Socialism is the Best Medicine

Socialism is the Best Medicine

Class Conflict Over COVID

August 29, 2021


Over the 20th century, life expectancy rose and medical advances virtually eliminated deadly diseases such as smallpox, leprosy, and polio. We were assured that, in time, economic development and medical science would enable everyone to live longer, healthier lives. This has not happened: life expectancy is falling, old infectious diseases are resurfacing, and entirely new ones are emerging: HIV, Ebola, H1N1, and now COVID-19.

How can we explain this failure of modern medicine? What is driving the conflict over masking, distancing, vaccines, and mandates? And how can we end this pandemic?

Medical failure

Medical experts know what should be done to eradicate COVID-19. However, they cannot do it because medical systems are controlled by capitalists whose priority is profit.

To serve their profit-driven system, the capitalist class shaped modern medicine to be: ahistoric in disregarding the history and evolution of disease; reductionist in treating parts as separate from the whole; focused on treatment instead of prevention; nationalist in addressing only local pathologies; and militaristic in approaching disease as a battle to win.

In short, capitalist medicine is structured to ignore systemic factors that damage health, such as unsafe work, racism, pollution, poverty, and war. Instead, it does damage control, addressing problems after they occur and primarily on the individual and local levels. While this medical model serves the capitalist order politically and financially, it neither prevents disease nor promotes health.

Capitalist medicine responds to infectious disease with ‘magic bullets’ – a specific medicine or vaccine to combat each disease-causing organism. This approach proved ineffective decades before COVID-19.

Syphilis was widespread before penicillin was found to cure it. Now syphilis rates are rapidly rising as social conditions deteriorate. Tuberculosis and cholera are both curable, yet still kill millions of poor people every year. In agriculture, new and increasingly toxic chemicals are required to counter the resilience of unwanted organisms. In medicine, antibiotic resistance has become a global public health threat. If humanity is at war with disease, we are clearly losing.

It is possible to create health-promoting social conditions and design medical systems that address the social sources of sickness. However, neither is possible in a capitalist order hell-bent on profit.

Class conflict

Rapid, coordinated action from the start could have stopped COVID-19 from spreading. The systemic failure to do this has created conflict over what to do instead. This conflict is falsely presented as a dispute between those who ‘follow the science’ and those who reject it.

In reality, no one is following the science. Following the science would require a massive investment in public health and a commitment to international cooperation that cannot be achieved in a system of competing nations.

Nevertheless, all capitalists (with the possible exception of pandemic profiteers) want to end this pandemic in order to stabilize their economies. Unwilling to do what is required to actually end it, they quarrel over how to limit the damage, that is, how much to restrict the economy with social distancing and lock-downs, and how much to open the economy by pushing children back to school and adults back to work, even doing cost-benefit analyses to calculate how many deaths are acceptable before a lock-down is necessary.

Pressure to reduce the spread of infection and prevent medical-system collapse compels some officials to mandate masks, distancing, testing, and vaccines. Pressure to open the economy compels other officials to minimize the severity of the virus by refusing to mandate masks, distancing, testing, and vaccines. As UK Prime Minister Boris Johnson screamed after a second nation-wide lockdown, “No more fucking lockdowns – let the bodies pile high in their thousands.”

This conflict among capitalists results in contradictory messages regarding the danger of this disease and what, if anything, should be done to stop it. The result is mass confusion. As The New York Times concluded,

An evolving virus and 18 months of ever-changing pandemic messaging have left Americans angry, exhausted and skeptical of public health advice.

Divide and rule

Capitalists create social problems, then blame the working class for those problems. They create poverty, then blame it on ‘lazy people.’ They incite racism, then blame racialized people for failing to overcome their oppression. Having failed to stop COVID, they blame unvaccinated people for spreading the disease.

Capitalists control the mass media, so they can saturate society with their blame-and-shame messages. As a result, 80 percent of vaccinated Americans blame rising rates of infection on the unvaccinated, while the unvaccinated are more likely to blame infected travelers.

To their discredit, some progressives echo the blaming strategy of the ruling class, shaming unvaccinated workers for lacking class solidarity. Vaccination is an act of solidarity and a socially responsible choice. However, it must be a choice, not the result of capitalist bullying. And there can be no choice without the social supports that workers need to get vaccinated, such as childcare, sick pay, transportation, and time off work.

