COVID caught the United States napping through a cacophony of shrieking alarms. When the novel coronavirus reached our shores, the CDC was spending only $500 million a year on programs aimed at tackling emerging diseases. The National Institutes of Health’s total budget for its program on infectious diseases, meanwhile, was roughly $5.5 billion, with only a small fraction of that sum going toward pandemic prevention. Little to nothing was spent on shoring up U.S. hospitals’ surge capacity. By contrast, in late 2019, Congress increased the Pentagon’s budget — which was already larger than the military budgets of China, India, Russia, the U.K., Saudi Arabia, Germany, France, Japan, and Australia combined — by $21 billion.
In other words: The U.S. government treated preparing for a pandemic as a nigh-trivial concern, or a matter roughly 0.01 percent as important as modernizing the nation’s stockpile of nuclear warheads.
Congress had been told plenty of times that this was a poor set of priorities. For decades, public-health experts and advocates had been warning of scenarios quite similar to the COVID-19 crisis. An episode of Vox’s Netflix show Explained from fall 2019 described how a Chinese wet market — where humans and a wide variety of livestock are packed into close proximity — could facilitate the spread of a novel influenza virus from animals to humans, and thus trigger a pandemic. In September 2019, a report commissioned by the World Bank and World Health Organization began, “There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people.” The first two decades of the 21st century also saw the SARS and MERS outbreaks — two previews of how a deadly new coronavirus could cause a global catastrophe.
Perhaps America could only have learned the hard way. Only after seeing a novel pathogen kill hundreds of thousands of its citizens, shutter its economy, and shred much of its social fabric would Congress finally see that spending a pittance on public health had significant downsides.
This is what I thought a little over a year ago, anyway. Today, such an assessment looks far too optimistic.
As the Delta variant has reminded the complacent, the COVID pandemic is not over. And with upwards of 616,000 Americans lost to the virus, and outbreaks still testing hospital capacity in many regions of the country, Congress is already back to treating pandemic preparedness as a minor concern.
The Senate’s bipartisan infrastructure bill includes no significant investment in public health. Meanwhile, Congressional Democrats are reportedly planning to scale back Joe Biden’s proposed investment in pandemic preparedness by more than 80 percent. Whereas the president called for spending $30 billion on fortifying the nation’s defenses against contagious diseases, Nancy Pelosi & Co. plan to dedicate just $5 billion — of their impending $3.5 trillion reconciliation bill — to such purposes.
This move is understandable, if indefensible. Democrats have a razor-thin majority in the House. And to pass partisan legislation out of the Senate, the party cannot afford a single defection. Moderates in both chambers have a limited tolerance for both deficit spending and taxing the wealthy. It’s not clear that the party has the votes to pass a $3.5 trillion spending bill, let alone one greater than that sum. And yet, the party’s myriad ambitions for public investment cost far more than $3.5 trillion. So something has to go.
Pandemic preparedness is an easy line-item to shrink for the same reason that it was an easy one to underfund pre-COVID: The constituency with the greatest stake in preventing or mitigating the next public health crisis is unidentifiable, let alone, organizable. The 600,000 Americans who died of COVID-19 over the past 17 months did not know in 2019 that they had a potentially life-or-death stake in the size of the CDC’s budget. If Democrats go small on pandemic preparedness, the victims of the next novel virus will not light up Congress’s phone lines. By contrast, if the party scraps its plan to add dental, hearing, and vision benefits to Medicare, the AARP would make its discontent known.
It’s plausible that Democrats could pass a large increase in pandemic funding on a bipartisan basis, as part of an omnibus budget bill. Or at least, Republicans would more plausibly support $25 billion in pandemic preparedness funding than a $25 billion investment in childcare. The $3.5 trillion reconciliation bill is Democrats’ only vehicle for moving partisan priorities. So why spend a full $30 billion of that limited sum on a cause that both parties (at least nominally) support?
This reasoning may be superficially compelling, but it doesn’t withstand scrutiny. If Republican support for funding pandemic preparedness could be relied upon, we would see such funding in the bipartisan infrastructure bill. In any case, Democrats can’t bet the nation’s public health on Mitch McConnell’s good sense. The inadequacies of America’s existing pandemic-fighting capacities are too myriad, and the stakes of increasing those capacities too great, to give the GOP veto power on the issue.
America needs to establish manufacturing surge capacity that can facilitate the rapid production of vaccines, tests, personal protective equipment, and syringes. We need to develop candidate vaccines for emerging viral threats, and get them through early-phase trials before they run rampant. We need to build up our chronically underfunded state and local health departments, so that they can more quickly detect and respond to outbreaks. We need to invest in the research and development of anti-pandemic moonshots, like a universal influenza vaccine. We need to develop better therapeutics, like antivirals and monoclonal antibodies, that can reduce the death toll of any future outbreak. It is madness to suggest that the U.S. cannot afford to do all of these things to protect itself and the world from another epidemiological disaster.
By one estimate, COVID will cost our country more than $16 trillion. The true costs of the pandemic, however, cannot be fully quantified. The knock-on effects of prolonged shutdowns and premature deaths are vast. As Alec McGillis documents in a recent ProPublica report, the pandemic eviscerated communal life in America’s most disadvantaged neighborhoods, denied kids with unstable homes the reprieve of schooltime, left adolescents to wile away their days with social media spats, enlarged the black market for firearms — and thus birthed the largest homicide spike in U.S. history.
Democrats are rightly concerned with finding space in their $3.5 trillion bill for investments in eldercare, paid leave, community college, and other vital social programs. But inadequate investment in public health threatens the core objectives of such programs: COVID has harmed the elderly more than expanding access to homecare would benefit them. The virus may well damage educational outcomes more than tuition-free community college would improve them. And it has reduced women’s labor-force participation more than childcare subsidies would be expected to increase it. In this sense, a $30 billion investment in pandemic preparedness would serve as an insurance policy for all of the bill’s other programs.
The American public is not known for its skill at risk assessment. But even the median voter recognizes that pandemic preparedness should be a congressional priority. In a recent Data For Progress poll, voters supported further investment in pandemic preparedness by a margin of 83 to 11 percent, rendering it the third-most popular component of the impending reconciliation bill.
In response to a terrorist attack that killed nearly 3,000 Americans, the U.S. spent more than $4 trillion on (largely counterproductive and homicidal) efforts to prevent the occurrence of such tragedies. In response to a virus that’s killed 616,800 Americans and counting, America can surely spend $30 billion. To pare back that sum by 80 percent for the sake of placating the deficit-phobic would be the opposite of fiscal responsibility.