After the Covid Pandemic Crisis. The time for a fundamental reform of capitalism is now

Prof. Stefano Zamagni | PASS President

After the Covid Pandemic Crisis. The time for a fundamental reform of capitalism is now

Photo: Gabriella C. Marino

1.                Introduction

In 2005, when addressing the graduation class at Ohio’s Kenyon College, the American writer David Foster Wallace recounted the following parable. “There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’”. Too often we fail to be aware of the most essential, important reality surrounding us despite its being plain for all to see; and for this reason, we fail to understand and grasp that reality. This is precisely what happened, in the case of the pandemic that has been with us since January of this year. SARS-Cov-2 remains largely unknown: we know where it originated (in Wuhan, China), but we do not know how the epidemic developed, or how long it is going to last; nor do we know whether or not the virus will self-restrain. More importantly, we do not know whether the reduction in the number of new cases is ascribable to the restrictive measures adopted, or whether it is also the result of other factors (a reduction in air pollution, the altitude of places, or other external factors).

The pandemic clearly reveals the risks of globalisation. The virus shows that we live in a completely interconnected world. The strands of biological, anthropological, economic and political globalisation interweave inextricably. This is why the widely utilized tunnel metaphor is misleading, because it gives the idea that we are going through a temporary phase, and when we come out of the tunnel we are in, we will see a reversion to the world of old, albeit considerably poorer than before. What I think is required, on the contrary, is a paradigm shift whereby vulnerability is taken to be a permanent state of affairs. The way that this vulnerability is dealt with, rather than the power of a war waged against this invisible

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1.                Introduction

In 2005, when addressing the graduation class at Ohio’s Kenyon College, the American writer David Foster Wallace recounted the following parable. “There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’”. Too often we fail to be aware of the most essential, important reality surrounding us despite its being plain for all to see; and for this reason, we fail to understand and grasp that reality. This is precisely what happened, in the case of the pandemic that has been with us since January of this year. SARS-Cov-2 remains largely unknown: we know where it originated (in Wuhan, China), but we do not know how the epidemic developed, or how long it is going to last; nor do we know whether or not the virus will self-restrain. More importantly, we do not know whether the reduction in the number of new cases is ascribable to the restrictive measures adopted, or whether it is also the result of other factors (a reduction in air pollution, the altitude of places, or other external factors).

The pandemic clearly reveals the risks of globalisation. The virus shows that we live in a completely interconnected world. The strands of biological, anthropological, economic and political globalisation interweave inextricably. This is why the widely utilized tunnel metaphor is misleading, because it gives the idea that we are going through a temporary phase, and when we come out of the tunnel we are in, we will see a reversion to the world of old, albeit considerably poorer than before. What I think is required, on the contrary, is a paradigm shift whereby vulnerability is taken to be a permanent state of affairs. The way that this vulnerability is dealt with, rather than the power of a war waged against this invisible enemy, is what will generate human creativity. In what follows, I shall focus on the ways of overcoming this critical situation, and suggest a number of possible courses of action to be taken. I would argue that this pandemic – which we already know will not be the last of its kind – represents an extraordinary opportunity to get the various countries back on track towards the integral human development, and this opportunity must not be passed up.

One point that should be made clear right from the beginning is that the metaphor of the pandemic as a form of war, so commonly used in public debate, is wrong, indeed misleading, since it diverts attention away from the search for effective remedies for the pandemic. The economic perspective helps distinguish between the two situations: war is essentially inflationary, since demand grows faster than supply; a pandemic, on the other hand, is intrinsically deflationary, given that demand decreases faster than supply (except for the demand for, and supply of, basic necessities). Note the asymmetry here: while there is a wealth of economic literature relating to the question of war, there is a paucity of such concerning pandemics. In a recent piece of work (“Longer-run economic consequences of pandemics”, Federal Reserve Bank of San Francisco, WP, March 2020), O. Jordà et al. study rates of return on assets using a dataset stretching back to the 14th century, focusing on 15 major pandemics where more than 100,000 people died. They also consider major armed conflicts resulting in a similarly large death toll. Significant macroeconomic after-effects of the pandemics persist for about forty years, with real rates of return substantially depressed. In contrast, the Authors find that wars have no such effect, indeed the opposite. This is consistent with the destruction of capital that happens in wars, but not in pandemics.

