Public health emergency or opportunity to profit? The two faces of the COVID-19 pandemic

“Never let a good crisis go to waste”.¹ The exploitation of disasters by those in powerful positions is not a modern phenomenon. For centuries, multinational corporations have demonstrated a remarkable ability to turn the misfortunes of others into opportunities for lucrative gains. In the 17th century, the English and Dutch East India Companies, among others, were at the forefront of the European colonial expansion, seeking opportunities to exploit cheap labour and natural resources in foreign lands. Later, England's Royal African Company would provide the logistics that made the Atlantic slave trade possible. In the 20th century, World War 1 brought new opportunities. While arms traders were the obvious beneficiaries, tobacco manufacturers were not far behind. When General John J “Black Jack” Pershing, commander of US forces in World War 1, was asked what he needed to win the war, he replied “tobacco, as much as bullets”.² More recently, the Canadian writer Naomi Klein has coined the term “disaster capitalism”, describing how corporations have profited from natural disasters, such as the Indian Ocean tsunami or Hurricane Katrina, as well as military coups, political revolutions, and the US war on terror.³ As Klein documents, the short-term and longer-term interests of corporations and their political allies are often prioritised at time of crisis over the needs of the public, creating further crises and deepening social injustices.³ It was therefore no surprise that the 2020 COVID-19 pandemic would be seen as offering many such opportunities.

Reminiscent of Klein's accounts, corporations exploited weaknesses in government procurement, with many particularly concerning reports from the UK, as documented in detail in The New York Times.⁴ However, this was only the most visible form of egregious behaviour. Some corporations exploited the pandemic in other ways, seeking to bolster their credentials as good corporate citizens and secure policy responses that align with their interests. An initiative led by the NCD Alliance in collaboration with the SPECTRUM research consortium used crowdsourcing to identify many such examples.⁵ They described four ways in which corporations producing unhealthy commodities, including tobacco, alcohol, fossil fuels, infant formula, and ultra-processed food and drink, have taken advantage of the pandemic, based on submissions from more than 90 countries. These companies moved quickly to portray themselves and their products in a positive light, employing long-established but largely discredited corporate social responsibility (CSR) tactics.⁶ They also seized opportunities to forge links to governments, increasing scope for lobbying, and incorporated messaging on their contribution to the pandemic response into their marketing.⁵

On their own, many of the initiatives described by the NCD Alliance report are worthy, such as the provision of personal protective equipment and clean drinking water, but we cannot ignore how some of the corporations involved have, through decades of sophisticated marketing and political lobbying, undermined public health, contributing to the rising burden of non-communicable diseases that has resulted in excess COVID-19-related deaths and disability among disadvantaged groups. Just because they have done some good things when in the spotlight should not divert us from their efforts to undermine health policies when they are in the shade. Involvement in very visible CSR does not make a corporation socially responsible. To take one example, Coca-Cola has pursued many different CSR initiatives during the pandemic, including donations to support health systems and vulnerable populations, yet has expended considerable resources over many years to undermine efforts by WHO and the US Centers for Disease Control to tackle the global obesity epidemic.⁷

Looking ahead, some of these corporations are seeking opportunities in the Build Back Better agenda, working to influence those policies that respond to the widespread desire to create a better normal than what went before. Yet many of the pressing issues that we must tackle in a post-pandemic world, including the unequal burden of ill health and unequal access to safe and healthy living and working conditions, are at least in part a consequence of the drive by these corporations for deregulated environments. The culture of profit at any cost must give way to profit for purpose,⁸ based on shared prosperity for all, if a better and sustainable future is to be realised.

The COVID-19 pandemic was not the first global crisis of the 21st century and it will certainly not be the last. We must learn the lessons,⁹ especially with respect to the importance of reducing the burden of avoidable disease that rendered our societies so vulnerable this time. Health professionals have a crucial part to play in exposing the limitations of CSR and its underlying contradictions, while asking whose interests are ultimately served. They must be a strong voice in questioning why the gaps in core public services that corporations have filled existed in the first place, advocating for sustainable solutions that address the root causes of ill health and inequity and that help to build resilient societies. They must also speak out when they see conflicts of interest in partnerships with industry, highlighting the risks they pose to public trust. They must challenge revolving-door practices, whereby public sector staff move to lucrative posts in the private sector from where they can help to influence public policy. WHO once called on health professionals to counter the tactics of the tobacco industry as they seek to subvert public health.¹⁰ We must learn from that experience as we challenge all commercial interests that undermine our efforts to build a fairer and healthier world (panel ).

Panel. What must health professionals do to support Building Back Better?

Keep asking why some countries were unprepared for the pandemic, with many people living precarious lives, social safety nets torn, and public services weakened

Demand sustainable policies, backed by effective accountability mechanisms, to address the unequal burden of ill health, grounded in a health-in-all-policies approach

Welcome genuine contributions by industry, but always ask who benefits

Demand independent appraisal and monitoring of industry relationships, through transparent and accountable processes

Call out conflicts of interest that undermine public trust

Demand stricter scrutiny of revolving-door practices