Made the first start on joint article on COVID and neoliberalism today, building on the CUP book proposal. We take the tack that beneath proliferating viral metaphors about neoliberalism and health and society over recent decades, there lies something fundamentally true about how it colonises different areas of global life and takes them over. The COVID piece will argue that this has now gone beyond metaphor, and that neoliberalism and COVID have proven a deathly pairing, the former multiplying effects of the latter.

News is full of revisions to or questions about true death rates from COVID-19. NY Times publishes an 11 country study that charts some 26,000 missing deaths, statistical anomalies that couch a far higher death toll than is being recorded. It is what Jenny Edkins describes as the disappeared of this crisis.

In one piece of terrible news some of the earliest fears of stretched supply chains in the world of medicines seem about to be realised. It resonates with the SPERI blog that we are just finishing on much the same. A senior civil servant in the Indian ministry of health writes a letter expressing the likelihood of India export banning anti-TB treatments, all due to shortages of personnel and lack of Active Pharmaceutical Ingredients (API). It seems that despite early bluster about Indian self-sufficiency in APIs, they are after all heavily dependent on China. They are prioritising their own domestic TB patients, which stand in the 400,000s per annum. With much of the rest of the world’s TB infected reliant on Indian generics, for first line at least, the stock outs will not be a good story for them or those they infect. Furthermore, it is reported that Baddi in HP state is now a containment zone. It is the home of a pharma hub with some 50 firms no doubt pumping out a range of essential medicines for the domestic and global market. Many of these firms have been forced to close due to the shortages above. As with PPE, gloves and ventilators, this crisis is exposing the parlous state of stretched supply chains for essential technologies and meds. What is breaking apart in India is, of course, the model that has supplied global generics at least since the early 1990s response to HIV with ART. We have become dependent on India for cheap generics and India is dependent on China for the raw materials to make them. It is clearly a system of neglect however well it has served. Foreign Policy carries a piece that seems to express some of this, though I confess it is in a pile on the floor unread.

The Washington Post carries a piece on conditions in US prison factories, with many inmates producing PPE in crowded conditions and lines. They are clearly being imperilled in these circumstances, and early outbreaks in jails such as Riker’s have gone eerily quiet. I am sure it is not a good story, and one of many I need to follow up. More widely, the USA continues its weird dissolution. I sent out one report which claims it is a failed state, this underscored by the Justice Department preparing to sue states with strong measures in place to mitigate the virus. This as the governor of Georgia announced yesterday the state would re-open on Friday. Lunacy. Medical staff are starting to file class actions at their conditions and lack of equipment; Trump announces suspension of immigration to protect Americans’ seeking jobs. It is a circus of gigantic proportions.

The virus has now infected 2.5 million globally and there have been 170,000 official deaths. It is now marching into Africa and other LMICs and some modellers anticipate 1 billion infections in Africa alone. The South African response, however, has been aggressive, and I really hope it makes a difference there. Yet DRC has also a new Ebola outbreak, and the double burden of COVID and that disease will be very hard to put a lid on. It is all quite distressing and depressing.

In the UK, the decision not to join the joint EU purchasing scheme has now been exposed as a political decision, a Brexit stance. Whatever the opinion on Brexit, this is just too stupid and careless to defend. To add to the charged atmosphere it is clear now that the government repeatedly lied about the basis of the decision, and has lied about PPE purchases and a whole raft of other botched attempt to organise. It seems clear that the cabinet is in complete disarray, they public give different versions of events in one day, and cannot even get their lies straight. In perhaps more positive news, the Oxford vaccine is being rushed into trials on humans, thus evading a whole host of trials and safety and regulatory barriers. People should realise the attrition with vaccines, with successes rare.

Finally, will be expecting contributions on Singapore later this week with the new outbreak being pinned on the migrant workers who live in the city’s overcrowded boarding houses, often many to a room. There is also a stark warning on the next COVID knock-on, a famine ‘of biblical proportions’ warns the WFP. It seems that the food system supply chains are breaking down as well.