2.                The lessons to be learned from the crisis

Before discussing the ways the present crisis may be overcome, mention should be made of some of the most important lessons to be learned from the SARS-2 pandemic. As Herodotus famously remarked: “Ta pathemata, mathemata” – that is, our difficulties and sufferings are the things that teach us. One of the most important such lessons is that all of us – scientists, politicians, business people, intellectuals and ordinary people included – need to learn to be humble. For too long we have been under the illusion that the new digital technology introduced by the 4th industrial revolution can guarantee regular, unlimited growth. One only has to think of the many promises made by the promoters of the trans-humanist project developed at the “University of Singularity” in California. According to one of the key representatives of the University of Singularity, K. Kurzweil, 2045 will be the pivotal year in which so-called “technological singularity” will become reality: that is, the moment in which the number of active microchips in existence will exceed the number of human neurons, and human and artificial intelligence will merge to become one. Hence the urgent need to re-employ a word that too often has been neglected, in particular within the world of science, and that word is “limit”. Within the healthcare field in particular, there is a limit to reasonableness, and a limit to clinical effectiveness, and this should never be forgotten. What is often not taken into account is that the “double burden of disease” does not completely describe reality, since in addition to chronic and acute diseases there are also viral diseases (hence the “triple burden of disease”).

In 1969 William Stewart, the US Surgeon General, informed Congress that “the war against pestilence has been won” and therefore “the time has come to close the books on infectious diseases”. Just a few years later, Harvard University’s Medical School, together with that of Yale University, closed their infectious diseases departments. This and other similar measures gave rise to the spread of a sense of invulnerability which was to subsequently degenerate into a kind of scientific hubris. (For specific details, see Mark Honigsbaum, The pandemic century. One hundred years of panic, hysteria, and hubris, Hurst Publishers, 2019). I would argue that while the inestimable worth of science is a given, it should also be said that science is just as erratic as other human practices, as Karl Popper’s falsification principle has shown. Thus it would be mistaken to cultivate the illusion that techno-science is going to save us from all illness, as believed by many people who do not think that such relief can be pursued within the realm of religion. Investment in artificial intelligence should continue, but we also need to invest time and energy in learning the lesson of humility. (From the Latin term humus, a humble person is one who keeps its feet firmly planted on the ground!).

I would like to consider a second very important lesson to be learned. Like all pandemics, COVID-19 – characterised by a severe acute respiratory syndrome – is not an accidental phenomenon, and certainly not one of a random nature. As history shows, epidemics afflict societies through the vulnerability created by people as a result of their relations with the environment, with other species, and among themselves. The microbes that trigger pandemics are those whose evolution has rendered them suited to the ecological niches created by people living in society. The coronavirus spread as it did because it found its perfect niche in the type of society we have built: inhuman megacities; an endemic rise in social inequality that leads the poorer members of society to feed on the meat of wild animals captured and sold live in wet markets; frenetic urbanisation that destroys animals’ natural habitats and alters relations between humans and animals. More specifically, increased contact with bats – a natural reserve of innumerable viruses capable of moving between species and afflicting humans. When the coronavirus began to manifest itself, this occurred in a world that had been warned in advance of the potential challenge and risk represented by such a virus. As the expert historian and scientist Frank Snowden (Epidemics and society, Yale Univ. Press, 2019, II ed. 2020) revealed, as far back as 2008 researchers had identified 335 human illnesses that had developed between 1950 and 2004, the majority of which originated from animals. In particular, the public health authorities had been warning of such a risk since the breakout of H5 N1 ‘flu in 1997, but this warning was systematically ignored. Moreover, David Quammen (Spillover. Animal infections and the next human pandemic, Milan, Adelphi, 2012; original edition 2010) had already foreseen the pandemic ten years ago, and his forecast was subsequently confirmed by Anthony Fauci, Director of the US National Institute of Allergy and Infectious Diseases (Healio, January 2017).

