The COVID pandemic has cost the United States 734,000 lives and more than $16 trillion. Both those tallies are rising on a daily basis.
We can’t know with certainty how many lives or livelihoods would have been saved had Congress invested more in public health before 2020. But we do know that Uncle Sam had been investing much less in pandemic preparedness than epidemiologists thought prudent.
If the novel coronavirus caught America sleeping, it wasn’t for lack of blaring alarms. For decades, public-health experts and advocates had been warning that a catastrophe quite similar to COVID-19 was nigh and that global governments were underprepared. 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 saw the SARS and MERS outbreaks — two previews of how a deadly new coronavirus could cause a global catastrophe.
Yet before COVID-19’s emergence, the CDC was spending only $500 million a year on combating emerging diseases. The National Institutes of Health’s total budget for its program on infectious diseases was roughly $5.5 billion, with only a small fraction of that sum going toward pandemic prevention. Little to nothing was being spent expanding U.S. hospitals’ surge capacity. In other words, the U.S. government treated pandemic preparedness as a frivolity, investing in it 0.01 percent of what it spent upgrading our national stockpile of nuclear warheads.
If Congress had little excuse for skimping on preventive public-health measures before 2020, it now has none whatsoever. And yet, thus far, the largest mass death event in modern American history hasn’t persuaded our elected representatives to take pandemic preparedness seriously.
In September, the Biden White House unveiled a proposal for a ten-year, $65 billion investment in pandemic preparedness. And the administration asked Congress to include a $30 billion “downpayment” on that program as part of this year’s Build Back Better bill. As moderate Democrats demanded a massive reduction in that legislation’s top-line costs, the administration trimmed its request to $15 billion.
In the version of Build Back Better unveiled Thursday, pandemic preparedness receives just $2.7 billion. And roughly half of that sum is dedicated to modernizing CDC laboratories, a vital endeavor, but not a core component of the administration’s preparedness agenda.
The scale of Congress’s underinvestment in pandemic prevention has been understated in some reports. It is true that the new Build Back Better framework includes $10 billion for pandemic prevention and public health. But the overwhelming majority of those funds are devoted to bolstering America’s state-level public-health agencies. That is an important initiative, and one with obvious relevance to the mitigation of pandemics. It is not central, however, to preempting a disaster like COVID-19.
Well-funded disaster-relief agencies can reduce the suffering caused by routine flooding in a coastal city. But a seawall can prevent the flooding itself. Pandemic preparedness is meant to function like the latter. The point is to snuff out outbreaks of emergent diseases before widespread mitigation becomes necessary. Although public-health agencies have a role to play in that endeavor, the biggest opportunities lie in biotechnology and epidemiological surveillance. More than half of the funding in Biden’s $65 billion pandemic-preparedness plan went toward the development and rapid manufacture of vaccines and therapeutics. Much of the rest was dedicated to building up America’s early-warning systems.
The COVID-19 crisis catalyzed innovation on both these fronts. Over the course of the pandemic, mRNA vaccines came into maturity. As a result of that development, along with other advances in vaccine technology, the formulation of universal flu and coronavirus vaccines — which is to say, vaccines that would inhibit the spread of any strain of such viruses — is now eminently plausible. Meanwhile, over the past 21 months, the surveillance technique of wastewater detection, which enables epidemiologists to anticipate outbreaks before they generate widespread symptomatic infection in a community, has grown more sophisticated and prevalent. For these reasons, COVID-19 did not just illuminate the costs of skimping on pandemic preparedness; it also increased the expected return on investment in that space.
Although indefensible, congressional Democrats’ piddling appropriation for pandemic preparedness is understandable. The party can only pass one major spending bill through budget reconciliation this fiscal year. And conventional wisdom holds that, come next year’s campaign season, Democratic lawmakers will lose all appetite for controversial legislation. Thus Build Back Better is the primary vehicle for every partisan objective in Joe Biden’s platform. Joe Manchin and Kyrsten Sinema have imposed a hard cap on the bill’s top-line cost. So something had to give. And, at least in theory, pandemic preparedness is the kind of program that should attract some Republican cooperation.
If Republican support for funding pandemic preparedness could be relied upon, however, we would have seen such funding in the bipartisan infrastructure bill. Democrats can’t bet the nation’s public health on Mitch McConnell’s good sense.
In any case, it is not obvious why pandemic preparedness funding must compete for dollars with Build Back Better’s other provisions. Even Democratic deficit hawks like Manchin believe that it is better to increase the national debt than to skimp on national security: The West Virginia senator has voted for tens of billions of dollars in unfunded increases to the Pentagon’s budget. Yet the worst foreign attack on U.S. soil in modern history claimed fewer lives than COVID-19 has since this Wednesday. Surely, if preventing another tragedy like 9/11 warranted more than $4 trillion in deficit spending, preventing another like COVID-19 merits at least $15 billion.
What’s more, there is an exceptionally strong case that investments in pandemic preparedness will eventually pay for themselves. If COVID-19 is any guide, merely shortening the duration of the next pandemic by a single day would have billions of dollars in economic value. And according to one recent estimate, there is a roughly 40 percent chance of another global pandemic breaking out within the next two decades.
While the substantive risk of underinvesting in pandemic prevention is high, the political risk of spending the money is nonexistent. In one recent Data for Progress poll, voters supported further spending on pandemic preparedness by a margin of 83 to 11 percent.
Perhaps moderate Democrats care more about keeping Build Back Better’s headline cost below the arbitrary figure of $1.75 trillion than about keeping Americans’ safe from emerging viruses. If so, the last thing anyone should call those lawmakers is “fiscally responsible.”