Are We Ready for the Next Pandemic?

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S1: When I told Ed Yong that it seems like he’s a little bit obsessed with pandemics, he sounded slightly offended.

S2: Well, I think I think it’s been a forced obsession, Mary. I’ve been thinking about them for a while and

S1: before it was cool, ruffled, Ed writes for The Atlantic. Way back in 2018, he published a piece that seems prescient now. It was called Is America Ready for a Global Pandemic? The answer to that question was no at the time. Ed thought being prepared for a pandemic, it was kind of an abstract concept. So he went to the Congo to examine how people there coped with Ebola. He visited a biocontainment unit in Omaha, Nebraska. Everywhere he traveled, he found creaky systems stripped of resources. It troubled him. Three years in a global pandemic, later, Ed says he remains troubled. His latest story is called Is America prepared for the pandemic after COVID 19? And you can probably guess his answer to that question.

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S2: Still, no. I’ve been looking at what people have said about public health for the last century, and the the laments are always the same. In the nineteen thirties, the US was spending just over three cents for every medical dollar on public health. That’s the system that’s meant to prevent disease in communities rather than just treating individually sick people. And the feeling, even back then, was that that amount of funding is clearly insufficient for preventing diseases among our population.

S1: How much do we spend now?

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S2: Right now, we spend even less. Now we spend just over two cents per medical dollar. And in those intervening decades, every time money has gone towards public health, there has been an equal and opposite disinvestment. You know, it’s like the tides. They go out, they go in and nothing much changes.

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S1: So it’s not just two steps forward, one step back, it’s like two steps forward, three steps back.

S2: Yeah, often that’s the case.

S1: You’re seeing that last time you wrote this article, basically because you thought we don’t have a concrete idea of what it would mean to go through a pandemic. And maybe if I show people what happens in a pandemic, people will be able to visualize it and respond. But what’s so? Heartbreaking about that is we’re in the middle of a pandemic, this is kind of as concrete as it gets. We still don’t see it. We still don’t see the fundamental problem here and how to fix it.

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S2: Yes, now we have already had, you know, a year plus of experience with the new coronavirus. And yet when the Delta variant started spreading around the world, we made many of the same mistakes and frankly, we were completely pummeled by this variant that we should have seen coming. And I think that bodes poorly for what is to come

S1: today on the show. You may think being in the middle of one pandemic means you get a pass on thinking about the next one. Ed says actually, it’s the opposite. I’m Mary Harris. You’re listening to what next? Stick around. If Ed Yong had to pick a couple of things about the American response to COVID it give him pause when he looks ahead, thinks about the next pandemic. He’d start here. First off, he says, Americans have thought about this pandemic mostly as an individual problem, not as a community one. We keep asking, how do I keep myself safe? That kind of thinking is pretty ingrained in American culture, makes it hard to fix. But the second thing he worries about is simpler. He wants Americans to focus a little less on MacGyver ing our way out of a pandemic with drugs and vaccines.

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S2: America, probably more so than other countries, really hews towards technological fixes for social problems like the idea is that we are going to find the new tool, the shiny new object that is going to save us. And in this case, it tends to be vaccines or drugs. And that’s so ingrained that it’s almost sounds absurd to question it like, of course, it’s a disease. Of course you’re going to want to treat it with drugs. Of course you’re going to want to vaccinate against it. What else are you going to do? Well, I think actually the what else is very clear if you look at the history of infectious diseases, like if you look at the 19th century, a lot of thinkers then were very clear that epidemics occur and are strongly influenced by social conditions like poverty, like inequality, substandard housing, bad sanitation. And these create the conditions in which epidemics spread easily, and they explain why some communities are badly hit and others aren’t. And if you want to address the problems of epidemics, you need to fix these underlying societal weaknesses. That perspective fell away in the late 19th and early 20th century because of germ theory, because we understood for the first time that diseases were the work of microbes and that gave scientists targets that gave them villains to focus on. And because of that, this idea of the social consequence causes of disease completely fell by the wayside. Instead, researchers got to think of diseases solely as battles between individuals and pathogens. And that again reflects like how we think about COVID today. I mean, look at look at everything from the last year. The Biden administration has absolutely gone in an almost entirely vaccine only strategy. It has pitted vaccines against things like masks and testing, which which, like all of those things, should be part of a unified, multilayered approach.

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S1: I mean, they might see it differently. I mean, they might say there are limited resources. And so we’ve chosen to focus on vaccination because we know it’s the most effective of all of these possible interventions. And so that’s that’s why we went in this direction. What would you say to that?

S2: I would say it is theoretically the most effective for an for an individual. Absolutely. If you pick one thing that gives a person the best chance of resisting this new virus, then yeah, get them vaccinated. But two things in that the Delta variant is transmissible enough that you can’t just rely on vaccinations alone to safeguard the society. You need to layer it with other protections. And also, vaccines are fantastic and almost miraculous and how effective they are. But vaccines are completely useless unless you can get vaccinations. The US has plateaued very early and at a quite low level of vaccinations compared to other countries that have widespread access. Consider that deaths from COVID per capita in the US, after all adults became eligible, are higher than deaths per capita in a 100 plus other countries before vaccines were ever available. That should alarm us. That should really make us think about what happens when you deploy very, very good medical interventions on a society where millions of people can’t access health care, where public health has been allowed to rot away for over a century, and whether a gross inequities in who gets to make choices that protect their own health.

