Coronavirus and the Coming Election

The first question at the final televised debate between President Trump and Joe Biden was about coronavirus. The candidates bickered over whether the outbreak in the United States is all but over, and in any case not that big a deal (Trump), or about to intensify, and indicative of the federal government’s dereliction of duty (Biden). Neither man offered much by way of specifics, but both mentioned vaccines.

That was a bad sign.

To be fair, Biden’s website outlines a plan for a large investment in testing and contact tracing, and to restore trust in government, in part by regularizing the provision of clear and accurate information about coronavirus. The plan would remedy one of the signal failures of the Trump regime, representing a 180-degree turn from its stream of speculation, self-promotion, slander of public officials, and outright lies.

But vaccination has been a focus for Trump, as it will be for Biden if he’s elected. Trump inaugurated Operation Warp Speed, a multiagency federal effort to give taxpayer money to private vaccine manufacturers with the ostensible aim of producing 300 million doses of an effective coronavirus vaccine by January 2021.

So far, Operation Warp Speed has delivered more than $10 billion to corporations, including $450 million for one company that is working on a Covid-19 treatment, not a vaccination: Regeneron, which is headed by a golfing buddy of Trump’s. The top scientist of Operation Warp Speed, Moncef Slaoui, holds stock in GlaxoSmithKline worth about $10 million, which, ProPublica reports, Slaoui refuses to relinquish even as he heads the effort to move public money into the company he has invested in. Three other Operation Warp Speed officials, ProPublica tells us, also have investments in companies working on vaccines, therapies, or coronavirus tests.

Will it be worth the cost to taxpayers, and the corruption, if an effective coronavirus vaccine results? Well, maybe. But only if Americans will allow themselves to be vaccinated. According to a study done by the survey research organization SSRS in early October, barely half of Americans are willing to undergo vaccination now, should there be a coronavirus vaccine at an affordable cost. About 45 percent said they wouldn’t even try.

If a vaccination project is going to have public health value, it has to reach everyone, or nearly so. But the current approach takes no note of vaccine reluctance, which has been increasing for some time now. Often, hesitancy to undergo immunizations is attributed to the rumor that vaccines are associated with autism. But that’s faulty reasoning. Clearly enough, immunization reluctance has to do with the decline in trust in the government, the dethroning of physicians as unimpeachable authorities as a result of widespread information access, and the general diminution of the sense of connectedness to communities and therefore a sense of obligation to help protect one’s neighbors. In addition to which, Americans have heard nearly four years’ worth of lies from the White House. More than two-thirds of respondents in the SSRS survey said they don’t trust much or most of what comes out of the White House.

On the grounds of maximizing its popularity, calling the coronavirus-vaccine program Warp Speed was an error. If you want people to trust a scientific project, surely it’s a bad idea to give it a name drawn from science fiction. Maybe this regime doesn’t know the difference.

Already, more than 50 coronavirus-vaccine candidates are undergoing testing worldwide, 12 of them now in efficacy trials. Such trials can establish that a given vaccine is capable of generating an immune response of the sort needed to prevent later infection. The U.S. Food and Drug Administration has announced that it is looking for a vaccine that can do so in at least 50 percent of those vaccinated. It could take some time before a candidate vaccine is produced that reaches even that modest level—January 2021 is an optimistic aim. It will take much longer to know whether a modestly efficacious vaccine can be delivered into human beings, and whether if delivered into humans it protects us from coronavirus infection. That is, vaccines can be efficacious at provoking an immune response without being equally effective at protecting human beings from infection. Even if it is, because the duration of immunity produced by coronavirus infection isn’t known, it will take some time to determine if any protection offered by the vaccine is durable. And it will be longer still before it is known whether such a vaccine dampens the virus’s spread.

Influenza vaccine, for example, is moderately efficacious at protecting you from infection with flu virus, but in most studies effectiveness doesn’t reach 50 percent. And at current levels of uptake—about 50 percent of Americans get a flu shot, with substantial variation by region, age, and group, according to the Centers for Disease Control and Prevention—flu vaccine has had no impact on influenza mortality nationwide, with only half of Americans getting immunized: influenza mortality has remained roughly the same, year to year.