Blaming the unvaccinated for prolonging the pandemic is a mass deception.

The capitalist class are 100 percent responsible for this pandemic; they alone create the conditions for new viruses to emerge and spread; they alone are responsible for the lack of access to vaccines.

It is true that most COVID deaths are among the unvaccinated. Most of them live in nations with no access to a vaccine. In the US, a recent poll found that 77 percent of American adults have either taken the vaccine or are likely to do so. Fewer than 15 percent of Americans are opposed to the vaccine on principle.

The primary reason for low vaccination rates in the US and Canada is lack of access. To get the vaccine you need time off work to attend a clinic, transportation to a vaccination site, and childcare. Particularly disadvantaged are those who are unhoused or undocumented, or work multiple jobs or inconvenient shifts. One community clinic increased the local vaccination rate from 5.5 percent in April to 56.3 percent in May, simply by offering barrier-free vaccine clinics during evenings and weekends.

Unvaccinated people are more likely to have children at home, be food insecure, and struggle financially. A disproportionate number are people of color. Working-class people are less likely to be vaccinated than college graduates, and uninsured Americans have the lowest vaccination rate of all. According to one US survey, a lack of medical insurance contributes to more than 40 percent of all COVID-19 infections and one in every three COVID-19 deaths.

Instead of investing in a universal medical system or simply making COVID tests and vaccines more easily available and free of hidden fees, capitalists attack the unvaccinated, turning one section of workers against another, while absolving themselves of all responsibility.

The pandemic is magically reduced to a problem of unvaccinated individuals and not the result of unsafe work, crowded conditions, racism, homelessness, poverty, and capitalist greed. How convenient!

Vaccination mandates

Having convinced the public that unvaccinated people are responsible for prolonging the pandemic, capitalists push mandatory vaccination as the solution – making vaccination a condition of employment, returning to school, traveling, or attending public events. They would have us believe that universal vaccination is the key to ending COVID-19. As one person wrote,

When I was in second grade, a classmate evaded his polio shot for 15 minutes while a teacher and a nurse chased him down and finally made him take it. Should we have defended his bodily autonomy, even if that meant thousands more kids getting polio?

This is a false choice. Vaccines cannot end pandemics on their own. While anti-COVID vaccines are safe and effective, billions of people have no access. Any population that remains vulnerable to infection enables the virus to spread, mutate, and return to infect the vaccinated.

Even if every person on the planet were vaccinated, the pandemic would continue.

The effectiveness of all vaccines declines over time, so booster shots are necessary to maintain protection. Viral mutations, like the Delta variant, can develop resistance to vaccines, so more effective ones must be produced to counter them. Chasing a perpetually evolving virus with new vaccines is a failing strategy. Much more is needed.


It is a socialist principle that the needs of the many outweigh the needs of the few, meaning, the needs of the working class outweigh the needs of the capitalist class.

Capitalists have hijacked this principle to position themselves as the protectors of public safety and to justify imposing vaccination mandates. This cunning ploy has seduced progressives into supporting capitalist vaccine mandates and casting all who question or oppose these mandates as right-wing, anti-science, anti-vaxxers.

While it is true that right-wing forces vigorously oppose anti-COVID mandates on principle, they are a small portion of the unvaccinated. Most unvaccinated people are disadvantaged, fearful, distrusting, or confused members of the working class. In addition to the lack of vaccine access, many workers distrust a government that notoriously mismanages crises. Others distrust a profit-greedy pharmaceutical industry. And many have been harmed by past encounters with the medical system.

It is a grave mistake to side with capitalists against unvaccinated workers, instead of joining with them to hold the capitalist class accountable for prolonging the pandemic.

We cannot trust the capitalist class to protect us. They wage endless wars, refuse to end their fossil-fuel economy, support a brutal and racist police force, and abandon children, the elderly and disabled to devastating poverty.

We cannot trust governments to keep people safe. They fail to protect millions of people trapped in COVID-spreading jails, prisons, nursing homes, and other congregate settings. They pave the way for mass evictions. And no government demands that work be made safe. Instead, they accept workplace illness, injury, and death as the cost of doing business.

Employers are the destroyers of public health. They force people to work in COVID-spreading conditions because it is profitable to do so.

Workers know their employers care more about profit than health, and they rightly distrust management mandates that claim to be in their interests. A survey of nurses and nurse aids in France found that the more negatively workers felt about management, the less likely they were to get vaccinated. This is class anger – people naturally bristle against the dictates of those who treat them badly.