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S1: Having questioned America’s pandemic preparedness for years now, Ed says people in public health have noticed this pattern. The U.S. has cycles of panic and neglect. So when there’s a national health crisis, a spigot of funding and public concern opens up. But then at the first hint that we’re on the other side of that crisis, the spigot shuts off. Leaders move on, ladies and gentlemen, the president of the U.S. There was a dramatic example of this this past summer. That’s when President Biden declared the pandemic all but over. On July 4th,

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S3: thanks to our heroic vaccine effort, we’ve gained the upper hand against this virus. We can live our lives. Our kids can go back to school. Our economy is roaring back.

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S1: This was just before the Delta variant walloped much of the country.

S3: You know, that’s how we’re going to stay ahead of these variants and protect the hard won progress we’ve made. We never again want to be we were a year ago today.

S1: You can hear in his speech, Biden saying the vaccines are here. We’ve solved it.

S2: So can you really just go in on one countermeasure? You’re very vulnerable when either you can’t get enough compliance with vaccination rates on high or if you start getting variants in the future that really start eroding into the protection that vaccines afford. But people have been saying since late last year that we needed layered strategies that complement each other. That didn’t stop being true this year. But we we kind of acted as if it was true. And to me, that reflects this very strong bias towards biomedical interventions.

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S1: I want to say two things about what you’re saying about prevention, because I think there are a couple of roadblocks I see just to the idea that you’re saying that we could have intervened in a different way earlier. One is that so much of our public health infrastructure, it’s shouldered by the states. So you look at a state like Florida where when it comes to testing for COVID, they’ve significantly ramped back their reporting and they’ve kind of made a unilateral decision on that. We’re not going to report daily. We’re in a different part of the pandemic. And so there’s not it doesn’t feel like there’s much that the federal government can do about that. When you’re relying on an individual state like that, that’s going to go its own way. The other thing I’d say is that. In some of these interventions, there’s this optimism, like with the masks, you talk a little bit about how, you know, the Biden administration basically said you can rip your mask off if you’re vaccinated, and it created this sense that masks weren’t as important anymore. But that was also meant to be a kind of incentive for people to get vaccinated. There was an intention behind it. And so I could sort of see why they made that decision. I guess what I’m trying to say is these things are pretty complicated.

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S2: I agree that it’s complicated, so I think actually we’re sort of in alignment here, right by both of these things are examples of the bigger problem that I’m talking about with this panic neglect cycle. So the idea of scaling back on state level data in Florida, for example, is a classic example of this. Things start getting better and then you pull back on the same measures that would have protected you in the first place. Same thing with the masking rollback, right? Like the minute things start improving, we already saw them headfirst into the neglect phase and we erode some of the measures that actually would protect us the next time round. You know, is it hard for the federal government to do very much when states are opposing them? Yes, and that is part of the problem. I will point out that Rochelle Walensky at the CDC did specifically say that their change in guidance was not, in fact, an attempt to incentivize people to get vaccines. So let’s just take that as as given. Even if that’s not the case, it is still trading off vaccines against masks like two of our best possible interventions in this pandemic. And it also it’s a move that is relevant to our discussions about the social causes of disease because it was a move that privileged people who had easiest and earliest access to vaccines the least vulnerable in our society, while also creating conditions that disadvantaged people who had a harder time like people. If you look at people who are unvaccinated, they are disproportionately likely to live in rural areas. They are disproportionately likely to have food insecurity, to have eviction risk, to work in grocery stores and agricultural settings. People who are in a more vulnerable state and those are the people who public health should be centering like always like the core of public health is equity, and that is what the field should be thinking of at all times. And that is the thing that is often lost. It is often seen as a sidebar to prevention rather than its central mission.

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S1: When we come back, how policymakers are trying to prepare us for the next pandemic and what they’re up against more with Ed Yong in a minute. Well, the Delta variant might have proven to add how unprepared the U.S. is for the next pandemic. He says there is good news. Plenty of people in Washington are trying to do better. The Biden administration recently released its pandemic preparedness plan, asking Congress for $65 billion over the next 10 years. But the thing is, even that is still well below what public health experts say they need.

S2: One thing that a few people mentioned to me was that that 65 billion. Two thirds of it is going into vaccines, therapeutics, diagnostics, which again seems so eminently reasonable given the way we think about pandemics and what it means to be prepared for them. But I would argue, as with several of the public health folks, I’ve spoken to, that that is insufficient. That is the wrong skew, given everything we’ve learned so far.

S1: I mean, one of the experts you spoke to gave this fiery quote, basically saying this is a welfare scheme for university scientists and big organizations, and it’s not going to trickle down to the people at the individual public health level. And I thought that was a really interesting way to frame it where this is bolstering people who want to make a vaccine real fast. But then the people who have to get the vaccine into arms potentially like, where are those guys?

