Bluesky

We’re closing in on five years of living with Covid-19. Anyone who has read my pieces in The Nation knows that I think the Biden administration’s response to the virus has been terrible, with the government essentially washing its hands of anything but a lackluster push for vaccination within a year or so. Many commentators, from David Wallace-Wells (many of whose New York Times colleagues were the downplayers-in-chief of the pandemic) to editors of major medical journals, have pointed out that we’ve “memory-holed” Covid and refused to learn the lessons it presented to us, even in the face of potential threats like H5N1 (bird flu).

The picture is not much rosier even if you put Covid to one side. Our life expectancy rankings lag behind our peer countries’, placing us in a pack with Albania, Panama, and Chile.

Kamala Harris has to do better. And, whereas a few weeks ago, I was mired in depression, planning on how to resist the next Trump administration, now I feel cautiously hopeful that she will have a chance to do so come January.

Where to start? The first step should be a “moonshot,” “Marshall Plan,” or whatever you’d like to call it, for our public health infrastructure. The Centers for Disease Control and Prevention almost always gets shafted when it comes to federal funding, and since much of the CDC’s funding flows out to local health departments, our towns and cities suffer as a result. It’s hard to believe it, but even after the worst pandemic in a century, Congress had the nerve to claw back hundreds of millions from the CDC in recent budget agreements, hobbling efforts against even old foes like syphilis, which is on the rise in the United States. We have a crumbling public health infrastructure around the country, and it needs to get fixed.

Americans will continue to be sicker and die younger than many people living in much poorer countries if we keep ignoring this crisis. No amount of fancy medical care is going to solve the fundamentals of the American dilemma, which is that many of the factors that drive health risks and health outcomes operate above the level of an individual patient, in what we call the social determinants of health. Only a dedicated, well-funded public health system will address those.

Next, we have to address the scourge of political interference in public health. During the height of the AIDS epidemic, many of us helped to fend off ideologues like Jesse Helms and others who fought HIV prevention efforts. During Covid-19, we took up the fight against the Trump administration’s nonsense around hydroxychloroquine and herd immunity. But shockingly, the Biden administration kept up the pattern of political interference.

Biden’s team pivoted away from its early plans for a robust, comprehensive plan against SARS-CoV-2, when they saw that it was politically easier to just “take the win” and declare mission accomplished. The blame for this resides squarely with political operators in the West Wing like Ron Klain and Jeff Zients and grifters who enabled them in my own profession. Public health took a backseat to political machinations, with the CDC and other health agencies on a short leash from the White House, from testing to vaccine access.

One way of insulating public health from political interference is to make CDC an independent agency. Soheil Shah from Brigham and Women’s Hospital and Howard Forman from Yale made the case for this at the start of the Covid pandemic in the journal of the American Medical Association, and Harris should consider this route.

There are many other proposals that could boost the health of all Americans, which should take center stage in a Harris-Walz administration.

It has been encouraging to see the campaign foreground the importance of the “care economy.” It’s impossible to care for ourselves if we can’t take care of those we love. Harris understands the need for basics of survival—housing, access to food, childcare, and elder care. These are all part of the “social determinants of health,” and making real investments in these areas will have a massive impact on human lives. In fact, the Boston Consulting Group has suggested that ignoring the “care crisis” is economic folly as well, putting at risk “$290 billion in GDP in the year 2030 and beyond, which is equal to the total GDP of the US state of Connecticut.” But Harris has an uphill climb as pundits like David Brooks at The New York Times call her proposals “economically illiterate” and his news-side colleague Reid Epstein calls the campaign light on policy, as if these are not fundamental policy questions. We need to have her back on these issues from day one.

Harris has wisely ignored the chattering classes for the past month, making her own decisions based on her own vision and instincts. Forward, as her campaign slogan goes. I feel optimistic that perhaps a Harris administration might take bold new steps to ensure the public health of all Americans for generations to come. Now we all have to “make them do it,” even if they may balk once they (hopefully) get into the White House. We’ve got to take the energy, the excitement many of us feel now and bank it for the months and years ahead. Because the change that needs to happen is not up to Kamala Harris and Tim Walz—it’s up to us.