Covid-19 is the latest in a long line of pandemics to hit the US healthcare system since the late 20th century. There’s been HIV/AIDS from 1981, SARS in 2002–03, swine flu in 2009–10, MERS from 2015 and Ebola in 2014–16, each with their own challenges. However, the Covid-19 virus is particularly disconcerting and dangerous. Not only is it highly contagious, but asymptomatic carriers can involuntarily infect dozens of people in just a few days. Unfettered coronavirus transmission combined with the difficulty of imposing lockdowns has made it complicated to implement effective policy. What’s more, the pandemic has become both an important issue and a key to understanding the election of the 46th president of the United States. Joe Biden must fulfill his promises and do everything within his power to halt the pandemic.
On November 9, Biden announced that he had created a task force to “limit the spread of the virus” on January 20, 2021, the date he will be sworn in. Throughout November, he continued to make statements on this topic: “I am not going to shut down the economy, period. I am going to shut down the virus,” he stressed on November 19, rejecting the idea of a national lockdown. This stance is questionable. What means and tools does Biden – and, more widely, the American federal government – really have to fight Covid-19?
It should be noted that government policies against this kind of pandemic deploy three kinds of “protection” for citizens: the production of medical equipment (tests, masks, respirators, hospital beds), behavior regulation to slow down the spread (quarantine, social distancing, forbidding large gatherings), and communication to legitimize these safety measures and the government’s temporarily increased infringement of civil liberties. In the United States, American exceptionalism has led to a perplexing, asymmetrical political response against Covid-19 (with the federal government and state governors in opposition). The death toll of more than a quarter million Americans is there to serve as a reminder of the failures of that response.
A chaotic political response
That being said, the federal agencies that form the core of the US public health system – the Centers for Disease Control and Prevention (CDC), the Federal Drug Administration (FDA), the Public Health Service (PHS), the Federal Emergency Management Agency (FEMA) and the National Institutes of Health (NIH) – are globally renowned for their scientific expertise. These public institutions are equipped with unequalled powers of analysis, even in times of crisis, when risks are high and time is short.
These agencies should have been on the front line to produce an efficient political strategy, but with Donald Trump considering them the embodiment of the so-called “deep state” in the healthcare sector, they and their highly qualified staff have been subject to his erratic will. Trump, publicly denying the reality of the epidemic despite the information at his disposal, exacerbated the weakness of the federal government. Returning it to a position of strength will be a major challenge for the Biden administration.
In the meantime, faced with the federal government’s erratic response and a lack of national standards, each state governor has developed its own version of protective measures. The way regulations were implemented in the blue and red states has certainly been enlightening. Democratic governors Gavin Newsom (California) and Andrew Cuomo (New York), for example, quickly rolled out social-distancing measures, whereas Republican governors in the South and Midwest used the pretext of individual freedoms and prioritizing the economy to avoid doing so.
This chaotic political response against the pandemic has led to an irregular spread of the virus across the country. The 2020 elections have exacerbated these disparities even further. David Mayhew’s theory of “electoral connection” gives some insight as to why, when political tensions are high, the desire to be re-elected takes precedence over effective public policy. For Republicans, this translated as unwavering loyalty to Trump, even when it was revealed that he’d concealed how deadly Covid-19 was.
And let us not forget the “it’s the institutions, stupid” factor – that is, the fragmented organization of the US healthcare system, which explains why creating effective national policy in this area has always been difficult. These reasons also explain why creating a large-scale program to fight Covid-19 remains a challenge for the new leadership.
The executive order way
Research into the transition between the Obama and Trump administrations have shown that Republican officials explicitly ignored the “briefing books” (diligently drawn up by their predecessors). Similarly, the Trump administration largely ignored the “pandemic guidebook” created by the National Security Council.
President-elect Joe Biden, who has shown his desire to be surrounded by experts rather than ideologues, will certainly not repeat the same mistake. The ongoing debate around whether to give Deborah Birx, the Trump administration coronavirus coordinator, a role in Biden’s future Covid-19 task force shows how important the transfer of information between the two administrations is. Birx is not a Trump appointee, and held the role of US global AIDS coordinator under President Barack Obama. Furthermore, her experience has allowed her to develop relationships with state governors and key senior officials in the aforementioned health agencies.
This expertise would certainly be an asset to the Biden task force, which intends to rebuild from scratch the government’s efforts against the coronavirus. Dr. Anthony Fauci, a key player in the fight against Covid-19 and the director of the National Institute of Allergy and Infectious Diseases, will almost certainly be part of that effort, although we won’t know in what capacity until 20 January: Fauci still holds a position in the Trump administration. The fact that Biden has chosen Ron Klain, who has experience in managing the Ebola virus epidemic under the Obama administration, to be his chief of staff shows strong political will. This should bode well for an effective, realistic national communication strategy that will legitimize the use of social distancing measures. This would prevent PPE shortages and help implement a country-wide, efficient, coordinated vaccination policy. However, overly picky interpretation of bureaucratic regulations in force could still cause road bumps.
A politically polarized country
On the other hand, state governors and other municipal must issue decrees for a significant number of precautions (closing public schools, venues and administrations, mask mandates, etc.) to be brought into force. In the current polarized climate, a number of red state governors have stated that they will not impose mask mandates, specifically those of South Dakota and Nebraska. These Republicans argue that the recommendations from the Centers for Disease Control and Prevention aren’t legally binding, and that mask-wearing should remain a personal choice.
If the Democrats hold the political majority in both houses, Congress could play a major role to assist the executive branch in implementing a large-scale public health program by supporting executive orders and unblocking necessary public funds. However, the current gulf between both parties and Republican fealty toward Trump makes the idea of using wide-reaching bipartisan measures against the pandemic a distant fantasy. So Biden’s only option is to use executive orders. This will allow him to promote and support mask, test and vaccine production, and create greater contact-tracing capacity. As dictated by the separation of powers in the US Constitution, however, mask mandates and other such measures will remain the prerogative of governors and local authorities.
On January 5, 2021, two run-off elections will take place in Georgia that will determine whether the Democrats will regain control of the Senate. The party’s candidates are campaigning to expand access to healthcare, whereas the Republicans are repeating attacks about “socialized medicine” despite the pandemic’s deadly toll in their state.
Against this political backdrop, it is likely that electoral politics will prevail over Biden’s effort to forcefully eradicate Covid-19. The road to the end of the pandemic looks to be long and painful, even with the ever-present hope of a vaccine to save the day.
Translated from the French by Rosie Marsland for Fast ForWord.
Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur organisme de recherche.
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