S2: Absolutely. It is almost unbelievable to me to for anyone to look at what has happened over the last two years and think the solution to this is make vaccines faster. That just feels like people are stuck in this very old, deep rooted way of thinking about the problem and not actually looking at what has happened. Do we honestly think that getting vaccines faster would have fixed things for America, especially given that so many people said that the rapid development of the vaccine was a a reason for them to doubt that safety had been properly considered that the right checks and balances were in place like fast development was actually a reason for vaccine hesitation and a lot of people.

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S1: That’s such a good way to frame it because it just means looking back at the last couple of years and saying, OK, how do we do? And like, you know, getting a vaccine out there, we got an A-plus. We probably don’t need any extra support with that right. We got we got that. But getting the vaccine in arms, maybe that’s like a C-minus or lower right?

S2: And yeah, exactly. Like, let’s, you know, let’s give full credit to the vaccine development process, right? This was the one area in which in which America’s response completely exceeded expectations. And I don’t mean to undersell the vaccine development process. But what I want to do is to reframe how important that is as part of this bigger picture of preparedness. So the interesting thing about the Biden administration’s moves is that it has pandemic preparedness stuff that isn’t billed as such. Yeah.

S1: What do you mean by that?

S2: So the American Rescue Plan, in my view and in the view of several of the public health people I spoke to, is a pandemic preparedness bill. It’s just that almost everyone would not talk about it in that way. Why not? Because it has some stuff that is directly relevant to pandemics or seemingly is directly relevant to pandemics. It has provisions for strengthening the public health infrastructure, which are much needed, but it also includes things like child tax credit. It includes things that are that have been estimated to lift millions of people out of poverty this year. And my argument is that that is crucial to pandemic preparedness, whether you think about it in that way or not, and you should do. It is the case that if you make large groups of people less socially vulnerable, they will be better able to resist a new spreading virus. And that means thinking of preparedness, not just in terms of vaccines or drugs, but also in terms of things like paid sick leave, in terms of food assistance, in terms of safe, decent housing for people. It involves thinking about things like, you know, decarceration in our prison system, universal health care.

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S1: Well, so now you’re getting into social welfare stuff. I am where I think some people would begin to feel uncomfortable and it’s where we hit this impasse. And it kind of makes me wonder how. You think about it when someone like Joe Manchin, senator of West Virginia, gets up and says, I want to prevent us from living in an entitlement state, which to me means looking at those social welfare programs and saying we don’t need

S2: all of that. A lot of America already lives in an entitlement state. A lot of America lives very privileged lives. That affords them the ability to look after themselves and their health in the event of a pandemic and frankly, are blissfully oblivious about the centuries of social discrimination that allowed them to be able to do so. Like expanding that ability to care for yourself and to care for your community in the event of a new disease is saying that is entitlement. When you yourself have benefited from the fruits of centuries of institutional privilege is frankly absurd, and it’s looking at that problem in the wrong way.

S1: Here’s something I think about all the time, which is that it’s not politically expedient to do the right thing here, especially for someone like President Biden, who’s been in Washington such a long time like doing the real right thing here requires saying out loud. Me and my colleagues have been fleecing the public health system for decades at this point, and we need to get it back to a healthy baseline, and it’s much easier to say Republicans did this wrong or Trump did it wrong. Or, you know, it’s much easier to say, let’s just go back to quote unquote normal the way it was a few years back. I wonder if you think that political problem gets in the way here?

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S2: I do, and I think that is a problem for all of us beyond just policy makers like it is to really think about why we have been dealt such a heavy blow by COVID requires much more than pointing at, say, Trump or any one actor or any one party or any or any specific group of people. It requires actually grappling with a century plus of racism, of classism, of terrible policies, of a normal state that we have all sort of collectively internalized and agreed to accept, and that we are all complicit in people so badly want to return to normal without grappling with the fact that normal led to this in the world that we built was a world of intense inequality and therefore a world that was intensely vulnerable to a new pandemic. And if we just revert back to that world, we are going to be in the same situation. And you look, I know it’s really hard to think about this stuff, right? It keeps me up at night. I don’t love thinking about it because it’s it raises some very hard questions about who we are as a society and what we have allowed ourselves to tolerate. It’s like to really think about it is like staring into the face of straight into the sun. But what choice do we have? Having one pandemic doesn’t get us like a get out of jail free card, right? Like, viruses don’t like forming an orderly line. They’re not taking a no, and they’re not waiting for us to be done with this before the next one, but queues up.

S1: So but that’s how I want it to be.

S2: I know. I mean, Harry. No one wants to not be thinking about this anymore more than I do. I promise you this.

S1: Ed Yong, thank you so much for joining me. Thank you for having me. Ed Yong writes over at The Atlantic. And that’s the show. What next is produced by Davis Land, Danielle, Hewitt, Mary Wilson, Olena Schwartz and Carmel Delshad. We are led by Alison Benedict and Alicia Montgomery. I’m Mary Harris. You can catch me over on Twitter. I’m at Mary’s desk. Meanwhile, I will talk to you back in this feed tomorrow.