By Jacob Assa and Cecilia Calderon

Unlike other epidemics or pandemics 鈥� such as tuberculosis, SARS, MERS or HIV/AIDS 鈥� COVID-19 has hit hardest at the world鈥檚 wealthiest countries. As of early June 2020, the 37 industrialized countries of the OECD accounted for 59% of all cases and 78% of deaths, even though they constitute less than 18% of the total population affected.

Looking at the pandemic鈥檚 effects in another way 鈥� using cases and deaths per million population 鈥� paints an even starker picture. OECD countries have a prevalence ratio of 2,890 cases per million and a mortality rate of 225 per million, compared with 869 cases and 51 deaths per million in the rest of the world. Furthermore, the case fatality ratio (CFR) 鈥� the ratio of deaths to cases 鈥� is also higher in the OECD (7.8%) than in the rest of the world (5.9%).

What can explain this phenomenon, the world鈥檚 richest countries impacted more than middle-income and poor countries?听 One explanation is that COVID-19 spreads faster in countries that are more integrated to the globalized economy, as the OECD members certainly are. A recent found that globalized countries have indeed experienced more cases per population, but less mortality.

We find this explanation incomplete. First, the extent of a country鈥檚 globalization may be masking other factors. And second, some of the most globalized countries have lower COVID-19 prevalence and mortality than countries more integrated into the global economy. For example, Germany has a higher KOF globalization index than the United states, but the latter has more than double the prevalence and mortality rates. Likewise, the UK is more globalized than Spain, but Spain has fared worse in cases per one million people.

Clearly something else is at play. One possible reason for the virus鈥檚 differential impact on countries is the relative structure of their health systems. In fact, a 2015 of tuberculosis (TB) rates in 99 countries found that cuts in public spending on healthcare and the privatization of the health sector were related to higher prevalence of TB. This was set against decades of privatization of health-care systems in developing countries, often encouraged by the World Bank and IMF.

However, the TB sample only included developing countries, while COVID-19 has struck across the entire world. We set out to find whether a similar difference in the financing structure of health care 鈥� private vs. public 鈥� had something to do with COVID-19 prevalence and mortality rates in countries at all different stages of development. We used data for 147 countries accounting for 93% of the world鈥檚 population, and spanning the five continents and all income levels.听

We ran several regression models for both COVID-19 prevalence 鈥� cases per million people 鈥� and mortality 鈥� deaths per million, and in each case the extent of private expenditure on health care had a large and positive relationship with the impact of the pandemic (see our full paper ).听

The first chart shows that, even when controlling for the level of income, the extent of urbanization, globalization and democracy, a 10% increase in private health expenditure results in a 4.85% increase in COVID-19 cases.听

The second chart shows that, controlling for the same variables, a 10% increase in private health expenditure results in a 6.91% increase in COVID-19 deaths. This is an average, and some countries perform worse (e.g. the United States in the top right corner) while some fare a little better (e.g. New Zealand). But the relationship is clear and statistically significant.听

For COVID-19 mortality we also looked at the proportion of people over 65 in the population. Since this is a high-risk group, we were not surprised to find that, on average, 10% increase in the percentage of older people results in a 1.18% increase in COVID-19 deaths.

While policymakers cannot change the demographic structure of the population very quickly, they do have control of policies such as cost-cutting and privatization, which also affect hospital capacity. We found that a 10% increase in the percentage of hospital beds per 1,000 people results in a 1.67% decrease in COVID-19 deaths. Some of the highest mortality rates are in the US, Italy and Spain (which have around 3 hospital beds per 1,000 people), whereas less privatized systems have a much higher ratio of hospital beds per people, e.g. Germany (8.2), South Korea (10.9), and Japan (13.4).

These findings suggest that short-term gains from privatization of health-care systems (such as cost-cutting and in some cases shorter waiting times at clinics) have to be weighed against long-term risks of lower capacity (in both equipment and staffing), less equitable coverage, lower adherence to medical standards and often over-prescription of antibiotics. In the case of COVID-19, the equity element may have played a large role, as uninsured people feeling ill are more likely to avoid costly testing or treatment, as well as less likely to be able to work from home, thus facilitating the spread of the virus.

While the most urgent task is coping with the pandemic at hand, it is not likely to be the last or even worst. Recent has linked the emergence of zoonotic diseases such as COVID-19 to increased pressure from human economies on nature, leading to declines in wildlife populations and thus a higher risk of animal-to-human transmission of such diseases. With this in mind, policy-makers need to urgently re-evaluate neoliberal policies such as privatization and commercialization of healthcare systems, if these are to become sustainable in the long-run.

