It is vitally important that people of the world recognize how public health policy in many nations has been harnessed to global markets. Instead of serving those at risk of sickness and death, these policies of financialization are constructed to benefit social impact investors. Transnational global capital demands the creation of new investment products to circulate the holdings of billionaires and further concentrate their wealth. This program continues to advance even as poverty rates skyrocket under conditions of economic lockdown. Social impact finance is the centerpiece of this new era of “stakeholder capitalism,” which was launched with great fanfare in Davos this January.
Data-driven “pay for success” deals are structured around the United Nations Sustainable Development Goals (UN SDGs). “Health” is goal number three. The World Bank has played a role in creating new investment products aligned to the UN SDGs. You can read more about the UN SDG financial apparatus here.
“Pay for success” finance is a performance-based contracting system that has been applied to a wide range of social issues ranging from pre-k, mental health and elder-care services to workforce training and supportive housing. It clear to me that “pandemic preparedness” is being fitted out for pay for success profit-taking, too.
The “pay for success” finance model works as follows:
1. Identify a social problem. In this case the possibility of a pandemic.
2. Get an academic institution or think tank to cost out the problem as a negative externality. Remember, the more expensive the problem, the bigger the potential profit from preemptively “fixing” it.
3. Establish an equation that fixes a rate of return for “evidence-based” “solutions.”
4. Select the type of data, the parameters, that determine “success” for the deal.
5. Set up infrastructure to track the data and provide “evidence” of success.
6. Identify partners – service provider, investors, and project oversight.
7. Deliver the services and collect the data.
8. After a third party determines if success metrics were met, performance payments are issued to investors (or not).
If you want a more extensive overview, see this post.
In 2018, the World Bank and the World Health Organization partnered on an initiative called the Global Preparedness Monitoring Board. Its task is to oversee member nations and identify pandemic preparedness “gaps.” Gaps is a red flag for technocracy. Once a social problem is turned into data, it can be put onto a dashboard and twisted to serve the needs of global markets. The “gap” between the data as it currently is and that which is desirable allows public services and resources to be placed under the control of systems engineers, technocrats. The following excerpt is taken from a paper prepared by the Johns Hopkins Center for Health Security in 2019. It speaks to the desire for data to “motivate” and “measure.”
Source: Preparedness for a High-Impact Respiratory Pathogen Pademic, Johns Hopkins Center for Health Security, September 2019
Narrowing the “gap” justifies private profit taking. Dashboard managers are incentivized to modulate the “gaps, but never close them. The pay for success model is based on tightening gaps, but just a little.
Problems that have wide gaps and can be tightened up pretty easily are more attractive investments than intractable problems where the gap is narrow. In the case of pay for success, the worse the problem, the better your chances are to show “improvement.” Start from a terrible baseline and demonstrating growth is easier.
The terrible reality of this market is that it is built and sustained on misery. Thus, if profit is made, more misery is needed in order to grow returns. There is no profit for investors in addressing the structural nature of social problems. Plus, real solutions can’t be shoe-horned onto a dashboard anyway. Those in power set up the deals, and the deals are structured to favor those in power. Imagine that.
Interactive model of map above can be accessed here.
In 2017, through the Pandemic Emergency Financing Committee, the World Bank issued the first pandemic bonds in response to the 2014 Ebola epidemic. While at first glance that may seem like a humane gesture, the truth is that the bonds were structured in such a way that it is almost impossible to trigger the payouts public health systems need to respond to disease outbreaks.
Neither the Ebola nor the Covid-19 pandemic bonds have disbursed ANY proceeds to governments; meanwhile, these instruments of “innovative finance” have generated $100+ million in returns for private investors.
If you want to take a deeper dive, I recommend Susan Erikson’s paper, “Faking Global Health” published last June in Critical Public Health Journal. Her exploration of how “health innovation” and “health finance” advance superficial techno-solutions that generate profit for some but never structurally address public health problems matches up perfectly with my own experience regarding the privatization of public education.
Erikson speaks directly to the ways in which data can be manipulated to preference certain outcomes and how harmful consequences can arise when “success” becomes tied to narrow impact metrics.
What are the consequences of large sums of money riding on death statistics?
What happens when in order to access healthcare funds, governments must allow a certain “death rate” to be attained?
HUGE ethical concerns have arisen in the three years since these bonds were issued, and yes it appears with the entrance of Covid-19 the World Bank expects the market for these bonds to grow.
Source: Faking Global Health, Susan Erikson, Critical Public Health Journal, June 2019
In September 2019, a month before Event 201, the Global Preparedness Monitoring Board published a compilation of white papers titled A World At Risk. That document lays out numerous “progress indicators” of the type that could be used to set up scoring rubrics tied to pay-for-performance contracting.
