Are Biomedical and Neoliberal

Responses to COVID-19 Good

Enough?
COVID-19 has broken the supply chain and institutional orders. Trust deficit between nations
and global institutions makes it further difficult to work in this fragmented world. In the
current situation, can we really afford to trust anyone blindly? Can we trust medical experts
because they are experts? Can we trust our governments because they claim to be working in
our interest? Or, can we trust the companies building much necessary infrastructures, such as
ventilators, hospitals, care centers etc., in such times? In manipulating the data, governments
may have their own share which Donald Trump made very clear with his statement “if we
stop testing right now, we'd have very few cases”. Similarly drug developing companies,
medical experts, vaccine and ventilator making companies may also have their economic
interests. All of them are motivated by their own interests and hence, people need to decide
very wisely on what to select and what to reject.

The responses to the crisis coming from all the corners, corporate or government, need to be
scrutinized before accepting them: how we respond in the end determines the result of our
response. It is thus important that not only we respond but also try to understand and improve
on how we respond. The world we live in constantly shapes and gets shaped by ideas. To
know our current situation, therefore, we must know the ideas that shape our actions and
policies and to understand them, we need to understand the popular discourses1 in which they
have been constructed.

1
Discourses, as we call them, are sets of ‘language in practice’ that define our thoughts, practices, and
even our identities. They are capable of legitimizing certain sets of knowledge while devaluing others.
They also shape what is regarded as 'appropriate' ways of understanding and responding to various
needs. They are, as Parton argues, 'frameworks or grids of social organizations that make some actions
possible whilst precluding others.' This notion of discourse emphasizes it as something practiced by
society as a whole rather than individuals.
 Two major discourses, the biomedical and the neoliberal, have changed the whole world in
recent times. The biomedical discourse translates a concern into biomedical language and,
through this, assigns biomedical meaning and significance to the concern2, while the
neoliberal discourse tries to make human beings accountable for their predicaments and
circumstances instead of looking at the larger structural and institutional forces3.

Biomedical discourse shaping our responses to COVID-19

The biomedical discourse relies on modifying the person, assuming any difficulty to be lying
in the individual's deviation from 'normal' rather than in the lack of an accommodative
environment. Disease and other malaises, according to this argument, are deviations from
normal biological functioning and thus, biological testing and intervention focus on
addressing these deviations and correcting them.4

This is illustrated very well in the fact that the governments have argued against community
testing. It has to be understood that COVID-19 has not affected us at individual levels but at
a mass level and thus the governments should have done extensive testing in a decentralized
fashion to control this pandemic effectively. Instead of doing that, most countries relied on
individual testing, except for a few like Germany, Italy & South Korea5.

Medicalization6 of non-medical problems pose another great challenge for all of us to deal
with. The Coronavirus has taken this to a further extent when many misappropriately
associated physical and ethnic traits with a particular disease. American president Donald
Trump and few others calling the Coronavirus a Chinese virus is just an example of this.
Another example is when Medicalization is being mixed with racism to put people from

2
Sointu, E. (2016). Discourse, affect and affliction. The Sociological Review, 64(2), 312-328.
https://doi.org/10.1111/1467-954X.12334
3
Wilson, B. (2007). Social justice and neoliberal discourse. Southeastern Geographer, 47(1), 97-100.
Retrieved from http://www.jstor.org/stable/26222262
4
https://www.ukessays.com/essays/sociology/the-biomedical-model-of-health.php
5

https://www.theguardian.com/world/2020/apr/02/coronavirus-testing-how-some-countries-germany-south-
korea-got-ahead-of-the-rest
6
It is when a non-medical problem is explained in medical terms
 north-eastern states of India in more vulnerable positions of getting attacked and humiliated
throughout the country.7

Neutral ventilators and vaccines?

Meanwhile, the recent race of companies towards making ventilators points us to the very
same fact. Formula One racing teams have also joined the effort.8 Dyson, a vacuum cleaner
company, has already received an order for 10,000 ventilators. But this is what Maurico Toro,
a Colombian engineer who was part of a group that completed three different designs of
open-source ventilators, has said about developing ventilators: “If they fail, the patient is
very likely to die. This is what makes them so challenging to build.”9 So the question arises,
can anyone without any experience in the medical sector be granted permission to
manufacture such critical products?

