Jaime Breilh* is a Latin American reference in critical epidemiology and the field of collective health. Professor and researcher, he questions the hegemonic ways of practicing medicine and science. He denounces “the dictatorship of scientific work” and the decades of domestication of academic thoughts. Far from anti-vaccine, he points out the risks of the new technologies used against coronavirus and calls to “break with the idea that the vaccine is the only salvation.” He proposes to target the causes of Covid-19 and assures that, for the post-pandemic, it is urgent to curb extractivism.
The name Jaime Breilh* is synonymous with critical epidemiology in Latin America. A reference in the field of collective health, this Ecuadorian professor and researcher is a tireless pedagogue of acute reflection on scientific practice and a critic of hegemonic medical practice. Although he has numerous academic credentials and the recent publication of his book Epidemiology and The Health of the People by Oxford University Press, Breilh is not rooted in the supposed superiority of the scientific voice, he calls for “leaving the dictatorship of the paper” and recognizing other non-hegemonic ways of thinking about health. In this vein, he calls attention to the deep structures of capitalism in order to realistically address the current pandemic world. “Not putting vaccines as a panacea,” denouncing the “infodemies of the hegemonic medical field,” and dismantling “decades of domestication of medical academies” are some of the key points he makes. His voice is an attempt to break through the increasingly narrow field of discussion between the denialists on the one hand and the pharmo-industry monoculture, a large part of governments and the mass media on the other.
A narrow vision, a reductionist approach
-How do you analyze the hegemonic approach to the pandemic?
-I see that thinking about the pandemic from the logic of causality has trapped us. If I approach this problem in a reductionist way, the pandemic will be a virus, vaccines, drugs, prevention, and individual etiology, contagion. And that is just the tip of the iceberg, just one part of the observable effects of a much more complex process. The first major link we have to make is between the pandemic and the agrifood system of capitalism in its 4.0 version, in terms of its ecological, health, and social impacts. At the heart of the pandemic is the agrifood system of capitalism. And so it must be said that there is no simple agriculture, no simple agri-food system, but rather a deep dispute over these categories of meaning, implications and practices that we must urgently discuss and bring into the health dialogue.
-You point to one type of form of agricultural and food production.
-First we have to start by distinguishing between agrarian models. There are two major production, political and social paradigms around agriculture. On the one hand, the agriculture of life, and on the other hand, the agriculture of corporations, the agriculture of business. And they are not compatible, they are antagonistic. Because there is one agriculture that is designed to defend, protect, and nourish the living social subject. And there is another that is based on greed and seeks to turn everything into a commodity, from human beings and labor power, to the genome, the land, the water. Everything is part of a structure of capital accumulation. It is the agri-food system of death, because it has profound consequences on human and non-human life, and we see this with the viral outbreaks that have been occurring in recent years, and with the vulnerability in the health of populations. We can no longer ignore this.
Looking at the whole, understanding the global syndemic
-In the critical field of health, it is said that we are experiencing a syndemic (synergy of several health problems with epidemic scope). How do you define this concept?
-It is true that we are in a syndemic long before the spread of Sars-CoV-2 (Covid-19). In other words, we are dealing with a confluence of several correlative and synergistic processes that reinforce each other, and the effect is more than the mere sum of these processes. My view of critical epidemiology is that the problem is not just viral and non-viral diseases, chronic diseases, mental health. That is one part of health, very important of course, but it is much more than that. The union processes go beyond that and we have to think about the structure. There we find a confluence of political, economic, social, ecological and cultural processes.
At the center of this is capitalism, whose capacity for concentration and destruction is unprecedented, with rampant growth of social inequality at explosive levels. This structure destroys the common good and produces large-scale exclusion from all that is necessary for a good human and non-human life.
-What other processes make up this syndemic?
-Another central point is the systematic accumulation of conditions of “pandemicity.” This is a globalized structure of an increasingly accelerated system to transform the minimal bases of ecosystem development. It is this structure that has caused the pandemics of recent years and those to come. It is impossible to continue thinking of viruses as a biological system with its logic, its adaptation processes, and the rhythms that it has historically had. If today we have an agro-industry that is generating conditions of animal massiveness with genetic uniformity, which is the basis for viral combination and mutation; an uncoordinated and uncontrolled vaccination system that will catapult the diversification of viral strains; and a social system where the neoliberal city and the neoliberal countryside are conducive to the concentration of a high viral load and a high load of vulnerable populations, we cannot think of viruses as something that flows naturally. This is the structural thing that needs to be understood.
