The ongoing COVID-19 pandemic has metastasized into a full-blown, global public health crisis. Coinciding with an impending economic collapse that may generate levels of unemployment not seen since the Great Depression, the last several weeks have seen governments utilize emergency measures to legislate reforms unthinkable only weeks ago. Corporations have taken advantage of crisis conditions to lobby for unprecedented bailouts with few strings attached, or to seek out profitable ventures from the vulnerability of public institutions.
Within the American health-care sector, the COVID-19 crisis has revealed the irrationality of for-profit insurance systems that leave millions underinsured and incapable of accessing affordable treatment, as well as the systemic weaknesses of public institutions racked by decades of cuts. Within this context, investment banks in the United States have been pressuring drug and medical supply firms to elevate prices on potential treatments, for example, in order to derive a profit from the current crisis.
Naomi Klein’s Shock Doctrine: The Rise of Disaster Capitalism provides a useful lens to understand the current moment. As she expounds in a recent video for the Intercept, “During moments of cataclysmic change, the previously unthinkable suddenly becomes reality.”
While Big Pharma and health insurance companies have long profited off the vulnerabilities of the underinsured and under-resourced, tech firms are now emerging as major players seeking to profit from the COVID-19 crisis, and to radically expand their reach into global health.
Promoting themselves as high-tech solutions to the distinctive challenges brought about by the COVID-19 pandemic, a multitude of digital health companies have come to the fore in recent weeks, securing lucrative government contracts and unique access to government officials.
Just days ago, Donald Trump announced that the White House was collaborating with major tech companies, including IBM, Amazon, Google, and Microsoft, to “unleash the power of American supercomputing” against COVID-19.
In addition to collaborations with established tech giants, new players have also emerged. Taking advantage of regulatory changes and the consumerization of health care in the United States, digital health companies, key among them Ro, have positioned themselves as leaders in telehealth to combat COVID-19, replacing functions previously within the purview of the Centers for Disease Control and Prevention (CDC) or state health departments. Ro claims to have joined a special tech task force created by the Trump administration to counter COVID-19.
This techno-optimism is not limited to the United States. In the UK, a confused and retrograde response by the Boris Johnson administration, paired with an underfunded NHS scrambling to cope with growing numbers of infected patients, has opened up space for private companies to offer their services in combating the crisis.
The biggest player so far is Babylon Health, a service provider known for its controversial public-private partnership with the NHS, as well as its checkered history of inflating the capabilities of its technology while minimizing concerns over validity and safety.
Babylon recently launched its “COVID-19 Care Assistant,” an online service designed to check symptoms, monitor patients, and offer virtual consultations. According to Ali Parsa, Babylon’s CEO and also a former Goldman Sachs executive, “COVID-19 is the biggest public health threat to our communities for nearly a century and Babylon has a huge obligation to help.”
It’s an “obligation” that evidently includes an unprecedented commercial opportunity for Babylon, which has secured additional government contracts in the United States as well as expanding its reach in the UK, even as eyebrows are raised about allegations of a conflict of interest with members of Johnson’s administration.
Indeed, tech companies around the world have not missed a beat in capitalizing on the opportunities this pandemic presents. Even in Canada, a country often praised for its universal health-care system, digital health companies flooded the market in the wake of announcements of new compensation models for physicians to deliver telehealth consultations. In Alberta, the right-wing provincial government recently announced that it would partner with Babylon Health (delivered in Canada by telecommunications giant TELUS) to provide telehealth consultations, leading to a backlash from primary-care physicians over issues of access and care fragmentation.
Similar trends have transpired in other Canadian provinces, such as Ontario, where the creation of new billing codes for e-consultation with a physician saw a flurry of companies seeking to profit from the opportunity. Meanwhile, Ontario’s nonprofit, publicly administered virtual-care platform is still reeling from recent cuts by the conservative provincial government, and an underfunded telehealth service struggles to deal with this public health emergency.
Numerous problems have already emerged within the sphere of private digital health, ranging from misinformation to unauthorized and fraudulent COVID-19 test kits marketed by several companies. Privacy concerns surrounding the extraction, use, and potential dispersion of patient health data, an endemic problem within the digital health sector, have been overlooked as companies have utilized the crisis to solicit the premature approval of their applications from governments.