Similarly, the level at which the development of drugs, test kits and vaccines is focused upon
by the world needs appreciation. But this should not become the reason for ignorance
towards the harassment done against people with meagre resources in the name of clinical
trials10. In many instances it has been found, how in the name of charity, drug development
companies get people to agree to clinical trials. By providing little support, people are made
obliged to go under trial who otherwise might not have undergone, seeing the risks involved.
11

“Medicine is a scientifically neutral enterprise” does in no way mean that it is also a socially
or politically neutral enterprise.12 There are a lot of examples of abuses of medicine. There
have been incidents where generic medicine manufacturers have ignored the quality and

7
Reports of people spitting on the face of a student in Delhi and expelling paying guests out in Hyderabad
tell how disastrous it becomes when medicalization of racism occurs.
8

https://www.indiatoday.in/business/story/britain-ventilators-f1-aerospace-consortium-1661271-2020-03-30
9
https://www.bbc.com/future/article/20200401-covid-19-the-race-to-build-coronavirus-ventilators
10
Clinical trials are research studies performed in people that are aimed at evaluating a medical, surgical,
or behavioral intervention. https://www.nia.nih.gov/health/what-are-clinical-trials-and-studies
11
Indian example of unethical clinical trials:
https://www.thenational.ae/world/asia/thousands-of-indians-die-in-unethical-clinical-trials-1.770992
12
https://literaryyard.com/2019/08/13/is-medicine-neutral-and-universal/
 instead focused on their profits.13 The economic and political interests of a few people can
manipulate the medicines to harm the broader social interest.

Hegemony of medicine

The hegemonic view of seeing vaccines as the only solution14 also arises out of the
biomedical discourse, which gives expert status to the doctors and other medical
professionals. Their expert status gives them the power to define and lead intervention
efforts. It is based on the view that doctors and pharmacologists know the best of an
individual's health conditions. Even if they know it best, what is the guarantee that they will
act for the best of people and not for their own profits? The fine line of knowing best gets
crossed, and acting best in the interest of people becomes the rhetoric as a result of the notion
that experts can't be questioned. These questions are necessary not because they will give an
answer but because they can hold those in authority responsible.

The biomedical discourse, thus, suggests the universal nature of the diseases, forgetting that
responses can never be universally the same. There are many social and cultural differences
based upon the regions which shape the responses. During India's former prime minister,
Indira Gandhi’s time, the mass-sterilization program15 had been responded to with hostility.
Even polio vaccination programs were thought to be sterilization programs, and people
became hostile towards the health workers. Considering the diverse impact of the
coronavirus on different people, including both symptomatic and asymptomatic people, and
on people of different ages, vaccinating everyone might be questioned. All these aspects need
to be considered while dealing with the virus.

Then again, use of certain terms may be problematic in light of an already happening crisis.
While talking about identifying the human protein with which the virus interacts, medical

13

https://www.npr.org/sections/health-shots/2019/05/12/722216512/bottle-of-lies-exposes-the-dark-side-of-t
he-generic-drug-boom
14

https://www.hindustantimes.com/world-news/covid-19-vaccine-only-solution-but-may-never-be-found-war
ns-uk-pm-johnson/story-GnM5oHPadC5lHntOSm2E8I.html
15
https://www.bbc.com/news/world-asia-india-30040790
 practitioners and researchers have been using the phrase “targeting host factors”. The target
word is used for describing an area that has to be attacked. Practitioners of social work need
to be extra careful while using such terms. It can be taken otherwise very easily by persons
outside the medical field.

One more thing that needs attention here is the interplay of biomedical and neoliberal
discourses that has led to the ineffectiveness of the public healthcare system. The biomedical
discourse followed the neoliberal argument of spending less on health services, perceiving
health to be an individual's responsibility16. Following this neoliberal argument, countries
across the globe have cut down their expenditure on public health. Now that they find it
impossible to conduct extensive testing, they are using the biomedical discourse again to hide
behind.

