Evan Vucci/AP Photo
President Joe Biden speaks as Kizzmekia Corbett, an immunologist with the Vaccine Research Center at the National Institutes of Health, looks on during a visit to the Viral Pathogenesis Laboratory at the NIH, February 11, 2021, in Bethesda, Maryland.
When Abie Rohrig saw a video of Vox’s Dylan Matthews donating his kidney to a stranger, he was hooked.
“Immediately, I was just like, definitely something I want to do. I looked at the numbers. It’s like, 3-in-10,000 risk of death, which is similar to appendicitis,” Rohrig said. “It’s only slightly higher than childbirth, which I would do, if I wasn’t a guy.”
Rohrig donated his kidney after his freshman year in college. He is now a junior at Swarthmore, and undergoing major surgery was just the start of his passion for bioethics. When the pandemic hit, Rohrig began advocating for high-risk, high-reward challenge trials, signing up to be infected with COVID-19 in order to speed along epidemiological research.
Rohrig might be keener to put his own body on the line than more typically demure public-health advocates, but he’s most unusual for being a young leftist pushing science policy. Right now, he is alarmed that, despite the ongoing coronavirus crisis, Congress is reportedly considering slashing funding for pandemic preparedness from the public-investment package being hashed out in budget reconciliation.
Infrastructure Summer banner
Originally, the Biden administration had sought to put $30 billion toward programs like medical stockpiling and vaccine development. But as the bill faces an uncertain future, with conservative members of the caucus calling for trims, that program has been an early target for cuts.
Last Friday, science adviser Eric Lander introduced a $65.3 billion preparedness initiative, but said the White House would urge Congress to provide only around $15 billion as a down payment, just half the original number demanded in the American Jobs Plan.
It’s a striking item to downsize in a year that by early summer had already seen more global COVID-19 deaths than 2020.
Mild-mannered scientists and Biden bureaucrats have quietly backed the funding, boosted by an eccentric cohort of science-policy enthusiasts like Rohrig. But it’s not obvious why preventing disease outbreaks should be defended by wonks and insiders, instead of public pressure campaigns. As a result, pandemic preparedness, even in name, has taken on a certain “eat your broccoli” flavor.
The pandemic revealed the fault lines of American inequality. We are overdue for a bout of avian flu, and climate heating is multiplying the threat of emergent infectious disease. Another pandemic would probably also punish the poor, and threaten national security. These seem like nakedly political issues, yet neither party has claimed them as a priority.
Some on the left say Democrats should draft off outrage from the coronavirus to make the case for initiatives like Medicare for All, better public housing with improved ventilation, and worker protections. But organizers have struggled to build campaigns around the COVID-19 shock.
Public health in the United States, where even hospital bills are made “personal” through extreme price discrimination, is a highly individualized affair. As a result, there is no pre-existing constituency to champion pandemic prevention. It’s a politically neutered issue, left to technocrats.
Maybe that’s not such a bad thing, some of those technocrats told the Prospect. The return on investment for outbreak prevention is huge. If it is not politicized, $30 billion (not even 1 percent of the proposed $3.5 trillion bill) could be slipped in under the radar, possibly helping avert trillions of dollars in losses to future outbreaks.
On the other hand, without a popular constituency, even small and highly cost-effective line items are the first cuts in a bill with a forced upper-bound limit.
Courtesy of Abie Rohrig
Passionate about public health, Abie Rohrig donated his kidney after his freshman year of college, and signed up to be infected with COVID-19 if eligible for a “challenge trial.” Now, he’s worried about threatened cuts to a fund preparing for future pandemics.
“I’M A QUANTY GUY,” Gabe Bankman-Fried, executive director of the nonprofit Guarding Against Pandemics, told the Prospect. Out of college, Bankman-Fried worked at Jane Street, a proprietary trading firm, before becoming a Hill aide.
“As a trader, the mindset is to look for inefficiencies, good bets, trades other people haven’t found. It’s sort of the same philosophy in donations,” he said. Even before COVID-19 hit, he said, that ethos drew him to chronically underfunded public goods, like biosecurity and climate.
Now, he wants to fund U.S. capacity to design and approve a vaccine for a future pathogen within 100 days of identifying an outbreak. For COVID-19, that would have meant vaccine viability by May 2020.
Guarding Against Pandemics is funded by Bankman-Fried’s brother Sam, who as of July was the world’s richest person under 30. After his own stint at Jane Street, Sam launched FTX, a cryptocurrency exchange.