This is not to dismiss the potential utility of technological solutions to the COVID-19 crisis. An app-based symptom checker and telehealth service has the potential to reach broad swaths of the population, and they may help relieve overburdened clinics and hospitals. Some of these technologies can be used to disseminate national and state guidelines, offering veridical sources of health information and access to medical expertise.
Nonetheless, the proliferation of these tools from the private sector, and our dependence on them during a global health crisis, has expedited the entrance of for-profit companies into the public health scene with little regard for the social consequences. Indeed, the seemingly sudden expansion of these digital health companies, promising short-term technological fixes, is a testament to the lack of public health resources to take on the COVID-19 crisis.
While the global pandemic calls for an “all hands on deck” approach to curtail the spread of the virus and ultimately save lives, shortsighted calls for patchwork solutions in times of emergency, often framed in techno-optimist market speak, do not address underlying conditions that have exacerbated the crisis.
“Could You Patent the Sun?”
Tech companies have been expanding into the public health sector prior to this current crisis, seeking to fill the void of austerity-ridden public health systems that have failed to provide digital health infrastructure.
Disease surveillance is a core function of public health institutions and will be critical in mitigating and containing the spread of the virus. However, enhanced population surveillance must be driven by democratic means and carried out by public bodies accountable to mobilized and informed populaces. It is not a task that should be outsourced to the likes of Google, Microsoft, or Facebook.
Disproportionate focus on private solutions distracts from much-needed public health resources. Control of prior pandemics was invariably the result of sustained efforts from public-sector workers, ranging from physicians and public health nurses responsible for contact tracing and quarantine, to epidemiologists and research scientists involved in disease modeling and vaccine development.
The discovery of the Salk vaccine against polio, for instance, was built off decades of government-funded research within public institutions. Jonas Salk declined to patent what he viewed as a public achievement, famously proclaiming “Could you patent the sun?” This public ethos is in stark contrast to statements from the Trump administration, which scoffed at the notion of price controls for a future COVID-19 vaccine. As Alex Azar, Trump’s secretary of health and human services, and a former Big Pharma lobbyist, recently stated, “We need the private sector to invest. Price controls won’t get us there.”
Private-sector initiatives are not only incapable of offering a coordinated response, they also portend a deepening of existing health-based inequalities. Digital-health solutions have long faced criticisms that they disproportionately target affluent, technologically literate segments of the population. These solutions invariably exclude the most vulnerable and the hardest hit by the COVID-19 crisis, such as incarcerated and homeless populations, who have little to gain from these private technologies.
Receiving advice from a telehealth app to stay home is cold comfort for many low-wage workers who are compelled to return to work in fundamental services, without the benefit of paid sick leave or adequate safety measures. In the Global South, where COVID-19 is anticipated to have a devastating impact, telehealth apps will have an even more limited impact.
While the Trump administration has consistently undermined public health experts, misled the public, and failed to mobilize state resources to address the crisis, the corporate wing of the Democratic Party has failed to marshal a response bold enough to meet the unprecedented nature of the crisis, spending their time instead shooting down basic policy proposals to provide income to populations.
While predominant state responses to the crisis thus far seem to be laying the groundwork for another corporate bailout and the further destabilization of public health infrastructure, there are alternatives.
Proposals put forward by Bernie Sanders, as well as by Alexandria Ocasio-Cortez, Ilhan Omar, and Rashida Tlaib, suggest a reasonable way forward. Their policy proposals — among them canceling student and medical debt, a moratorium on rent and mortgage payments, the nationalization of private hospitals, and, most important, the call for single-payer health care — offer a starting point to revitalize the capacity of health-care systems while also addressing the needs of those hardest hit by the crisis.
Such efforts must also provide an agenda for investing in and de-commodifying digital health infrastructure for socially desirable ends. This agenda must prioritize radically democratic principles of bottom-up social participation, coordinated planning toward public health needs, accessibility of technologies, and security and control of one’s data, as part of a broader means to socialize and democratize the digital sphere. This begins with exposing the threat posed by private firms seeking to capture public health infrastructure under the guise of crisis alleviation.
While moments of global crisis are often fertile ground for corporate takeover and authoritarian overreach, they can also be moments of profound transformation to radically restructure our public institutions to meet the needs of poor and working-class populations. The shock of the COVID-19 pandemic, with its ensuing quarantines and social distancing, need not deter social solidarity and political mobilization. Part of this effort should include envisioning a democratic digital-health infrastructure that rebuilds our capacity to enact organized and equitable responses to current and future public health crises.