Nearly 60 US professional medical organizations have called for the mandatory vaccination of all medical workers, presumably, “to put patients first.”

Putting patients first has to mean more than vaccinating staff. It has to mean demanding medicare-for-all, nurse-to-patient ratios, and complete unionization of the medical workforce. Unionized nursing homes were found to have a 30 percent lower mortality rate from COVID compared with non-union facilities.

Massive investment is urgently needed in hospital systems to relieve severe understaffing and lack of equipment. The opposite is happening with plans to cut hospital budgets and nurses’ pay. Frustration over intolerable working conditions has exploded in a wave of nurses’ strikes across the US and Canada.

We’re working at half-staff basically. They don’t care that we’re short. They just keep loading us up and keep criticizing if you’re not moving fast enough. There is no appreciation. All those ‘healthcare heroes’ signs were garbage. We’re like healthcare suckers because they didn’t protect us.

The capitalist claim of protecting society has long been used to justify eugenic policies (to protect society from ‘degenerates’), forced psychiatric drugging (to protect society from ‘lunatics’), racist police (to protect society from ‘criminals’) and mass incarceration (to protect society from ‘undesirables’).

Under capitalism, ‘protecting society’ is code for protecting the wealth and power of the elite, regardless of the harm to everyone else.

Class power

Capitalists seize every opportunity to increase their power over the working class. Mandates give them more power and must be opposed on that basis.

Class power is a zero sum game; one class can gain power only at the expense of the other. Compromisers try to get around this fact by claiming one can hand power to the capitalist State and then limit or direct how it is used. As one Jacobin author stated,

It’s possible to oppose mandatory drug testing and non-consensual medical experiments while seeing vaccine mandates as a pragmatic solution to an exceptional and life-threatening crisis.

Instead of demanding that authorities implement proven measures to end the pandemic, these aspiring social managers justify capitalist mandates. For them, “The question is how to get as many jabs in arms as possible, as quickly as possible.”

No. The question is which side are you on.

Vaccination mandates are being used as a substitute for making school and work safe and financially supporting workers through the pandemic.

Where are the mandates we really need: sick-pay mandates, no-eviction mandates, status-for-all mandates, and safe-work and safe-school mandates?

Unions are divided over employer and State-imposed vaccination mandates. The President of the AFL-CIO declared his support, stating, “What we need to do now is to get more people vaccinated, and I think the mandate is a very acceptable way to do that.” The head of the American Federation of Teachers agreed, “ I think that we need to be working with our employers, not opposing them, on vaccine mandates.”

Other unions oppose vaccination mandates, including the American Postal Workers Union, transit unions, and 1199 SEIU (the largest healthcare union in the US), which states,

We believe that our members are best equipped to make the healthcare decisions that are right for their bodies and for their families. We have been promoting vaccination, but to make vaccination a condition of employment is absolutely wrong.

Worker mandates

Only workers should have the power to decide if vaccinating everyone at work is necessary for job safety. If they vote yes, then that is the same as voting yes to a strike; everyone must be vaccinated, with accommodations for those who cannot comply.

A vaccination mandate is easier to accept when it is decided by co-workers who are taking the same risks as you, unlike employer or State mandates that are decided by people who profit by making your life miserable.

Capitalists and their State cannot allow workers such decision-making power. If workers got to decide how to make work safe, they would do more than mandate vaccination. They would question the organization of their work, its purpose and social value, what it takes from them and what it gives them. They would dispense with profit as an obstacle to safe work. They would begin to construct a worker-run, socialist society.

Meantime or Revolution time?

Capitalists view vaccine mandates as their magic ticket to end masking and social distancing; reopen their economies; maintain health-damaging social conditions; acquire more power over the working class; and make a profit in the process.

Students will be forced into unsafe schools and workers into unsafe work. Future infections and deaths will be attributed to the unvaccinated or, in those who are vaccinated, to the lack of a booster shot. The toll in human suffering and death will be enormous.

Compromisers say, “That’s all well and good but, in the meantime, we need to get everyone vaccinated, and mandates will do that.”

Measures to lessen the impact of the virus, like measures to lessen the impact of climate change, can be likened to rearranging deck chairs on the Titanic. Some will survive, but the ship is still going down.