The cards are stacked against the bet on a coronavirus vaccine. Given the Trump administration’s track record, it’s not surprising that its officials have been eager to use the opportunity offered by the outbreak to siphon taxpayer money into the hands of wealthy pharmaceutical executives. The CEOs of GlaxoSmithKline, Astrazeneca, and Pfizer each take home more than $10 million per year. And those salary numbers don’t cover the full compensation package each gets. Plus, the CEO isn’t the only executive at each vaccine company whose salary is in the multi-millions. Operation Warp Speed might or might not offer much benefit to the public, but it will certainly aid the wildly wealthy, including investors on the inside.

Set vaccination aside, then, as it will not end the outbreak anytime soon. What should the next administration do? Following any particular plan popularized elsewhere would be a mistake. The current furor over whether to take either a Sweden-like approach to accumulating natural immunity or to continue a state of emergency until there is a vaccine is naïve. To say that coronavirus is pandemic is to say that each nation, even each locality, must deal with its own version—because no epidemic can be divorced from the social forces that shape it or the cultural ones by which it is apprehended. No lessons can be learned from Wuhan (because the idea that American families would be locked into their houses or apartments for weeks on end is ludicrous), or Sweden (because our social services are delivered differently, if they are delivered at all), or even New York City (because the mayor’s and governor’s delayed and tepid response to what was self-evidently a hospital cataclysm let thousands die needlessly). The United States has to find its own approach, flexible enough to accommodate the vast differences among parts of the country. Because the Trump administration was more dedicated to having no approach at all than to a standard-but-flexible one, the response to coronavirus will have to be invented.

A Biden presidency could alter the course of the coronavirus outbreak, but only if the new administration emphasizes public needs. That will mean backing away from the giveaway to vaccine manufacturers, at least until one of them has a vaccine so efficacious that it deserves the chance to demonstrate that it can be widely accepted as well as highly effective, and therefore have public health value. It will mean doing more than just promoting social distancing and mask wearing. It will have to find a way to reverse the lack of faith in government endeavors that currently impairs even such valid public health approaches.

Testing and contact tracing sound great, but, as Mirjam Kretzschmar and colleagues show in an article in The Lancet, a delay of as little as two days in testing contacts, or a compliance rate of less than 80 percent (that is, the proportion of people who test positive who are willing to give information on their contacts), interferes with the effectiveness of the testing-tracing program. Many U.S. localities are far behind this standard. In late August, a number of states and municipalities were reporting that fewer than half of those who were sought for testing in local contact-tracing programs responded, Olga Khazan reported in The Atlantic. And a testing-tracing strategy tends naturally to lose its value as an outbreak expands; in the United States, with more than eight million known infections already, it might well be too late for this strategy to blunt the outbreak, at least until the case rate declines dramatically.

Coronavirus is with us for the near future, at least. It will be with us no matter who is in the White House come January. The challenges facing Joe Biden, should he be elected, will include promoting research into treatments for Covid-19 so as to continue to diminish the death rate; creating a national system for informing the public about the virus without overstating the likely benefits of contact tracing and testing or distancing; giving life to a now moribund system of surveillance and testing-tracing that can be of use for the next outbreak, whatever it will be; and finding a way, somehow, for American life to go on—not returning it to “normal,” which will not happen, but rededicating us to pre-Trump tenets like justice and decency—even though some people will continue to get sick with the new virus, and some, sadly, will die.

Very many reasons exist to turn Trump and his accomplices out of power. I hope that happens. But the coronavirus situation isn’t going to change merely because Democrats step in. A new regime will have to make fundamental changes to the current structure and ethos of public health. And it will have to find a way to soften the blow of coronavirus until the outbreak ends, as outbreaks do. Not the White House, not Congress, and not even both together, will be able to end the coronavirus outbreak abruptly. But life could be much better than it is, even with coronavirus lingering. That’s a disappointingly modest goal, but it is one that must be achieved.