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Fatal abstractions

Disease, death, and capitalist abstraction

There are effective vaccines for COVID-19 and effective treatments for HIV/AIDS, but both remain global epidemics. Medical researcher Sam Friedman explains how the profit system offers life-saving medicines to some of us while keeping them out of reach for others.

Capitalism is a system that creates and runs on real abstractions. This brief article is about what this means in the context of two pandemics—first HIV/AIDS, then COVID-19. The most visible of these real abstractions are money and profits. Money is the generalized, abstract form of value (which is another real abstraction, but one which I won’t go into here.) Money is real—you can buy fruit, nuts, medicines, or bombs with it. It is abstract also—in itself, it is nothing but a pretty useless coin or piece of paper, or more usually, in terms of where most of the dollars “live,” just a record on some electronic balance sheet.

Profit is also a real abstraction. It is abstract—nothing but the difference between money costs and intake on some balance sheet. But it is real—companies that make adequate profits eat companies that do not; and people who live off of profits (whether due to ownership of capital or being top executives) eat very much better than you or I.

In Capital, Marx wrote “Accumulate, accumulate! This is Moses and the Prophets!” This is both a beautiful pun on “profits” and reflects the abstract fact that the net worth of a capitalist firm is equal to its accumulated profits. More importantly, it points to the force that drives capitalism and its firms—the need to accumulate profits lest they be eaten by other firms or simply disappear.

Disease, death, and profits

I have worked as an AIDS researcher from 1983 until now, and have done some work on COVID-19 as well. In addition to being employed as a researcher, I have also been somewhat of an activist and a socialist commentator on various aspects of the struggles around them.

What I have learned is simple: Capitalism kills! It kills even when it seems to do good, as when capitalist companies—based heavily on research that the National Institutes of Health paid for—created antiretroviral therapy, which now keeps most patients with HIV alive and healthy for decades, and the COVID vaccines, which at least reduce the damage that infection does to the body. The fact that only profitable firms survive and the resulting drive to “accumulate, accumulate” means that these scientific miracles do not reach many of the people who need them. That is, capitalism kills these people by denying them the medicines they need to stay alive. In spite of the success of antiretroviral therapy, approximately 650,000 people died from AIDS in 2021. Most of them are in countries where the pharmaceutical companies have priced the medicines at rates few can afford, although even in the poorest countries, the rulers and business owners usually can afford the medicines and thus live much longer than the infected poor.

Two images are photoshopped together. The left image is a photo of a masked health practitioner, wearing a medical jacket and surgical gloves, injecting a vaccine into the exposed bicep of a masked man wearing a vest and button down shirt. In the background, a sign says ‘USAID.’ The right image is a graphic that says ‘THE CRISIS IS CAPITALISM.’ Behind the text is a pattern of repeating icons, one of a Covid-19 virus and the other of a cloud that says ‘CO2.’
The creation and distribution of COVID-19 vaccines are prioritized to make profit in capitalism. Photo Credit: U.S. Department of State (left) and Nicolas Lampert (right)

Access to antiretroviral therapy has been an issue that has received considerable attention over the last 25 years, including massive social struggles for access in South Africa starting in approximately 2000, and in some other countries that led to the rise and funding of the Global Fund to pay for treatment in poorer countries. Jennifer Chan provides a wonderful discussion of these struggles in the 2015 book Politics in the Corridor of Dying. As a UNAIDS document put in in 2021,

Civil society activism and competition from manufacturers of generic drugs drove down the prices of antiretroviral medicines from about US$ 14 000 per person per year for first-line regimens in high-income countries in 1990 to about US$ 1200 per year in low- and middle-income countries in 2003. By 2018, the price per person per year in sub-Saharan Africa was under US$ 100 for most fixed-dose combinations that include tenofovir. The prices of other fixed-dose combinations also have continued to decline over the past few years.