Dr.听Jacob Assa, The New School for Social Research. He Tweets at听.

Cecilia Calderon, statistics specialist, United Nations Development Program.

When the majority of Southeast Asian countries began to enact more aggressive responses to the novel coronavirus, Indonesia turned a deaf ear to virus mitigation efforts. As it had no confirmed cases of the coronavirus as of February, Joko Widodo鈥檚 (Jokowi) government instead kept pushing extensive economic reform agendas. It submitted a 1,028-page Job Creation Omnibus Bill on 12 February, calling the bill the country鈥檚 third great structural reform program after the听 1998 International Monetary Fund鈥檚 (IMF) Letter of Intent and the 1967 Foreign Direct Investment Law. Despite criticism from the opposition, the president insisted on this neoliberal agenda, claiming that the objective of the bill is to promote more foreign direct investment (FDI) in the manufacturing sector and thus create more jobs.听

What effects do neoliberal policies have on political and economic life in Indonesia and state-capital relations in particular? This blog post follows David (2006) in taking a historical-geographical approach to investigate this question, with a focus on policies put in place in the current president Jokowi鈥檚 second term. For , such a bold move to deregulate the economy signals the resurgence of state-led development in a new form. Put differently, what this article would like to argue is that deregulation, an all-encompassing hegemonic ideology rather than simply a policy, has become some sort of 鈥榖anner to unite under鈥� for the ruling capitalist class in Indonesia.听

The Omnibus Law: A Panacea for the 鈥楥risis鈥櫶�

During Jokowi鈥檚 second term, narratives about economic growth and the importance of FDI have been constantly evoked to lend legitimacy to his government. The Omnibus Law is indeed a bold step in a bid to to carve out an open-market economy. From the outset, the draft of the Omnibus bill was built upon a 鈥榗risis-narrative鈥�. This narrative presents FDI-based manufacturing as essential, and therefore deregulation as a key solution. This crisis-narrative has also been popularised by the World Bank, for example in its听 2019 to Jokowi stressing that Indonesia needs to attract more FDI as it is other ASEAN countries. The report is said to have shocked the president, as he quickly his ministers to revise existing laws and draft the 鈥渙mnibus law鈥�. Since then, he has continued to on the country鈥檚 poor economic performance (e.g. the economic downturn in the fourth quarter of 2019) on the confusing regulations and hostile bureaucracy that put off foreign investors, especially in the manufacturing sector. Under Jokowi, the neoliberal tenets of more open national markets and deregulation have become all-encompassing panaceas for the economic slowdown.听

The call for deregulation masks material processes which benefit dominant class interests and invokes a brokerage role for the state. As Mitchell (2012) puts it in Free Economy, Strong State, defining neoliberalization can never be 鈥渜uite as simple as lining up a list of attributes of neoliberalism, such as privatization, deregulation, and the limited state.鈥� The Omnibus bill has facilitated domestic conditions for the ruling capitalist class and will help sustain the primitive accumulation practices.听

The bill covers various matters that have allegedly been hampering the creation of employment and investment in a hyper-regulated market. The bill includes more than 1,000 proposed amendments to at least 79 existing laws. This includes a call for a stronger central government and a new financing regime of the Sovereign Wealth Fund (SWF), that is set up for infrastructure development, including those in the new capital city. If the bill passes, there will be higher concentrations of power at the central level, effectively watering down the 2001 Local Autonomy Law. This means the central government will be able to change prevailing laws for the sake of employment creation through Presidential Decree (Peraturan Pemerintah / PP), relax environmental standards, issue business licenses across almost all business sectors, and crowd in 鈥減rivate investment鈥� through the SWF.听听

The New Capital City in the Spotlight听

My main contention is with the contradictory process of neoliberalism, in line with Peck and Theodore鈥檚 (2012) , that neoliberalism is 鈥渁 signifier for an always contradictory process鈥� reconstituted, reproduced, and shaped by opportunistic moments.鈥� With the new bill, the central government issues not only the manufacturing license, but also business licenses for extractive sectors, electricity, infrastructure and public housing, agriculture and forestry, maritime and fisheries. Central to this, the concentration of power would reestablish the condition for sustaining capitalist accumulation for the dominant class – which is made up of conglomerates, powerful politicians and military figures, who may in fact not be terribly interested in the manufacturing sector. For example, over the past decade, East Kalimantan province where Indonesia鈥檚 planned new capital city is located, has been fraught with local capture and disputes over mining licenses. Most permits have been allocated illegally in conservation and protected areas without a detailed environmental impact assessment.听