Neoliberal discourse shaping our responses to COVID-19

The neoliberal discourse17, as an extension of capitalism to save it, surged in the 1970s with a
re-emphasis on the economic principles of the free-market. Part of the neoliberal ideology is
that free-market concepts in health and social services bring better and cheaper services than
those by the government. This is an argument that legitimizes the privatization of welfare
service, thus letting governments cut the costs incurred on public healthcare expenditure.

The current discourse of universal vaccination gets its support from quasi-market concepts as
well. The quasi-market concepts are based on the consumer's limited capacity to pay. But
ridiculous is the fact that neoliberal discourse sees limited capacity to pay as an inability to
make choices and thus advocates for making decisions on a person's behalf. While educating
people about the benefits of the vaccine and assuring them completely free care, it should be
left upon them to decide whether they want vaccination or not. The word ‘consumer’ reveals

16
Section II: How has globalisation affected health in different countries (P. 18):
http://communityhealth.in/~commun26/wiki/images/7/7b/JSA_Globalisation_and_health.pdf
17
It has been defined by David Harvey as “a theory of political economic practices that proposes that
human well-being can best be advanced by liberating individual entrepreneurial freedoms and skills within
an institutional framework characterized by strong private property rights, free markets and free trade.
The role of the state is to create and preserve an institutional framework appropriate for such practices."
 the intention itself. Thinking of people in terms of consumers reduces their worth and goes
against the fundamental humanitarian principles which emphasizes the dignity and worth of
the individual.

The principle of taking decisions on behalf of its consumers is carried forward in

policy-making by the neoliberalists. It is argued that everyone acts in self-interest and it is
best to leave all the actors free. Thus, it is the duty of experts to design policies and programs
based on the principles of rationality and efficiency. The fact that bureaucrats, well-versed
policy planners or some academicians form this group of experts contradicts the values that
neoliberalists cherish, i.e. everyone acts in self-interest. If everyone acts in self-interest, so
will the service users, which means they should be leading the policy-making which is going
to impact them directly.

The past situation in India when migrant workers' demands to go back to their respective
villages were denied reiterates the above philosophy of neoliberalism. Delhi's government
pushed migrant workers out of the state while workers in Gujarat were not provided with
facilities to return for a very long period. In the name of the public good and knowing best in
workers' interests, the governments didn't facilitate their safe return which led to many
migrant workers walking back to their homes on foot. The neoliberal principles undermine
human dignity and freedom by putting forth arguments like “the government can do best for
its citizens”, limiting choices of individuals that can be exercised.

The popular notion now rings with social media, where these workers are seen as
problematic rather than with problems. Viewing workers as problematic associates the
problem with them and not the system, thus seeing police control measures as solutions. This
view goes in tandem with the social control policies18 of the neoliberal state.

Even as railways resumed partially to facilitate workers' return, it seems very difficult to
make it possible for all of the workers, who are huge in numbers. This has been exactly the
excuse of the government for why workers weren't sent home while foreign nationals were

18
http://www.ichrp.org/en/projects/126
 being airlifted back to their countries.19 But the question arises, can this excuse of the
government to wash off their hands be accepted? Is it not the responsibility of the
government to take care of every citizen? These excuses are to hide the face of a neoliberal
state according to which it is not the state's responsibility to take care of individual citizens.
So why did the state airlift Non-Resident Indians then? And can a community of migrant
workers be reduced to a group of individuals instead of a community entitled to be taken care
of by the state? The neoliberal ideology is to save private properties and thus, a certain class.
With this understanding, it becomes quite clear why Non-Resident Indians can be airlifted,
and migrant workers be left with their plight.

These are the same neoliberal principles guiding middle-class thinking, where tit-bits of
relief packages given to the poor are seen as a waste of public money. Sadly, this notion has
gotten into the thinking of the poor as well who think of it as 'freebies' too, instead of their
rightful share.