Moreover, if we observe the period between the outbreak of SARS 1 in 2003 and the advent of the Ebola epidemic in 2013, we see the following: in 2005 the World Health Organisation (WHO) published the Global Influenza Preparedness Plan setting out guidelines and practical recommendations in the event of the outbreak of an epidemic. Not only was nothing done as a result of this publication, but indeed the funds assigned to the WHO were subsequently reduced, and the corresponding Action Coordination Agencies were closed. Finally, in September 2019 the WHO published a report entitled A World at Risk which stated that: “High-impact respiratory pathogens, such as an especially deadly strain of influenza, pose particular global risks in the modern age. The pathogens are spread via respiratory droplets; they can infect a large number of people very quickly and, with today’s transportation infrastructure, move rapidly across multiple geographies”. The Report then listed the instruments that should be used to combat the pandemic, which we all know about today. No country, starting with Italy, appeared to have understood the message contained in the Report, and three months later the COVID-19 disaster unfolded.

In view of the above, how could inexperienced citizens have been led to believe that COVID-19 was a case of a “black swan”, that is, an unpredictable, shocking event? Nassim Taleb, the Lebanese scientist who at the time of the 2007-2008 financial crisis had divulged the expression “black swan” – a term, however, that had first been introduced by Aristotle – employed the turkey metaphor to get across the idea of the serious responsibility of governments for the current pandemic. Based on Bertrand Russell’s famous metaphor of the inductivist turkey, Taleb tells the tale of the turkey being fattened which, day after day, becomes increasingly convinced that its owner is there to feed it every day for the rest of its life. However, when Thanksgiving Day comes, that day is a “black swan” for the turkey, that is, something completely unforeseeable. Not so for the turkey’s owner, of course. So, the coronavirus pandemic is a black swan event for “turkeys” only, that is, for those of a naïve disposition. (As we all know, Russell used this tale to warn scientists of the serious limitations of empiricism, according to which knowledge originates from sensorial experience. Unfortunately, economic science is currently suffering from excessive inductivism).

So, what important lesson can be learnt here? The answer is that in recent decades, western culture has in fact forgotten, and sometimes derided, the practice of that cardinal virtue “prudence” – the auriga virtutum, according to Thomas Aquinas’ definition, that is, the one virtue guiding all others. In fact, it was held that prudence was a quality of the fainthearted, that is, of those afraid of making decisions because they were averse to risk. On the contrary, the very opposite holds true: prudence, from the Latin providentia, is the virtue of the farsighted, that is, of those capable of making cautions decisions in any given circumstance. (S. Zamagni, Prudenza, Bologna, Mulino, 2015). Why were no decisions taken until 21 February of this year regarding the implementation of measures to combat the virus, when it was a known fact that for over two months the virus had been killing people in China, and subsequently in South Korea? The justification initially given for this delayed reaction was that there were “too” few known cases for such measures to be taken, which is completely groundless: the reason for this is that the initial part of the exponential curve indicating the trend of the spread of infection is virtually flat, only to skyrocket a few weeks later.

Finally, I must mention a third important lesson to be learned from this tragic affair. I am referring to the radical difference between government and governance. Government is the political body that has the last word in regard both to the establishment of the rules to be observed, and to the ways in which compliance with such rules is to be controlled. Governance, on the other hand, refers to the how, that is, to the manner in which those decisions are implemented in order to achieve the desired aims. Authoritarian regimes alone are characterised by the superimposition of the two levels, since bureaucracy and the other public administrative entities are tasked with implementing the decisions taken by Government. Of course, only those who do not accept the principle of subsidiarity, because they are blinded by authoritarian cravings, can think this is the correct way of carrying on.

It may be claimed that proclamations, recommendations, decrees and explanatory circulars could suffice. However, that is simply not true. As the social sciences have shown for years, if the rules are not heeded, and are thus not interiorised by citizens as the fair, right thing to do for the common good, they will simply not be complied with, despite the implementation of strict measures designed to enforce such rules. Hence the need for specialised educators whose role is, in fact, to show people that there is no discrepancy between legal norms and social norms, but indeed the two operate in the same direction. This is the most important mission of community, as constituted by Third Sector organizations, which neither the State nor the market will ever be capable of replacing. An empirical confirmation of this point comes from the recent work by J. Barrios et al., “Civic Capital and Social Distancing during the Covid-19 pandemics”, NBER, WP 27320, June 2020. The authors show that during the early phases of COVID-19, voluntary social distancing was higher when individuals exhibited a higher sense of civic duty and that, after re-opening, social distancing remained more prevalent in high civic capital counties.

