Jurisprudence

Joe Biden’s Cancer Moonshot Falls Way Short

Biden crouches over a presidential podium.
President Joe Biden speaks during an event to announce the relaunch of the Cancer Moonshot initiative in the East Room of the White House in Washington, DC, on February 2, 2022. Brendan Smialowski/Getty Images

Along a stretch of the Mississippi river, ash grey plumes of smoke stain a dusk-lit lavender skyline. Occasional fiery flares pulsate eerily. “Cancer Alley,” an 85-mile length of land flanked by New Orleans and Baton Rouge, is a pollution nerve center. Parishes in Cancer Alley once boasted more of the lush and magnificent swamplands native to the Mississippi corridor. Now, the region is blanketed by more than 150 oil refineries and chemical plants.

It is home, too, to 80-year-old Geraldine Watkins, a family matriarch and citizen of a small Louisiana town, LaPlace. The levels of cancer risk in LaPlace are staggering— residents of a LaPlace census tract are about 50 times more likely than the average American to develop cancer from air pollution. Watkins tells me that when she opens her ranch home’s back door at nightfall, she sometimes sees flares—propelled by plants burning off excess gas—leaping from the stacks and casting a jaundiced glow on the town. The air smells like sulfur. She has seen, she says, multiple friends and family members die from cancer, or simply suffering from cancer. “When you live in a community of this size, and you get to know the people of the community,” she says, “every day you get a notice either on the phone or in the newspaper … the schoolteacher, the preacher, the grocery store owner, the dress maker, the clerk in the store—one of them has died.”

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(Watkins is a member of a local advocacy group, Concerned Citizens of St. John, that is represented by a nonprofit environmental law organization for which I previously worked.)

The Biden administration announced this month that it is renewing the Cancer Moonshot Initiative, a cancer-fighting enterprise that President Biden first championed in the Obama administration as vice president. The reignited program includes a formidable new goal to slash U.S. cancer deaths by half over 25 years. First inaugurated in 2016, the renewed program aims to complement current federal funding for cancer research by calling for increased screenings and detection efforts, and by promoting coordination among federal agencies and the private sector. Missing from the seven-page factsheet publicizing the relaunch, though: A new commitment to cutting air pollution.

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The aims of the president’s cancer moonshot are good. Its goals stretch over a multi-decade time horizon, well beyond the administration’s tenure. Hopefully the program will see swifter gains, though advocates and experts lament that a fresh infusion of program funding has yet to materialize. Some medical and biostatistical experts also seriously doubt that the program’s proposed actions, while desirable, will result in such a steep decline in deaths.

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Still, there are straightforward, uncomplicated actions that the government could take—that it is charged by law to take— each day to protect public health. And each day, the government falls short of discharging that statutory and moral duty. A federal government that took seriously its responsibility to diminish the public health burden from pollution—by issuing strong regulations, by enforcing violations of existing pollution standards—could do so much good. Why not chase the clear, obvious wins in addition to the moonshots?

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Outdoor air pollution is estimated to kill  as many as 8.7 million people per year globally. These deaths are attributable to not just various cancers, but also to heart disease, strokes, respiratory illnesses and other ailments. In America, air pollution is estimated to contribute to between 90,000 and 360,000 deaths each year.

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Those deaths persist despite the presence of the Clean Air Act, the nation’s flagship law dedicated to safeguarding communities from the devastating health harms caused by air pollution. In addition to regulating common “criteria pollutants,” such as particulate matter, the act requires the government to establish standards for major industrial sources of “hazardous air pollutants,” which principally affect communities near industrial pollution sources. According to the act, these standards must reflect effective technological performance for pollution control, prevent unacceptable health risks, and allow for an “ample margin of safety” to protect public health. The act also directs the government to periodically review and update pollution limits.

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But over the past several decades, the government has repeatedly set sub-par pollution standards, interpreting its obligations remarkably narrowly. The government has failed to update certain standards to match new technological capabilities. It has been laggard and unambitious in acting to protect communities from chemical disasters. It has often failed to require monitoring for pollution levels at facilities’ fence lines. It has entirely failed to set standards for some pollution sources. Gallingly, successive administrations have mostly failed—deliberately—to sum cancer risks from multiple facilities and equipment when setting pollution limits. The result is that some of the most vulnerable people in the country face astronomically high cancer rates: A recent ProPublica investigation estimated that 256,000 people in America are exposed to cancer risks beyond the upper limit that EPA deems to be acceptable—a limit that many experts justifiably think is too high.

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The D.C. Circuit Court of Appeals has occasionally rebuffed the government’s efforts to underperform. But it has more often sanctioned the government’s failure to set stronger pollution standards. Because court review of Clean Air Act regulations is confined— in the first instance— to the D.C. Circuit, that court is essentially the sole caretaker for a large body of jurisprudence about, well, breathing, that affects the entire nation. The court’s permissive stance appears at odds with the purpose and vision of the statute. Its decisions have often consigned hundreds of thousands of Americans to live with preventable health harms. The upshot? It is often up to the government to do the right thing without being commanded.

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That has not yet happened in LaPlace, Louisiana, where Watkins lives. A majority-Black town in the heart of Cancer Alley, LaPlace hosts a neoprene rubber production plant that spits into the air vast quantities of a chemical called chloroprene. In 2010, the Environmental Protection Agency classified chloroprene as a chemical likely to cause cancer. But the agency has neglected to update its regulations to account for that decade-old classification. The result is that the federal government does little to protect residents of LaPlace from plainly unacceptable levels of cancer risk. Watkins’ message to the government, meanwhile, is simple: “Please set up a standard or regulation to stop these plants from killing us and our children,” she pleads. “We’re dying from what’s going on.”

Astonishingly fast-paced treatment breakthroughs that halve total cancer deaths would be miraculous—an unequivocal good. There are things the government can do to reduce deaths and improve public health, though, that aren’t miraculous at all. More attention to those more pedestrian items would serve us all well.

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