In the screenshot below you see how the World Bank is setting up this program noting a potential 10 to 1 return on investment and the high costs of not taking action. The next image shows economic impacts of the 2014-16 Ebola outbreak.
Source: World At Risk, 2019 Annual Report, Global Preparedness Monitoring Board
The numbers in World At Risk build off a 2012 study, People, Pathogens and Our Planet Volume 2: The Economics of One Health. That document actually posits a 44 to 71 annual rate of return, which is totally unbelievable. The One Health approach, which I think we will be hearing more about in the coming years, addresses vulnerabilities around zoonotic disease, situations where pathogens jump from animals to humans. This type of transmission is increasingly linked to human encroachment into wilderness areas for the purposes of resource extraction and development.
During this pandemic, we have seen a growing media push around One Health – the idea that the world is a better place without humans getting in the way; that Earth is healing itself in our absence. This easily-consumed, “feel-good” content could become very dangerous if deployed with eco-fascist intent to remove people who are indigenous to their lands from them for the sake of “conservation.”
The other point I want to raise is regarding how One Health will play in the finance realm. Pay for success deals are built on established cost-offsets that can be layered. The most attractive investments are those where one solution “fixes” multiple problems, because that allows investors to take profit across multiple channels.
So think about One Health. If you have an intervention that creates a documented impact on both human health and animal populations, you’re going to increase your rate of return. In that way pandemic bonds may end up coming out ahead of vaccine bonds in terms of investor interest. The ROI for human impact is not likely going equal the ROI for a double-dipped One Health “solution.”
Source: Investing In One Health, World Bank Policy Brief, January 2018.
The excerpt below is from a paper that lays out global investment strategies around emerging diseases. It was prepared for the World Health Organization in the fall of 2017 by researchers affiliated with the Duke Center for Global Health, the United States Agency for International Development, and the EcoHealth Alliance.
Source: A Framework For Stimulating Economic Investments To Prevent Emerging Diseases, Bulletin of the World Health Organization, 2018.
Take note of two important things: 1) public health has been placed under the jurisdiction of custodians who expect to get an “attractive return on investment” and 2) there is an expectation that the cost of inaction around disease mitigation will be quantified. Those costs include: reduced trade, financial market losses, food insecurity, impacts to agriculture, premature mortality, lost wages, and social order disruption.
So what are we to make of all this in light of what is happening around Covid-19?
Well, it is clear those in positions of power are prepping us for a future punctuated by repeated viral outbreaks.
Our national response has been horrible due to a combination of austerity, poor leadership, free market healthcare, and a shredded social safety net.
Health data is being weaponized and politicized.
The government continues to advance the financial interests of the elite over the masses.
There will be profound, almost incalculable, economic fall out from the lockdown.
As tragic as this is, it actually makes sense within the context of global markets. Pandemic finance is meant to be a growth sector, and market logic dictates a terrible first time out of the gate will guarantee “improvement” on future dashboard metrics.
Kind of like we were very ill-prepared this time, but next time around we promise to do somewhat better, so our investors get their payout; and remember the payouts are based on the negative externalities, and in this case go big or go home. By tanking the global economy, which was planned to jumpstart the Fourth Industrial Revolution and human capital investment markets anyway, those with an eye on pandemic markets maximized potential future profit.
For them it was a win-win. Impoverish millions so they will be forced to become social impact data commodities and set up a really robust futures market in pandemic preparedness with a side of biometric surveillance. I’m sure the fin-tech oligarchs are beside themselves right now.
So, I guess we will see where this all goes. The impact investors definitely have their eye on growing vaccination and pandemic investments, and are looking to structure them as social impact bonds and development impact bonds. See the screenshot below regarding the relationship of the International Finance Facility for Immunisation to GAVI, the Gates Foundation-funded vaccination program.
To scale them while collecting all the data required to disburse proceeds to investors, I expect they’ll want to set up some sort of digital identity system. The World Bank has its own platform serving its Human Capital Project called ID4D.
I’ll close with a map I made of vaccine finance. Though these are uncharted waters for us regular folks, the stakeholder capitalists know where they want us to go.
Interactive version of map above here.
Global public health has become a plaything of financiers. Though if you read Daniel Immerwahr’s insightful book “How to Hide an Empire,” on the Rockefeller Foundation, Cornelius Rhoads and the horror he wrought in Puerto Rico, perhaps it always has been.
Can we wrest the right for a healthy life for all people away from global markets?
Will we allow our humanity to be commodified into vaccine bond portfolios?
As portfolio assets of stakeholder capitalists are we subject to digital tracking forever?
In the name of disease surveillance?
What does resistance to this agenda look like?
I welcome your ideas. Drop a line in the comments.