3.                After the crisis: two possible future scenarios

The intriguing crossroads facing all countries concerns the choice of strategy called for to overcome the ongoing crisis. There are two main options available. On the one hand, we could return to the situation as it was prior to the crisis, once the urgent, necessary changes have been made. This is the “flood approach”: we wait for the waters to subside and return to the river bed after the flooding is over, before strengthening the river’s banks; afterwards, it is “business as usual”. On the other hand, however, there is the transformational resilience approach, the aim of which is to increase the system’s resilience to future systemic crises. While the first option focuses on fragility, the second approach focuses on all of those measures capable of significantly reducing the country’s vulnerability. (It should be pointed out that being vulnerable means being exposed to wounds. Thus, vulnerability should not be confused either with fragility, which concerns the intrinsic inconsistency of things, or with precariousness, which consists in the transitory, passing nature of a situation. In spite of the fact that the damage caused by vulnerability is considerably more serious than that deriving from fragility or precariousness, public debate and political action very rarely concern themselves with the question of vulnerability). I think there can be no doubt about which option ought to be chosen. Even the most convinced conservative could not fail to see that there is little point in trying to become more resilient, if the aim is that of preserving the pre-existing model of social order. After all, why waste the opportunity offered by the onset of a severe crisis to implement a radical change of pace in the economic system? Rather, it is proper to ponder the key points of a transformational project capable of radically affecting the structural causes of present-day anxieties and dark problems. I shall illustrate five such points which, although not the only ones, I believe are the most urgent ones.

I shall start with the question of the de-bureaucratisation of the public sector. Perhaps Honoré de Balzac wrote in his essay Les employés (The Government Clerks, 1841): “As a rule the lazy, incapable individuals and imbeciles stayed on or arrived. Thus slowly mediocrity became rooted in the civil service… Entirely composed of wretched souls, the bureaucracy hindered the nation’s prosperity, and by now had taken over, controlling all and even keeping the country’s ministers on a leash”. The famous sociologist Max Weber remarked: “Every bureaucracy seeks to increase the superiority of the professionally informed by keeping their knowledge and intentions secret”. In other words, a simple, clear law will not be to the bureaucrat’s liking, since it cannot be “interpreted”.

One wonders where all of the ills we attribute to bureaucracy actually derive from. In truth, bureaucratisation, that is, the untoward growth of bureaucracy, is the effect, not the cause, of such ills. Their cause, on the other hand, should be ascribed to the pervasive phenomenon of rent-seeking, which is typical of our political systems. Just like all parasitical phenomena – such as the coronavirus in fact – rents exist by extracting value generated by others, rather than by producing such value. (The term “parasite” derives from the Greek words “parà” (near/at) and “sitos” (food), and denotes a person who eats at another person’s table and expense). There are many different forms of rent (financial, real estate, land, bureaucratic), but all of them have the same connotation, that is, their lack of generativity. The Italian economist Achille Loria (1857-1943) offered a number of enlightening thoughts on the question of rent, which he considered the worst of capitalism’s ills. Well, bureaucracy is the principal instrument wielded by those who hold political power in order to consolidate and preserve their rent positions.