– that is, the political dimension in the very spread of the virus must be made explicit.
-It is not about a virus acting according to the logic of a manual, because to talk about this would be to engage in the most perverse neo-Darwinism. To think that the virus is walking by its own dynamics, from its own genetic structure, and that it is seeking to mutate itself as in an experimental trial, is false. The virus is driven by a system of recomposing the relationship between humans and nature so brutal that the table is set for its reproduction.
-What role does the accelerating climate crisis play in this syndemic?
-With these drastic transformations, a fourth and central point of this syndemic is climate change. It seems that, as we are seeing with the floods, fires, glacier loss, sea acidification, and cyclones of late, we are facing very serious signs of a comprehensive environmental disorder that is giving its last warnings as it enters the point of no return. And this dimension not only cannot be left out when thinking about health from a critical and integral perspective, but must also be part of the approach to the pandemic.
Democratic information is health
-You criticized the hegemonic information on health approach. What is there to say about this?
-Here we have the fifth point of this syndemic, which is the misinformation that exists about an issue like this pandemic and that concerns the entire global population. And here I take a critical view of the discourses that have dominated the approach to health. At the time, the WHO (World Health Organization) talked about infodemics in terms of fake news and disinformation about the pandemic on social media. This is fine, but in the end, this is ridiculous compared to the pandemic of manipulated information exerted by the real corporate power around the virus. The world’s health care systems are structured around a mega infodemic system. The science of power works on all of this with data sophistication around the peak of the iceberg we mentioned earlier. That is, they talk about the effects of the virus, contacts, present multiplication systems, differential lethality rates. The most they manage is to say that in the United States the lethality of blacks and Latinos is higher than that of whites.
There is a dramatic misinformation where the information is not up to date and does not cover what is needed for a comprehensive approach. The structural aspects that we have been talking about as part of the health approach are totally absent. This information that dominates the discourse around the pandemic is not democratic, and is totally manipulated in favor of the big business interests of the pharmaceutical industry.
-What can you say about the “single truth” status that hegemonic medical science has acquired in the context of the pandemic?
-To understand this, we must first realize that we have endured decades of domestication of academic thought in health. A domestication based on positivist, Cartesian science, looking at reality in a fragmented way. The idea of sophistication in science is to be able to deal with bits of reality that are called variables, and thereby make complex formal systems, and thereby predict a probability or describe empirical behavior. But there, at that peak of the iceberg that we can know in detail, is not the essence of what is happening to us. There is a deep control over the functioning of the hegemonic research centers, which is very slowly beginning to crack. The other day in the Texas legislature, one of the great cardiologists in that hegemonic center of science said, “we are going crazy.” He asked, “How can we invest millions and millions just in a tool like a vaccine that is not even fully proven to be effective, and leave all the other basic questions unsolved?
-Is there room for dissident voices to this medical-hegemonic vision?
-In the Andean world and in other countries, many medical practices that break away from the hegemonic, peer-reviewed model have been persecuted. What is outside the hegemonic framework, such as the social practices of doctors working with communities and the knowledge of the communities themselves, is demonized. We are living the dictatorship of scientific work. What counts to qualify your voice as valid is how many papers you have written in high impact journals. There is no denying that there are some very valuable things in these journals, and many of us make an effort to write papers. But when we fall to that level, we should know that high-impact journals are not neutral. And in the end, what does the medical student, the resident physician, or the health care staff read? What is in the high-impact scientific journal. But knowledge is not just about that, far from it. The pandemic brought that to the fore. We have a plethora of fields to study from blind areas of science that are key to deep, real, consistent pandemic prevention. And this is not taken into account because it doesn’t fit the hegemonic logic.
-As you said, this approach cannot be separated from the capitalist command.
-You have to understand that medical science is controlled by a commercial logic, often disguised as scientific neutrality. That kind of irrationality rules in this world. The same is true for vaccines, which have been developed largely in a 9-to-1, 7-to-3, or 6-to-4 ratio between public and private funds. But we have no open source to know how they are made, and in any case to see how they are made elsewhere in a public way. This is crazy. Moreover, this same health care system is structured in much of the world to cause a high mortality rate among front-line health care workers, and the pandemic has shown this to be the case as well. Therefore, we cannot help but point out, review and change these aspects that denote a way of understanding health care as a business rather than a way of caring for life.