It is foolish to think we can be saved by giving more power to the same class that brought us here. As long as capitalists rule the world, COVID will continue to spread, the world economy will continue to falter, and millions more people will sicken and die, needlessly.

In a similar social crisis, Lenin was asked how the slaughter of World War I could be ended. He replied,

There is no easy way out of this terrible war. The war has been brought about by the ruling classes, and only a revolution of the working class can end it. Whatever sentimental things may be said, however much we may be told, “Let us end the war immediately,” the war which the capitalist governments have started can only be ended by a workers’ revolution.

The same can be said about this pandemic.



  1. Once again a brilliant one. This distillation of the current state of play in North America offers us access to the primary source materials underpinning the arguments advanced for the working class, around the world, to create the solutions together. Thank you Susan Rosenthal

  2. Yes Susan, the whole world needs to be vaccinated. We in Rotary have done this with Polio (currently 2 cases in the world this year), vaccinated everyone. I agree with you that we must solve all the other problems as well, pay our health care workers, have more of them, provide them with masks and equipment. But I would not be arguing against vaccination.

    • I am all for vaccination. I oppose vaccination mandates that are imposed by those who refuse to invest in making schools and work safe.

  3. Yes, thank you Susan: a brilliantly reasoned and referenced revolutionary perspective. It combines the justified anger of a (small ‘a’) anarchist with the scientific precision of a (large ‘S’) socialist.

  4. There are abundant shortages in staffing on nursing units. Reliance on casual nursing staff to fill staffing gaps does not seem to be effective in the summer months. Regular staff are being forced to work overtime and being denied vacation time to fill slots. Meanwhile, new nurse graduates cannot get full-time positions and are being diverted into casual staffing positions. With casual staff denied benefits, this appears to save costs for the system. Meanwhile, regular nurses are being paid 2x to fill gaps and are getting burnt out perpetuating the staffing shortages. Why is this happening?

    • Yvonne: You identified the problem: hospitals are run as a business, and under-staffing saves them money.

      Organized nurses are fighting to raise the quality of care; however, it’s a problem when union leaders don’t trust front-line nurses to know what they need to do their job, and when they don’t build support for nurses’ demands within the labor movement and across the broader working class. We need to push them to do this, and also show them how it’s done.

      Health (and the means to achieve it) is the core of working-class struggle. It is the central issue from which all other issues flow. People need social support to function well, do meaningful things, and enjoy their lives. That is worth fighting for, and we really have no choice.

      Survival depends on us raising our expectations of what we can achieve together. We’ve been brainwashed into believing that we who actually do the work aren’t capable of organizing it. In reality, the manager class block our initiatives because they fear losing control to people they see as less competent. Their social role is to limit our expectations, so we keep working to enrich the capitalist class.

      We need to call it like it is, and we need to change it.

  5. Wow! Inspiring directness. A tour de force. Let’s get it out there.

  6. According to John and Sonja McKinlay’s “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century,” all of the infectious childhood diseases were in steep decline and on their way out before any medical treatments of any kind, including vaccines, were developed. Sociologist Ivan Illich discovered the same thing in his book Medical Nemesis. They attribute the decline to better sanitation, nutrition and hygiene in the early 20th century.

    I’m a Marxist (who has no health insurance) and I’ll be losing my healthcare-related job on October 1st here in California because I won’t be vaccinated — ever. Millions of other Americans won’t be vaccinated either. We will get along. Neither Gates nor Fauci nor capitalist politicians nor the pharma-captured media will work their will on us. Very quickly the thrice vaccinated will be hating and vilifying the twice vaccinated. That’s where this madness is going.

    “Solidarity is the best medicine”? Nobody is in solidarity with me who thinks it’s ok to throw me out of a job and vaccinate me against my will.

  7. Dear Susan,
    Thank you for this brilliant and nuanced article (and for your many other writings which I love).

    I support a hundred percent the argument that capitalism is bad for human well-being/health as well as environmental health. What is good for profit is detrimental to human physical and psychological well being. This explains why we’ve been seeing for example governments reluctant to order gyms, bars, and stripclubs to close down even with Covid case counts through the roof – it would hurt profits and they would have to provide income replacement for the unemployed.