This would explain why all political parties, whilst ranting at the excessive levels of bureaucratisation present within the system, do little or nothing to re-direct it back into its natural ‘riverbed’. (In fact, it should not be forgotten that we hardly do without bureaucracy, since there are no self-operative laws as such). Selecting managers on a meritocratic basis rather than by virtue of their political sympathies; equipping offices with appropriate technology in order to increase productivity; freeing bureaucracy of worthless or damaging external constraints, and strengthening it from within by adopting appropriate incentive schemes: it is all of this that the political class does not want to see come about. The phenomenon of over-regulation goes by the name of “gold plating”, and it only serves to shift responsibility to others and to preserve unnecessarily over-sized bureaucratic arrangements. This is why it would be important that the principle be heeded whereby no decision can be taken by the decision-making body without a full execution procedure accompanying such decision. In turn, “legal hypertrophy” results in a torrent of criminal laws and corresponding penalties, the effect of which is not only ineffectiveness, but also the diffusing among the population of an impoverished, primitive anthropology whereby Man is not perceived as a thinking, responsible being, but as an automaton to be mechanically reduced to obedience through the threat of punishment. We fully understand why bureaucratisation constitutes a really serious threat not only to the economy, but also to social cohesion. Ultimately, if we really want to win the battle against bureaucratisation, then the political system needs to be transformed by a shift towards the model of deliberative democracy. (To avoid misunderstandings, it is proper to recall that deliberative democracy has nothing to do with decisional democracy).

In order to invest in society’s resilience by adopting a perspective that looks beyond the present emergency, we need to avert the risk of a return to neo-statism in any form: this is a second key point of the transformational strategy I am advocating. (Statism is not the same thing as statuality). It is clear that in emergencies such as the present one, the State has to intervene, significantly if necessary, to support private actors operating in a variety of different spheres. However, it needs to do so whilst keeping its eyes on the post-emergency phase, if it is to avert the risk of “crowding out” the market. State budgets are under unprecedented pressure: public deficits are doomed to rise. Thus, it is imperative that the extra resources that are provided to revitalise overall productivity, be used for such purpose. In fact, the current crisis derives from a shock to both supply and demand, which renders it different from those crises that arose after the Second World War. In a post-war period, war expenses no longer exist, while growth and inflation lower the burden of public debt. In the present case, however, healthcare spending will of course be higher, there are no signs of any inflation, and private economic activity is not strong enough to restart of its own accord after twenty years of slow growth.

The State must operate as a facilitator of entrepreneurship and not as an entrepreneur itself – the expression “the entrepreneurial State” suggests a contradiction in terms – in order to create the necessary conditions whereby private undertakings and Third Sector subjects can survive and flourish of their own accord, without the State paternalistically standing in for them. New instruments will have to be created that permit the State to invest in equity, in order to favour business aggregations in key economic areas. (For example, in the green economy, in new infrastructure for the health and education systems, etc.). My favourite image of the State is that of a midwife who, after the birth of a new being, quietly withdraws from the scene. As Luigi Sturzo often said, the State cannot become a total institution given that it belongs to the category of means rather than ends. The State ought to be judged on its ability to safeguard the nation’s common good, if one wishes to keep faith with the liberal democratic model. Thus, there is no room for out-of-date ideological projects postulating State intervention whilst ignoring the grounds for such. To put it rather simply, the war economy ends when peace reigns once again.

A specific and fundamental role of government is to operate in such a way as to implement policies that combat both the COVID crisis and the climate crisis. Government should seek to identify where the intersection between COVID policies and climate policies lies. Policies ranked as “good for the climate” should be expected to yield substantial long-run emission reductions. Policies ranked as “good for pandemic recession” should help alleviate job losses due to the current recession and have public health benefits regarding current or future pandemics. In an interesting paper, G. Engstrom et al. (“What policies address both the Coronavirus crisis and the climate crisis”, CESifo WP 8376, June 2020) identify a set of policies that can help to reduce the economic fallout of the COVID crisis and simultaneously aid societies in meeting climate change targets in the long run. Mainstream economics tends to assume that when something is necessary, it will happen; that the market will take care of it. It is now well known that this is not true in reality: that is why government should enter the picture, not to substitute, but to enhance the traverse path.