Besides the deniers and “scientific dogma”, other voices
-A critical point in this closing of the scientific debate is vaccination. What insight can you bring to this issue when the debate is simplified to vaccines or anti-vaccines in the face of such a delicate issue as caring for the fabric of life?
-First of all, the panacea of the vaccine as the great way, the only salvation, must be broken, even because the much-talked about herd immunity is an entheology. What is the classic herd immunity? If I have a measles epidemic, I have a certain vaccination coverage, a controlled number of contacts. This generates a stop or decrease until the contagion system disappears. Today there are several discussions about this possibility around this specific virus. Studies are already raising concerns that front-line staff in hospitals have been infected by vaccinees. There is accumulating evidence about this, at least from Pzifer vaccinees in the United States. The vaccinees themselves are being a source of contagion. The classic system of vaccinating the population and that’s it, it’s not clear that that’s what works now.
-We also talk generically about vaccines when in fact there are classical technologies, other new ones based on genetic modification and messenger RNA. What can you tell us about this?
-It should be clear that a vaccine, properly speaking, is an inactivated virus or an attenuated virus, period. In the case of classical vaccines, nothing has happened to your genetics, there is no introduction of an abnormal and artificial protein-producing code into your body, nor are we introducing or inoculating the instructions. We have to investigate what will happen in ten, fifteen, twenty years with these technologies, which I don’t call vaccines, but drugs that generate immunity based on an RNA-M genetic induction mechanism. We don’t know that today. And anyone who says they do is not giving a scientific fact.
–This kind of warning, which befits the scientific precautionary principle, is canceled out as “anti-vaccine.”
-Any research or warning about this is questioned by the centers that control these decisions. They are having to take advantage of the acceleration of vaccine sales and nothing can question it. All of this is not being debated, because the media has kept us on our toes about the latest developments of this or that vaccine. When we stop and think that we are not being able to debate this, it really feels like the world has gone mad, while the horsemen of the greed apocalypse are unleashed. That is the logic of the pandemic world, and that is what the academies should be questioning.
-And what is happening as a hegemonic practice in academia today?
-Most within universities are not even aware of this background, the uncertainty zones about some technologies, nor are they questioning all of this. They are just desperate to get a vaccine. And you don’t question that amidst the personal fear of suffering a severe case, but at the same time you shouldn’t stop discussing all these power structures that affect the scientific field. From the health sciences, we have to see what areas of uncertainty exist around transgenesis that could be dangerous in the future. Therefore, we have to be cautious with information. For example, we have to think carefully about what to do with young people and children who have not had serious cases. In any case, we must do something sequenced, highly monitored, in observation groups, in order to be able to make precise and very specific decisions.
Agro-ecology for the post-pandemic period
-What urgent policies do we need at this time?
-There needs to be a comprehensive proposal to get out of the pandemic, where I see agro-ecology as a very important tool. The fight for agroecology and the food systems of life, which replace agroindustrial extractivism, is a way out. We have to build policies to promote ecological production, quality rural employment, to give bonuses to those who take care of the environment, who don’t use agrochemicals, who don’t destroy ecosystems, who protect water. These are anti-pandemic policies.
-Organic agriculture as a key axis.
-I emphasize the promotion of the four S’s of life: Sustainability, Sovereignty, Solidarity, and integral (bio)Security. To get out of the pandemic cycles we have to create sustainable societies where agriculture undoubtedly plays a key role due to its implications on water use, land use, biodiversity, and social relations. This process must be sovereign, it cannot continue to depend on the logic imposed on us by large corporations. For this, we must cultivate solidarity at all levels as a fundamental political aspect in order to leave behind this patriarchal, racist, and classist society. And finally, the final security that we cannot omit as a project is that of life, and this depends on very concrete policies. For the post-pandemic, we urgently need a stop to extractivism, a ban on the massive use of pesticides, a ban on GMOs, and a ban on the massive production of animals and their high viral load. These are concrete examples of life-saving policies, and a true path of anti-pandemic organizing.