Neoliberalism shaping biomedical discourse

Neoliberal philosophies have shaped even the biomedical field. This is evident from the fact
that efficient, cost-effective propositions of neoliberalism resonate with the doctrines of
biomedicine today. Drug-discovery and production are all subject to cost-consideration.
Health care is also seen with managerial lenses. That's not to say that these practices have not
brought any good to the health care or social sector. But they have mostly negated the
relationship-based practices as inefficient. Health care has to deal with human history, along
with many other factors that impact the service users and these need relationship-based
practices.

The biomedical discourse also legitimizes the neoliberal principle of surveillance on which
many governments’ surveillance policies are based on. The Aarogya Setu app, developed by
the Indian government to tell people of the risk of coronavirus around them, requires a person

19
Indians being airlifted:
https://timesofindia.indiatimes.com/business/india-business/airlifting-indians-stranded-abroad-to-start-on-t
hursday/articleshow/75565475.cms
 to keep GPS and Bluetooth always on. A French hacker has listed a number of issues with
the application.20 The public is at greater risk of breach of their privacy. There has been
speculation of under-the-skin surveillance, which would mean regular medical check-ups, the
data of which will be monitored by the government. The current requirements shouldn't force
people to move in a submissive regime but shall give them the power of scientific knowledge
which they can utilize to monitor their health.

In this light, it is very interesting to see an argument21 explaining the dilemma faced by
medical professionals at such times. This argument comes from Victor Cheng, who is a
former consultant at Mckinsey & Company.

He argues that under normal circumstances, The US, and similarly most of the countries
prescribe to “do what is best for the patient,” but in case of Mass Casualty Incidents (MCI),
the guidelines change to “do the most good for the most people.” This has major implications
on who gets the support during MCI. MCI is a situation when the number of patients exceeds
the capacity to care for them. It thus happens that extremely severe patients are intentionally
not treated to provide the limited care-giving resources to those whose survival chances are
more.

The current situation is similar and it is difficult to provide all with the support. The
exponentially growing COVID-19 cases in Italy forced their healthcare system to ignore the
extremely ill and old age patients.

Towards the end, Cheng argues that while he was in his training phase, it was a very difficult
decision for him to take on whether to leave an extremely ill patient during MCI to support
those with higher chances of survival or to treat them with equal care. In a
resource-constrained environment, it forces healthcare workers not to treat a patient who may
consume too many resources or is not likely to survive even after the treatment. He further

20

https://www.thequint.com/tech-and-auto/tech-news/aarogya-setu-app-data-security-issue-raised-by-french
-hacker-elliot-alderson
21
Read the full argument here: https://www.caseinterview.com/coronavirus-hospital-bed
argues that death due to resource unavailability is a preventable death and we should not let
this happen.

When we look at how low capacity in terms of medical necessities pushes a professional
towards following MCI rules, it seems very important to allocate resources for building
capacities as well as for responding to the more immediate needs of people.

Let's take responsibility to face the crisis

This is not the dilemma of any single profession. Social workers are also facing a similar
dilemma where there are many people in need, but the capacity to address them falls short. It
will require efforts on both fronts to effectively deal with the issue. The shortage of
professionals in all the fields and necessary equipment needs to be addressed on one side, and
people affected by the coronavirus need to be given proper response on the other.

The above argument elaborating the dilemma comes from a management professional. He
might have limited himself to understanding the dilemma and allocating resources
accordingly. But social workers have a greater responsibility not just towards the people but
also the profession. They should take up the responsibility to reach out to all other
professionals with the values and principles which keep people-centric approach to the core
of it.

In such grave situations, we must revisit the discourses and create one which is more suitable
to the world’s needs. Elements of neoliberal and biomedical discourses that are good and
useful shall always be there in the new discourse but it must have a people-centric approach
in which all have the same dignity and value. This shall not be the discourse of one or a few
fields but of all the fields. Our economy, policies, laws, medical practices and all other
aspects of life should primarily be concerned for our lives.

In the light of this new discourse that we intend to create, we shall reshape our response to
the ongoing pandemic. It will not just change the way we engage with each other but will
also guide our practices. The long-awaited reforms in the subtler aspects of our lives, i.e.
popular discourses can be achieved if we think now with an open mind. This pandemic can
be taken as an opportunity to do away with what is not working for the world and come up
with something which is fresh and dynamic.