A third proposal concerns the re-founding of the Italian tax system. Apart from the question of tax evasion – a devastating phenomenon jeopardizing the total factor productivity of the system – a delicate issue has to do with the unfortunate “tax and spend” policy, whereby government first taxes and then redistributes the resulting tax revenue. This would be a serious mistake during this phase. Unfortunately, a policy of this kind is designed for one purpose only, given that those taxed represent a limited number of votes lost, whereas the beneficiaries of the resulting spending provide a great many votes. The government needs to resist this temptation, in order to favour those capable of generating added value with which to sustain development. More generally speaking, the objective ought to be the achievement of a transformation, and not merely a reform, of the tax code which is still too “finance-friendly”. For example, a Tobin Tax on financial transactions cannot but be introduced. The American Congressional Office has recently estimated that a 0.1% tax would generate more than one thousand billion dollars in a decade in the USA alone. The technical and administrative difficulties of applying such a tax are well known: however, they are not enough to justify the abandonment of such an idea. In his article “Taxing financial transactions”, Thornton Matheson of the IMF ( reports that taxes such as the Tobin Tax are in force in 23 different countries, and the revenue from such taxes is used to stem the growing volume of high-frequency trades on the stock market that are automatically generated by computer algorithms. Basically, therefore, such an approach is designed to reduce the intensity of financial market speculation. (On this specific issue, see D. Schoenmaker et al., “Is COVID-19 a threat to financial stability in Europe?”, CEPR, DP 14922, June 2020). The urgency of a radical transformation of the tax system is also revealed by the circumstance that the pandemic very likely will exacerbate growing inequalities. In a most interesting paper (“Will Covid-19 affect inequality? Evidence from post pandemics”, Covid Economics, 12, 2020), D. Furceri et al. provide evidence of the impact of major epidemics from the past two decades on income distribution and conclude that the distributional consequences from the current pandemic will be larger than those flowing from historical pandemics.

I move to the fourth of the desirable lines of action. During this long lockdown period we have become accustomed to communicating with one another remotely, and holding meetings and lessons online. Likewise, there has been an upsurge in the remote provision of medical and psychological assistance, and in smart working (although in truth this has been more like home working, as smart working is something rather different). Thus, we have discovered that many countries are lagging behind in matters of professional digital communications. A point worthy of particular attention in this regard is that poor countries especially should have access to broadband and to technological instruments suited to the present day.

A word of clarification about the notion of smart working may be convenient. This concept concerns a work organisation model of the post-Taylorist variety, according to which work is done on a project basis, and performance is assessed ex-post. A project is different from an order, as the latter involves controlling the workers in person. Consequently, smart working cannot be achieved without the “smart factory”. In other words, even managers – and not only workers – have to become “smart”. So, what are the main difficulties encountered here? One significant difficulty is of a cultural nature. In general, companies’ middle managers have serious difficulties devising models with which to control projects assigned to workers: there is a reluctance to move away from the Taylorist model. Another difficulty concerns negotiating labour contracts with trade unions, since there needs to be a transition from traditional employment contracts towards new forms of work contract. All innovation processes are also participation processes. The risk that must be averted here is that of smart working constituting a return to a low-cost model that dispenses with existing universal safeguards. Therefore, what is urgently needed is to track changes to the nature of remote work, asking how pandemic-induced changes transform workplaces in the short and long-term. (A stimulating discussion about how the US labour force is responding to the COVID-19 pandemic can be found in E. Brynjolfsson et al., “Covid-19 and Remote Work: An Early Look at US Data”, NBER, WP 27344, June 2020).

A fifth required transformation also deserves commenting on, and that is the speeding up of the transition process from the welfare-state model inherited from the recent past, to a model of welfare society or welfare community. While the welfare state is based on the idea that the State (and other public entities) alone must take care of the nation’s welfare, the welfare society concept rests on the belief that society as a whole, of which the State is an essential part, should be responsible for people’s wellbeing. As it is well known, the welfare state model is no longer sustainable: firstly, for financial reasons (the discrepancy between costs and revenue is going to rise in time for a number of clear reasons, regardless of whether resources are allocated efficiently or not); secondly, because this model has resulted in citizens’ being relieved of their responsibilities. If the State alone is entrusted with the care of the population, protecting it from the “cradle to the grave” to use Lord Beveridge’s famous expression (1944), it is clear that the unrestrained expressions of civil society’s potential will be overridden. The word “community” comes from the Latin cum-munus, meaning the joining together of gifts: it is difficult to create a proper community when a sovereign body thinks about, and provides for, everything and everybody. So, if we do not wish to abandon the idea of universalism, which has been the welfare state’s greatest contribution to civilisation, and drift towards the American idea of welfare capitalism, then the only viable option is that of a welfare society.

