On Sunday, November 8, President-elect Joe Biden and Vice President-elect Kamala Harris released the Biden-Harris plan to beat COVID-19—and on Monday they announced the names of the doctors and public health officials who will head up their coronavirus task force. The plan and the board members who will implement it are mostly to be celebrated. Still, both create cause for concern, particularly in regard to how incarceration, health care access and the persuasive (and bipartisan) ideology of ableism have plagued so much of the coronavirus response in the United States.
First, the good news: There is a national plan! “The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis,” it begins, correctly, and explains how it will test, treat and mitigate the virus. To my pleasant surprise, it mostly elides nationalism; even its call for an “American-sourced and manufactured capability to ensure we are not dependent on other countries in a crisis” isn’t overly jingoistic.
For months, President Trump has blamed China for COVID-19, while not only doing nothing to stop community spread within the United States, but also recklessly putting himself (and his wife, his son, his press secretary, his Secret Service detail, his rallying supporters, everyone who worked at the many venue where he dangerously held rallies, and seemingly as many people in the United States as possible) in the path of SARS-CoV-2. I was relieved to see that the Biden-Harris plan does not seek “to blame others”; indeed, it pivots from the anti-Asian hysteria of the Biden campaign’s own advertising. Instead, it outlines how they want to scale up a variety of testing, hire “at least” 100,000 people to provide contact tracing and support, and “fix personal protective equipment (PPE) for good.” This firm rejection of how Trump shamefully had states bidding against one another for masks and reportedly told them to “try getting [ventilators] yourselves” is a welcome relief.
Linguistically, I appreciate how the Biden-Harris plan assesses risk on a spectrum and proclaims that “Social distancing is not a light switch. It is a dial." It acknowledges that there are degrees between free-for-all socializing and lockdowns.
But I have mixed feelings about the creation of a “Nationwide Pandemic Dashboard that Americans can check in real-time to help them gauge whether local transmission is actively occurring in their zip codes.” While there are clear benefits to this approach, such data will likely also have deleterious consequences in terms of stigma and housing segregation.
Financially, I was relieved to read of a desire to “establish a renewable fund for state and local governments to help prevent budget shortfalls, which may cause states to face steep cuts to teachers.” The feds can always print money, while cities and states cannot, and it’s great that the new administration will use the pandemic to keep teachers employed and cities running as local tax revenues fall.
But I was more skeptical of the economics of addressing the crisis in terms of medical treatment. They promise to provide “$25 billion in a vaccine manufacturing and distribution plan that will guarantee it gets to every American, cost-free” and to “ensure all Americans have access to regular, reliable, and free testing.” Both of these are necessary, good and long overdue.
Still, while they are mostly promising free testing (but not treatment), I have concerns as they look down the road. In writing they want “everyone—not just the wealthy and well-connected—in America to receive the protection and care they deserve, and [that] consumers are not price gouged as new drugs and therapies come to market,” Biden and Harris reveal, however, that COVID-19 care won’t be free forever. “Once we succeed in getting beyond this pandemic,” they write, they promise to “ensure that the millions of Americans who suffer long-term side effects from COVID don’t face higher premiums or denial of health insurance because of this new pre-existing condition.” To do so, they promise “protections for those with pre-existing conditions that were won with Obamacare are protected.” But while Medicare for All would cover everyone, the “Medicare-like public option” they are proposing would still leave millions out.
The plan utilizes two phrases which arouse critical inquiry: a pledge to always “listen to science,” and the mischaracterization that public health “isn’t about politics.” It is dangerous to either “listen to science” unquestioningly or to think that a medical plan of this scope is not extremely political. Even though Trump seemed to ignore science entirely, science isn’t inherently good, and it’s certainly never any one thing. We can address COVID-19 with science, but science can sterilize an immigrant woman without her consent, and science can make an atomic bomb to kill hundreds of thousands. With a technocratic new administration, it’s important to be critical of the culture and politics of science.
Similarly, it would be dishonest to say politics has no role in health policy when health science is rigorously political. Who is being studied? Who is interpreting the data? Which populations are being tested? Who is receiving medications? Who is designing the studies, and how? These are all political questions.
Perhaps the most obviously political part of the plan is a proposed national mask mandate. While I want people to use them, I am not a huge fan of mandates. Requiring their use outdoors, for example, not only focuses on low-risk activity and puts vulnerable people at risk for policing; it can also turn people off to the need to use them in higher risk indoor settings. (Harvard epidemiologist Julia Marcus put it best: “It’s a bit like saying we’re going to ask people to wear condoms when they’re masturbating, because we think it’s going to get them to wear a condom when they’re with another person.”)
In terms of masks, condoms or any prophylactics, what I am a fan of is the power of modeling positive behaviors. In the 1980s, gay men did not get other gay men to wear condoms through threat of arrest; they did it through peer-to-peer education and by wearing them with each other. Similarly, the Biden-Harris campaign has modeled the use of masks beautifully for months. What I’d love for them to do now is revive a plan the Trump administration shamefully scuttled: the postal service’s intention to mail 650 million masks to Americans, along with funding to mail food to people in quarantine, get hotel rooms for those in isolation and provide financial relief to the struggling.
Perhaps the best political part of the plan: the establishment of a COVID-19 Racial and Ethnic Disparities Task Force that “will transition to a permanent Infectious Disease Racial Disparities Task Force.” To reckon with racialized health disparities is amazing and radically political. While I was concerned to see nothing explicit about incarceration in the plan given that it is a major driver of infectious disease in the U.S., I was thrilled to learn that Marcella Nunez-Smith of the Yale School of Medicine, who has co-authored research on the health disparities caused by imprisonment, will co-chair the overall Biden-Harris COVID task force. She will be excellent.
At the same time, I was deeply dismayed to see Ezekiel Emanuel appointed to the task force. In 2014, Emanuel published an ableist essay titled “Why I Hope to Die at 75.” In the most commonly reviled piece I’ve heard about in my reporting on disabled communities, Emanuel argues that old age “renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.” It is odd that a president-elect of some 77 years would appoint the author of this essay to a board overseeing a disease that mostly kills people in their 70s and 80s—and it’s especially disappointing since Biden had just shouted out to disabled people in his acceptance speech on Saturday night.
All told, it is an enormous relief to have a plan, and to have lots of competent people working on it. But while liberals love technocratic order, there is no consensus on how to equitably approach the most pressing public health challenge of our time. And so the most marginalized people who did so much to defeat Trump are going to get little rest before having to get back to work, in order to maximize how the Biden-Harris plan can become not just a blueprint for survival for some, but for liberation for all.