The brothers are part of a growing set of tech philanthropists, including Facebook co-founder Dustin Moskovitz, who are using private wealth to fund utilitarian aims. Many support “effective altruism,” a movement for evidence-based giving, and are interested in risks with exponential or long-term harms. Moskovitz has bragged that his charity, Open Philanthropy, supported averting global catastrophic risks like pandemics long before COVID-19.
If pandemic preparedness wins full funding in the final bill, it may be due to their inside lobbying.
According to this logic, early detection and response systems not only help prevent disease outbreaks—they also stave off culture wars.
“People haven’t formed much of their political identity around this issue,” Sam Bankman-Fried told the Prospect in an interview. “It just hasn’t been on the public consciousness for that long.” Even as COVID-19 has become a political football, Sam said, the broader problem of developing vaccine capacity hasn’t gained much currency.
That’s not an obstacle, but an opening. Sam worries that if pandemic preparedness is politicized, it would quickly be snarled in congressional gridlock.
According to this logic, early detection and response systems not only help prevent disease outbreaks—they also stave off culture wars.
Once a pandemic gets out of control, “any decision you make is going to be infringing on something that people hold really deep,” Sam said. “What we’re left with is, for many people, a really galling choice, which they see as having to choose between their health and their freedom.”
The way out of this box, Sam argued, is to build rapid disease containment into a perfunctory budget line. “Ideally, what you can do is take the technocratic approach before it seems like a choice,” he said.
CALLS FOR PANDEMIC PREP from progressives, meanwhile, have been tepid.
Twenty Democrats last month asked congressional leaders to back the full $30 billion in spending, citing broad public support for heading off “more devastating impacts to our country when the next pandemic arises.”
A few progressives, including Massachusetts Sens. Elizabeth Warren and Ed Markey, signed on to the letter, which was organized by Rep. Ritchie Torres (D-NY) and emphasized COVID-19’s disparate racial impacts. Senate Budget Committee chair Bernie Sanders did not.
Sanders has been a longtime supporter of increased funding for pandemic prep. In 2005, he invoked the death toll of the 1918 influenza pandemic to argue that when preventing catastrophic harm, Americans “will forgive us if we end up doing things and spending money that in the long run may turn out not to be necessary.”
Now, Sanders is being forced to pick among competing interests he has previously championed. Joe Manchin’s rejection of the bill’s price tag inflicts real penalties, and the choices should be seen as a test of tactics rather than values.
In that environment, some on the left say pandemic prep is a line item best left to moderates.
“Moderates tend to be more focused on what the middle class and upper middle class is experiencing. And the pandemic was a moment of profound vulnerability for everyone,” said Emma Claire Foley, who chairs the health care working group of NYC Democratic Socialists of America.
The pandemic preparedness proposal, Foley said, is a “piecemeal, and hopefully efficient, but fundamentally limited approach that fits very well in a moderate agenda.”
Several organizers said the left should prioritize universal health care in the wake of the pandemic, but admitted it has been hard to mobilize people amid fallout from COVID-19. “We were really just baffled that it did not lead to like a groundswell for health care expansion,” Foley said.
Some on the left say pandemic prep is a line item best left to moderates.
The left has favored expanding health care benefits wherever possible, predicting that people will then fight to keep them. One attempt was Washington Rep. Pramila Jayapal’s Health Care Emergency Guarantee Act, which would have looked something like short-term Medicare for All. In the reconciliation bill, the action has been on Sanders’s priority of adding dental, hearing, and vision benefits for Medicare.
Some would like to see a more combative approach, but the discussion has been kept to backroom conversations.
Partly, it’s a constituency problem: Pandemics are diffuse, whereas if Democrats abandon benefit plans, AARP would balk. Also, there’s the problem of claiming credit. It’s hard to do a political victory lap on an averted crisis.
It’s not impossible. Invoking the Iliad, Boris Johnson has sought to rally Europeans around pandemic preparedness, saying Britain would help forge the way past a world “as disunited as Achilles and Agamemnon.”
For now, though, the American effort is still led by understatement.
“Research takes time. And obviously, if it’s not funded, then things are slowed down,” said Stanley Plotkin, a distinguished vaccinologist and consultant to vaccine manufacturers, in an interview with the Prospect about the need for pandemic preparedness funding.
Asked why his manner didn’t seem to match the urgency of his message, Plotkin demurred.
“There are people like Dr. Fauci, who are more voluble,” Plotkin said, but most scientists aren’t activists. “It’s not our style. We prefer to spend time in the laboratory, rather than out on the streets.”