This is particularly true in regard to healthcare, as recent experience has clearly shown. We need the courage to admit that healthcare is a common good, and not a private or public good. Consequently, its governance cannot be of a private or public nature, and what has happened with the COVID-19 pandemic is the most cogent proof of this. The transition from a healthcare system centred on hospitals to a system based on local healthcare provision, that is, from an organisational model centred on individual patients to one centred on the community as a whole, which everyone now believes indispensable, will never be achieved until we truly understand that healthcare is a common good. The new healthcare system needs to be generative, that is, empowering, rather than redistributive or paternalistic.

4.                 Pandemics and ethical dilemmas

The pandemic has presented countries and the world with a series of difficult ethical dilemmas. Should we prevent more infection or reduce unemployment? Limit contagion to lessen mortality or cease social isolation? Re-open schools or not risk a second wave of the pandemic? These are difficult decisions. Moreover, the trade-offs between these options are likely to differ in different regions. In the present context, I will limit myself to briefly consider two specific cases of ethical dilemmas. The first one has to do with the ethical legitimacy of the patentability of lifesaving vaccines – in our specific case, the Covid-19 vaccine. The effectiveness of a vaccination campaign depends on its being universal: vaccinating certain groups or nations and not others, is of little use. So, to ensure that everyone has access to a vaccine, governments need to make it available to their citizens free of charge; in other words, vaccines need to be freed of patent rights. Does this mean that those doing time-consuming, costly research work are not going to be compensated for the costs borne and are not going to receive a fair return on their investment? Of course not. What it does mean, on the other hand, is not to allow those who have discovered the vaccine to extract monopoly profits by granting them patent rights on a good, the demand for which is not the expression of users’ free choice, given that a vaccine is a lifesaving product, and to do so would be unlawful. (For the record, despite the term used, the gain obtained from a monopoly position is not a profit but a rent). Therefore, it is imperative to propose that the vaccine becomes a global common good for all of humanity, in order to avoid wealthier countries crowding out poorer ones. GAVI, the Vaccine Alliance, the WHO, and several governments have formed the COVID-19 Vaccine Global Access (COVAX) Facility. They propose that any effective vaccine that emerges be treated as a global common good to be distributed equally around the world, regardless of where it was invented or of a country’s ability to pay. The same direction has been taken by the recently established “Lancet Covid-19 Commission”, chaired by Jeffrey Sachs, whose specific purpose is to ensure that any new COVID vaccine and other key technologies are equitably accessible across the world, so to counterbalance the temptation of vaccine nationalism.

Is this a sweet utopia? The answer is no, as there are various illustrious precedents: for example, there is the case of the anti-polio vaccine of which we are all aware. In the 1950s the American biologist Jonas Salk (1914-1995) invented a vaccine against poliomyelitis, with the financial support of the Foundation set up by US President Roosevelt, and of millions of donors participating in one of the largest-ever crowdfunding campaigns in recent history. Salk had absolutely no intention of patenting his invention, and in response to a TV interviewer’s question as to whom the patent belonged to, Salk responded: “Could we patent the sun?”. In a nutshell, the patenting of inventions regarding key common goods should not be permitted. Private goods and certain public goods may be patented, on the other hand, as J. Schumpeter clearly observed. In the case of common goods, new forms of regulation other than patentability need to be established.