As Mongabay, the area the new capital city overlaps with, 162 coal mining and pulpwood plantation concessions are connected to Indonesian top conglomerates and politicians. The central government so far tends to put a gloss on the issue by presenting a vision for a green, sustainable new Indonesian capital city and mobilizing particular forms of techniques such as to pitch ideas for the new capital city and op consulting companies such as McKinsey and Japanese Nikken Sekkei to develop the master plan for the city. Nevertheless, such depoliticising languages obscure the state鈥檚 brokerage role in the neo-extractive activities. The ruling class would not relinquish the land without the state offering tenable compensation, such as land swapping deals or use of coal for electricity generation. The Omnibus law thus could help the state facilitate land expropriation elsewhere in the country. What鈥檚 more, there are at least three mine-mouth coal-fired power plants that are already planned for construction in East Kalimantan. Meanwhile, the state continues to pledge commitment to renewable energy, despite the fact that coal has become the closest source of energy to meet the anticipated surge in electricity demand.听听

The 鈥楽overeign鈥� Wealth Fund听听

As part of the Omnibus bill, the SWF establishment is deemed essential to support the government鈥檚 efforts to attract investment. As Jokowi at the end of 2019:

鈥淎lways thinking negatively can be a problem. We have to sell the project of moving the capital to other parties outside the government鈥�.听

The SWF would be owned by the central government and managed by a 鈥榮pecial authority agency鈥� led by the Ministry of Finance that would be able to partner with third parties to manage the fund.. Funding of SWFs such as Singapore鈥檚 Temasek Holdings, Malaysia鈥檚 Khazanah, Saudi Arabia鈥檚 Public Investment Fund, or Kuwait鈥檚 Investment Authority, comes from current account surpluses, fiscal surpluses, receipts from commodity exports, or proceeds of privatization. However, in Indonesia鈥檚 , the SWF would be funded by state capital injections, state-owned enterprises鈥� (SOEs) assets, grants and other defined sources. Rather than the SWF functioning to recycle capital surpluses and diversify investment portfolios, the Indonesian SWF will finance infrastructure projects, especially for the new capital city. Thus far, the United Arab Emirates (UAE), Japan鈥檚 Softbank Group, and the United States鈥� International Development Finance Corporation (IDFC to invest U$ 22 billion through the SWF. Put simply, the proposed SWF resembles a 鈥榩ooled fund鈥� – a combination of direct lending, hedge fund, securitisation of infrastructure loans, and refinancing. Such an arrangement suggests that the creation of a SWF proceeded under pressures from dominant forces and transnational capital where the Indonesian government would appear a responsible financial agent to the stakeholders. Furthermore, it is not clear how this fund will remain independent of 鈥榮overeign鈥� interference. Given that not all infrastructure projects are commercially viable, the SWF could potentially serve as safe havens for investment in domestic extractive sectors facilitated by the state. Misappropriation of the fund is also possible. For example, the controversial 1MDB originally set up to promote development and finance infrastructure in Malaysia was rather good at collecting debts and ushering in fraudulent activities.听听

Entering the Trial

There are parallels between the deregulation proposed in the Omnibus bill and the policies pushed for by the capitalist class in the 1990s. In the 1990s Soeharto rolled out a series of听 reforms including deregulation and attempts to open up strategic sectors to foreign investment. Then, the telecommunication sector underwent the process of deregulation and privatisation. required a relaxation of state control as well as听 entry restrictions on private firms wanting to operate networks and provide non-basic services. Restrictions were removed on the condition that at least two SOEs, Perumtel and Indosat, would hold an equity stake in the new business entities. There was neither consensus about what the privatization exactly meant nor about how procurement would be carried out. was that the sector became an adequate outlet of capital accumulation for well-connected business elites and Soeharto鈥檚 family partnering with foreign firms. Insofar as Soeharto鈥檚 children and their foreign allies competed fiercely for the Kerja Sama Operasi (KSO) project (in English this is equivalent to Build, Operate and Transfer, or BOT), the contracts would be brokered through the state. The state privileged consortiums that had established links with Soeharto鈥檚 family and the immediate outcome was the state shared the spoils and determined 鈥榳ho gets what鈥� in lieu of competitive bidding. The 1989 Act indeed became some sort of 鈥榖anner to unite under鈥� for the dominant capitalist class.听

I am not arguing that the 1990 deregulation is exactly the same as the Omnibus draft, but rather wish to highlight some parallels. I argue that the continuation and proliferation of primitive or original accumulation practices shaped by the dominant class have always existed and that in Indonesia they are brokered through a centralized state again. We can expect that the newly proposed bill rolls out dynamics of uneven development, of politically mediated capitalist competition, and trials with costly errors. After all, neoliberalism will be brought to trial for its own contradictions and externalities.听

Trissia Wijaya is听a Ph.D. Candidate at the Asia Research Centre, Murdoch University. Her research interests primarily lie in state-business relationship, the political economy of infrastructure, and Chinese and Japanese foreign aid and investment in Southeast Asia. She tweets at .