    Another example, in Canada the College of Physicians has prohibited doctors from issuing accommodation letters for patients with pre-existing medical conditions that place them at high risk of contracting Covid and dying from it. When patients ask for such a letter in order to get accommodation from their employer, doctors state that their condition cannot be a basis to be exempted from working with the public in the context of the pandemic. So I strongly support all the arguments you’ve presented here.

    I do have a bit of a gentle objection to the question of vaccines. Vaccines are a tool of prevention which in turn is a principle of a socialist medicine – oriented towards prevention. The fact that capitalist states are encouraging vaccinations, doesn’t change the fact that vaccines can save lives. The fact that big pharma is making billions in profits from the vaccines, again does not change the fact that we need vaccines. The house building industry is also a billion dollar industry, but we are not going to reject the idea of housing. What we can do is advocate for affordable/social housing but not reject housing all together.

    Now, as far as the opposition to vaccines. I think that the majority of people who are unvaccinated, are not unvaccinated due to not having time or access to the vaccine. It is due to distrust or fear, a lot of which is driven by social media (which in fact has proven to be for the most part a very convenient and useful distractor from class struggle).

    I totally agree, that vaccines alone will not eliminate the virus and that we need better work places, more resources in health care, etc. But perhaps, workers who are opposing the vaccines for this reason, should put this as a condition – we will get vaccinated after you commit to X,Y,Z for instance. But for now, I have not seen such an argument on the part of those refusing to get vaccinated. Rather, the argument I hear is “my body my choice”, “it’s my freedom” etc. – argument that really reflects the individualistic egoistic/ self-centred psyche that capitalism produces – the kind of subjectivity that is perfectly suitable for the capitalist logic – to think individualistically and not collectively; to believe that your well-being is disconnected from other’s well-being. This is why I continue to see vaccine hesitancy and Covid denials as by-products of capitalist socialization, even if capitalist states are now criticizing the unvaccinated. I hope this makes sense. Thank you again for your important work!

    • Jasmin – Vaccines are both vital medicines and political tools, and we need to be clear on the distinction. Governments are not acting in the public interest by mandating vaccines. They are using vaccine mandates as a political tool to avoid enacting the entire spectrum of social measures required to stop this disease.

      Governments could mandate an end to all profit-taking in medicine. They could compel employers to make work safe, accommodate vulnerable workers, and pay sick workers to stay home until fully recovered. They could mandate safe schools and an end to evictions. They could confiscate the wealth accumulated by pandemic profiteers and distribute it to the working class. Instead of mandating measures that could actually stop this pandemic, capitalists demand that workers get vaccinated to make them more ‘resilient’ to health-damaging conditions.

      Workers are right to distrust governments that protect employers while forcing them to “live with the virus.” People without social power still have the personal power to say NO. The remedy is not to remove their last vestige of power but to ensure they have the social power to protect themselves where it counts – at work.

      We can and should support vaccination, without supporting mandates that give the oppressors more power over our lives and divert attention from their own miserable failure to protect anything but their profits and their system.

  8. Hi Susan,

    I just found this blog after reading The Red Deal. Your blog post “Capitalism must die to protect the sacred” was the only commentary that I could find from Canada about it. Thank you so much for that post. It was very informative. The one point made on that you make on that post is that Indigenous people need the support of other oppressed groups to defeat capitalism. You suggest that the working class could could be a group that alliance could be made with. I’m sure you’ve seen the Truck Convoy movement to Ottawa. I’m just wondering if these are the kind of people that alliances with Indigenous people and their struggle could be made with?

    • Good question, Josh. The Truck Convoy is largely composed of far-right individuals egged on by capitalists and their media who want to lift all restrictions that disrupt the flow of profit. They do not represent the views of most workers who support public health measures to stop the pandemic.

      It’s true that people are fed up with repeated bouts of restrictions that don’t work because they are applied in an inconsistent manner. The right-wing response is to sacrifice public health to the needs of businesses and individuals. The left-wing response is to prioritize public health and demand a truly effective response, regardless of the impact on profits.

      In the absence of a real left alternative, some workers will be drawn to the right. However, right-wing strategies can’t end the pandemic, and workers need it to end because they suffer the bulk of sickness, death, and job loss.

      Workers and Indigenous people are natural allies because they are both oppressed by the capitalist system. Capitalists expend a great deal of effort to divide oppressed groups and turn them against each other. If they didn’t, their system would be overthrown. It is our job to clarify how workers and Indigenous people would benefit by joining forces against their common enemy – capitalist rule.


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