I pass now to the second ethical dilemma I was referring to above. It concerns the procedure for the selection of patients to be treated in a health crisis. During the present pandemic, procedures for the selection of patients to be admitted to intensive care units have been implemented, as a result of which certain patients requiring intensive care have been redirected to non-intensive care units. Such policies have a name: “wartime medicine” – medicine that absolves those practicing it from responsibility, despite their awareness that those patients excluded from intensive care are at risk of dying. (This is why, as I have mentioned, war as a metaphor for the pandemic is a dangerous and misleading one). In March 2020, the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care published its “Recommendations on Clinical Ethics”. Points 3 and 4 of these Recommendations state that “it is necessary to establish an age limit on patients admitted to intensive care”. The aim of this is to reserve resources first and foremost for those who are more likely to survive, and secondly, for those who have more years to live. This is the so-called QALYs (quality adjusted life years) principle. I do not have the space here to provide an adequate radical critique of this position which continues to be the dominant one. I limit myself to indicating that it is immoral to value economic consequences or personal happiness against the number of lives lost. It is true that happiness and life satisfaction are important, but it is even more true that human flourishing extends beyond this and includes meaning and purpose, health, character and social relationships. QALYs, being inscribed in Benthamite utilitarianism, presuppose a trade-off between life and wellbeing and between life and value of life. The Human Flourishing Program at Harvard University has recently elaborated the “total-lives-saved approach” that treats all lives as being of equal worth. It still takes into account wellbeing, but it does so through its effects on life itself. It accounts for wellbeing that prioritizes human life. (T. VanderWeele, “Challenges estimating total lives loss in COVID-19 decisions”, JAMA, July 9, 2020). What I would like to add is that wartime medicine in the 21st century should be banned and condemned as being basically inhuman, as well as completely unnecessary when trying to resolve the moral dilemmas that are going to increasingly intrigue the future world of healthcare.

5.                In lieu of a conclusion

The world has recently been struck by a systemic crisis triggered by an airborne virus of animal origin, which has affected all spheres of human co-existence and interaction. It would thus be unwise to respond to such a systemic crisis by implementing sectoral, partial actions and measures, even if they are considered per se valid and meaningful. The Sars-2 (Covid-19) pandemic represents a great opportunity to abandon the path to growth followed to date, and to begin anew on the path towards integral human development. To forego such an opportunity would be an act of grave irresponsibility. Today, acting responsibly means shouldering the weight of things (res pondus) and not simply avoiding committing crimes or other irregularities. The latter is responsibility in the sense of accountability – one responds for the negative consequences of one’s actions; the former, on the other hand, is responsibility intended in the sense of taking care – one is responsible for the good one fails to do, despite being capable of doing it. It is this form of responsibility that there is much need for in our country, particularly at times like this.

The COVID-19 pandemic is unfolding at a time when democracy is in decline. According to data compiled by Freedom House (2020), democracy has been in a recession for over a decade, and more countries have lost rather than gained civil and political rights each year. A key concern is that Covid-19 will turn the democratic recession into a depression, with authoritarianism sweeping across the globe like a pandemic. (C.B. Frey et al., “Democracy, Culture and Contagion: political regimes and countries responsiveness to Covid-19”, Covid Economics, 18, 2020). We bear responsibility for the ideas upon which institutions, both political and economic, are based. And we bear responsibility for what bears us: nature. Now, it is a well-recognized fact that market systems are consistent with many cultures, conceived as tractable patterns of behaviour or, more generally, as organized systems of values. In turn, the type and degree of congruence of market systems with cultures is not without effects on the overall efficiency of the systems themselves: in general, the final outcome of market-coordination will vary from culture to culture. Thus, one should expect that a culture of possessive individualism will produce different results from a culture of reciprocity where individuals, although motivated also by self-interest, entertain a sense of solidarity. In the same way, a culture of cooperative competition will certainly produce different results from a culture of positional competition.

But cultures are not to be taken for granted. Cultures respond to the investment of resources in cultural patterns, and in many circumstances it may be socially beneficial to engage in cultural engineering. Indeed, how good the performance of an economic system is depends also on whether certain conceptions and ways of life have achieved dominance. Contrary to what it might be believed, economic phenomena have a primary interpersonal dimension. Individual behaviours are embedded in a pre-existing network of social relations which cannot be thought of as a mere constraint; rather, they are one of the driving factors that prompt individual goals and motivations. People’s aspirations are deeply conditioned by the conventional wisdom about what makes life worth living. The truth of the matter is that it is thanks to culture that mankind does not need to be transformed into a different species in order to adapt to the environment, which human beings themselves have helped to modify.

To conclude. Those with no hope in the future have only the present and those who have only the present have no compelling reason to be interested both in sustainability and in innovative endeavour. But fortunately people who continue to entertain hopes in the future have not disappeared altogether.    

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