Since Chan’s book was written, and in spite of these decreases in prices, there have been increasing shortfalls in the provision of international assistance to pay for such therapy in the Global South. The shortfalls have arisen from budgetary pressures due to the economic problems of capitalism, from the COVID-19 pandemic, and because of declining interest on the part of the powerful. This means that people are dying, and the virus is more able to spread, since fewer people are being treated than otherwise would be. Throughout these struggles, the United States has led efforts to protect “intellectual property rights”—that is, the right of corporations to charge whatever they like for medications without fearing competition.

The situation with COVID is more complicated because the vaccines that have been developed so far are less effective at protecting people than antiretroviral therapy is for keeping alive those people who can afford it. Nonetheless, the vaccines that exist do reduce the chance of death, albeit by varying rates for different vaccines and different strains.

Similarly to the situation with AIDS, the companies that produce the most effective vaccines have priced them too high for many countries to afford. Efforts to subsidize vaccine access have been organized, but have raised far too little funding to cover even initial vaccination in many countries. (For comparisons of vaccination rates by region and country, see the World Health Organization’s coronavirus vaccination dashboard.)

As I write this, almost 2,000 people worldwide are dying of COVID-19 each day—which is probably an undercount, so COVID deaths this year are similar to those from AIDS. They would be much higher without the vaccines—and much lower if everyone had access to the vaccines. And again, governments of the United States and Europe have held up global vaccine distribution by defending intellectual property rights and companies’ right to make huge profits. And profits they make! For example, Pfizer was a well-established pharmaceutical company making hefty profits before COVID-19 arose. Yet here is what happened to its net earnings during 2019 (the year before COVID became a pandemic), 2020 (when the pandemic affected business worldwide), and then in 2021 and 2022 as Pfizer profited from its COVID-19 vaccine:

Pfizer net earnings by year (in billions of U.S. dollars)

2019 16

2020 9

2021 22

2022 30

Source: Macrotrends (accessed November 28, 2022)

In short, this single product contributed heavily to doubling Pfizer’s profits over a two year period. Moderna, the other initial maker of mRNA COVID-19 vaccines, began to make a profit only with this vaccine, and went from zero to approximately $12 billion for 2021 and similarly for 2022, according to the investor site Macrotrends (accessed November 28, 2022)

The same points apply to the obscene prices of hepatitis C medicines and much else.


Abstractions like money and profits are all too real in their effects. They drive corporations and governments to make them their priorities. And this kills people every day in massive numbers. Although it is not the subject of this paper, capital’s need for profits drives fossil fuel production and use, the building of massive stadiums and business properties, and the destruction of tropical forests in the Amazon Basin and Indonesia (and elsewhere). That is, these abstractions drive climate change and the impending deaths of many millions of people each year from excessive heat, drought, hurricanes, and other effects thereof.

We can end these fatal abstractions and build a new world where people can live in peace with the planet and protect themselves from disease. This would have to be a socialist world, where people produce things for human use—and health—not for profit.

Featured Image credit: DFID – UK Department for International Development; modified by Tempest.

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Samuel R. Friedman is a lifelong social activist and long-time socialist. His writings on social justice topics include about 50 publications on workers’ movements, how we might create socialism, political economy, racism or social movements—including Teamster Rank and File (Columbia University Press, 1982) and What happened in Ukraine (2015). He currently is a research professor of Population Health at a leading New York university and previously the Director of the Institute for Infectious Disease Research at National Development and Research Institutes in New York. He has published two books of poetry (most recently A Precious Residue: Poems that Ponder Efforts to Spark a Working-Class Socialism in the 1970s and After, as well as several chapbooks and many individual poems. He is the author of over 500 publications on HIV, COVID-19, STI and drug use epidemiology, prevention, and harm reduction. He is a member of the Tempest Collective, Jewish Voice for Peace, the Central Jersey Coalition against Endless War, the People’s CDC, and the Ukraine Solidarity Network. He can be reached at