‘Wrangling’ is how some journalists describe the chaotic decision-making enveloping Covid-19 vaccine distribution. The word connotes testy verbal dispute but that does not capture the chaotic nature of the public health policy making that may eventually claim the lives of half a million Americans. Understandably, reporters and editors tend to deploy softer language like that when they are uncertain who will ultimately be assigned political responsibility. Few journalists want the news media generally or their own news organization in particular to be scapegoated for the failure of others. Referring to the angry recrimination and extraordinary uncertainty that cloud the interaction between the Federal government, state governments and Big Pharma as ‘wrangling’ does sound rather less terrible.
The reasons for the chaos are clear enough however. Incompetent decision-making by the Trump White House hamstrung the bureaucratic response of the Federal government to the pandemic from the beginning, and every subsequent message from Trump seemed to further undermine its effectiveness. Trump and other Republican politicians were aware that members of demographic groups more likely to vote Democratic were more likely to succumb to the disease, and probably calculated that the electoral damage would be suffered by their Democratic rivals in Blue states like New York and California. That national leadership failure forced state and municipal governments to devise their own policy responses, some more effective than others.
The latest chaos takes the form of Trump administration and Pfizer management trading accusations over the shipments of the BioNTech vaccine. The Trump administration claims that the company is struggling to ship the vaccine in quantity. Pfizer management responds that it has vaccine sitting in warehouses awaiting shipment instructions from HHS and “Operation Warp Speed.”
Governors complain that their states are not receiving enough of the vaccine. Washington Governor Jay Inslee described his state’s 40% cut in distribution as “disruptive and frustrating.” Michigan Governor Gretchen Whitmer describes the Federal government’s distribution process as “slow walking.” That one of the loudest complainers is Florida Governor Rick DeSantis, whose incompetent performance in the pandemic echoes that of the outgoing administration, is eyerolling irony. DeSantis’s latest messaging reflects the scramble for political cover, blending in with the other governors now that Trump is of less use as a patron.
Big Pharma is obviously in it for the profits and ought to be lauded for the speed with which it has developed and is mass producing vaccine. That Americans will pay more for Pfizer’s BioNTech than citizens of the European Union is consistent with the general exploitation of American consumers in health care markets. We will be paying $19 per dose ($38 for the two dose round) of Pfizer’s vaccine while Europeans will be paying €12 or $14.70 per dose (€24 or $29.40 for the two dose round). Here too is further evidence of the risible negotiating skills of Trump and anyone else in his weird coterie.
America has actually experienced something like this chaotic policy making before. Although the images of Americans wearing facemasks persuaded many to compare it to the 1918 Spanish Flu, the better historical analogy is probably to Yellow Fever in 1878. That 19th century outbreak was the result of business interests successfully lobbying to reduce the time period that ships spent in quarantine. Longer quarantines were more likely to reveal disease among crew and passengers which could then be isolated before it spread the contagion. Decision-makers were aware of the risk to public health from Yellow Fever carried by ships from the tropics but commerce won out. When informed of the initial outbreak in Memphis, Republican President Rutherford B. Hayes dismissed it as “greatly exaggerated.” Even as the epidemic raged state governments were at odds over authority to set quarantines. Where Northern politicians demanded state control, Southern politicians demanded Federal control. The germ theory of disease was still disputed and medical experts disagreed about both the etiology of Yellow Fever and the best public health response. Health care provision collapsed in some cities as doctors and apothecaries fled together with wealthier citizens. Just as with Covid-19, deaths from Yellow Fever also presented a distinct demographic pattern: recent European, and especially Irish, immigrants were much more likely to die than were African-Americans. What 2020 shares most of all with 1878 is systemic failure. Federalism and pluralism may be wonderful in the abstract but the reality is that weak national leadership, fragmented response at the state level, and the sacrifice of public health to commerce meant that many died before their time.
So ‘wrangling’ among policy makers is just a symptom of deeper institutional malady. Preventing future systemic failures like this will mean insulating decision-making from the sort of incompetence and disruption performed in 2020 by demagogues like Trump and his epigones at the state level. If monetary policy is so important that it must be insulated from partisanship and corruption via an independent Federal Reserve, surely public health policy deserves a comparable level of protection. If the idea of Trump changing the value of M1 (in effect the money supply) via midnight tweeting episodes seems obviously wrong, then why isn’t it outrageous that a president could be permitted to ignore medical science and unleash an epidemic that kills hundreds of thousands out of personal resentment or for political benefit. Trump’s historical ‘legacy’ ought to include prevention of another disaster like the Covid-19 nightmare by circumscribing presidential authority over public health policy making.