that the WHO has had a policy on antibiotic misuse and resistance since 2001. However, there is little control of the antibiotic market in most countries and of sales on the internet, often of faked, or poorly manufactured and ineffective treatments, which are then taken in a haphazard manner. Money, it seems is the main issue in what is, in the last resort, a deadly trade.
Capitalism bugs us
New Scientist reports that eight Big Pharma companies have abandoned antibiotics since 1990. They are following the capitalist health model. This consists of feeding people on junk and forcing them into a sedentary lifestyle, where distances between homes, jobs, schools, shops and entertainment are so large as to make walking or cycling impossible. The resulting health problems, like high cholesterol and blood pressure, will then preferably be treated using life-long prescriptions for statins and beta-blockers. They enter the world market for hypertension drugs, greater than $30bn per year, or may use the best-selling ever drug, Lipitor, a statin, that netted Pfizer $125bn up to 2011.
Meanwhile, in the world of antibiotics, drugs in development have stalled, due to regulatory hurdles or lack of finance. After all, why would Big Pharma research and make drugs that cure when taken for a week, when they can develop ones for chronic conditions that we have to take for life?
An examination of the top-selling pharmaceuticals (Wikipedia) contains two drugs that treat bacterial infections, in a list of 108. Of other infectious diseases, there are four for HIV, one for ‘flu and one for herpes. So, 100 of the drugs are for chronic non-infectious conditions and 3 or 4 for short-term infections, none of them tropical. These are clearly priorities established by the world market and not by people’s needs.
While we face the threat of antibiotic resistant infections, the public health body in England, the Health Protection Agency, is to be abolished on April 1st, as the new Health and Social Care Act comes into force, and replaced by Public Health England. The aim is to reduce staffing and budgets, so it is likely that there will be less oversight of possible outbreaks of infectious disease and less scrutiny over breaches of drug control regulations.
Summing up the whole antibiotic resistance picture, a Cardiff academic is reported as saying: “It’s like going back to the pre-antibiotic era”, at least for the next 10-15 years. This is the apocalypse that the capitalist system is inflicting on us all.
*A difficulty in using the term apocalypse (Greek for “revelation”) is that it can be used interchangeably with two different emphases: “the end of the world”, with or without “the dawning of a new age”, the latter being the original, biblical one, as used in the Book of Revelation. Friedrich Engels gives an interesting account of this second meaning.
(The Soil Association has just published a comprehensive report about bacterial resistance in agriculture.)