Photo: Industrial mine in Indonesia.

A story is told that a few years after independence in 1964, Kenneth Kaunda, Zambia鈥檚 first president, visited one of the mines in the mineral rich Copperbelt Province and was immediately struck by the complete absence of Zambians in senior management positions. He proceeded to ask the mine owners as to when they reasonably thought Zambians would be ready to occupy positions of influence within the country鈥檚 mining sector. With straight faces, the mine owners responded 鈥渘ot before 2003, Mr. President.鈥�

Following independence from Britain, Zambia鈥檚 economy was organized broadly along capitalist free market lines. The economy, split up into mining and non-mining sectors, was wholly in the hands of foreign private interests. The copper mines, the country鈥檚 jewels, were owned a 100% by Anglo American Corporation and American Metal Climax. Both companies having obtained the rights to mine copper in perpetuity from Cecil Rhodes鈥� British South Africa Company (Rhodes had himself obtained the mining rights under dubious circumstances). The non-mining sector 鈥� including banks, insurance companies, construction companies and so on 鈥� were similarly in the hands of foreign interests.

The logic, or at least hope, in organizing the economy in this way was that unfettered foreign capital would not only drive productivity improvements at home, including knowledge and technological transfers, but would, crucially, play a big role in meeting the newly independent country鈥檚 social expenditure targets. The latter point was of vital importance given that the colonial government had disproportionately privileged whites in the provision of social services.

Unsurprisingly, unfettered foreign capital did the exact opposite. Instead of re-investing a considerable proportion of their profits in local operations, the mining companies externalized almost everything. Before independence, mining companies had re-invested about 50% of their profits in Zambian operations. After independence, the rate of re-investment fell to about 20%, according to , a Zambian development expert.

Things were not any better in the non-mining sector. Saasa estimates that the outward remittance of dividends to foreign owners increased by 84% in 1966, two years after independence. As for the commercial banks, they continued just as before to favor resident Europeans in the provision of credit facilities. Only was extended to Zambian citizens, a move that constrained the emergence of an indigenous entrepreneurial class. In as far as funding the state purse was concerned, the mining and non-mining companies utilized all manner of gimmicks, including 鈥渋nvisible costs,鈥� to ensure that their tax liabilities in Zambia were kept to a bare minimum.

It very early on dawned on Kaunda and his team that 鈥�.鈥� Rather than be engaged in a never-ending game of dubious logic with the foreign capitalists, Kaunda decided to act.

On 19th April 1968, he announced the Mulungushi Reforms and ordered that the state would henceforth take a controlling position in all private retail, transport and manufacturing firms in the country. In the following year, at a community meeting in the historic township of Matero, Kaunda announced a partial nationalization of the country鈥檚 mines.

was now in the hands of the state. A process of realigning the objectives of enterprise with those of the country was immediately set into motion. The copper mines were to fund a generous 鈥溾�� welfare system that would reverberate beyond the Copperbelt and benefit everybody. Within a decade of the reforms, Zambians were occupying leadership positions in the economy putting to shame the dire predictions made in the 1960s. More importantly, free education and free healthcare for all with guaranteed social mobility became the mantra by which the country was to live by.

In 1991, Kenneth Kaunda graciously exited from office after losing that year鈥檚 elections. The new government, intoxicated by the fumes of neoliberalism then sweeping the globe, embarked on an ambitious privatization program whose coup de gr芒ce was the re-transfer of the mines to foreign private interests.

Immediately afterwards, unemployment and destitution, particularly on the Copperbelt, became the order of the day. Access to quality social services, once guaranteed to all, were now the preserve of a tiny elite. A schism ran right through the country forming class cleavages wherever it went.

In our hurry to get rid of Kaunda, we had also gotten rid of Kaundanomics and we therefore lost our way.

Grieve Chelwa is a postdoctoral fellow at Harvard University.听

This article was originally published on .