Biden’s COVID Plan Is Better Than Trump’s, But Still Far From Sufficient

Joe Biden’s campaign promised to “build back better.” Better than what? one might ask. The Trump administration? That low bar hardly matches the expectations of the millions of voters who earlier this month risked health and welfare to make a change in our national trajectory.

Presuming Donald Trump’s electoral defeat will lead to little more than some revenge firings, a parade of pardons for any Trump fixers still standing, and a practice run at the mechanics of a rightist coup for next time, what does a Biden administration promise us come January 2021?

Biden’s transition team has released its program for the presumptive administration. Its economic plan continues the campaign’s careful efforts to circumvent any whiff of economic populism in the face of 65 million unemployment claims filed since March 2020, much less the more foundational matter of a bourgeoisie selling off of the infrastructure of empire at the end of the American cycle of capitalist accumulation.

Biden’s White House homecoming, New York Times columnist Charles M. Blow writes, is a restoration and not a revolution: “He is not so much a change agent as a reversion agent.” With U.S. inequality as measured by the Gini index the highest in the Global North outside Turkey, such a reversal may mark a revanche far more dramatic than merely, for some, a comforting return to Obama policy.

A Biden administration that acts upon the wishes of its largest donors risks reconstituting the preconditions that led to the emergence of Trump in the first place. Could the so-called moderates of the extreme center that turned a sure thing of an election into a nail-biter possibly miss the perils of resetting the political pins for a fascist of even a modicum of competence greater than Trump?

Well, yes, they could, and willingly so, if the short-term demands of the billionaire class serve as impetus enough.

That kind of cultivated myopia is already programmatic. The transition team’s plan to address the COVID pandemic dovetails with just such a regression. The plan’s objectives, and the adjacent task force selected to see it through, telegraph a campaign aimed at rolling back COVID without changing the system that brought about the outbreak and all the other deadly pathogens in the epidemiological queue.

Plan Points, Good and Bad

To begin, the Biden COVID plan sports some good starting points, even under the loosened constraints that anything proposed, in all likelihood, would exceed what a murderously negligent Trump administration never bothered to offer. “We’re not going to control the pandemic,” White House Chief of Staff Mark Meadows told CNN.

The Biden plan declares the new administration will “always” listen to science and public health professionals, and err on the side of transparency and accountability. It is time, Biden himself announced, “to end the politicization of basic public health steps.”

The plan calls for more testing — free and reliable — run by a Rooseveltian Pandemic Testing Board. Contact tracing would be run through a Public Health Jobs Corps. The Defense Production Act would finally be deployed to ramp up American-made personal protective equipment (PPE). Biden’s plan calls for a national mask mandate that, reading between the lines, appears more suggestive than legally enforced. But such a notice on high would clearly offer a better model than the mask-less pieholes currently flapping loose in a COVID-blitzed West Wing.

Although missing from the Biden COVID plan, presumably the incoming administration would be amenable to restoring an April U.S. Postal Service proposal (that Trump quashed) to ship masks to every U.S. household.

The Biden plan calls for the kind of federal funding for state and local governments running low from COVID outlays or tax shortfalls that the Trump administration out-and-out refused to provide in spiteful tightfistedness.

The plan places vaccine rollout in the hands of scientists and federal staff, who will oversee safety, upload testing data for all to see, and testify to Congress uncensored about the campaign’s logistics. It calls for $25 billion for vaccine manufacturing and distribution, free vaccines for all, and a handwave of a declaration opposing price gouging for any other new therapies. Enforcement will be key, as hospitals and insurance companies continue to charge patients for federally subsidized COVID tests.

The plan also calls for establishing another task force, one to offer recommendations around racial disparities in COVID and other diseases.

It calls for creating a pandemic dashboard tracking local transmission at the zip code level. Publicly available COVID data are presently available at no finer level than U.S. county, although New York City just began to offer such zip code level reporting.

Swerving past the entirely expected bump in the road that no plan survives its implementation, much is also missing from the very start here. And it isn’t merely a matter of operational planning. With good will, funding and the right people, that’s fixable. What’s carefully omitted from the plan is more emblematic of the U.S. political class’s ideological presumptions — in this case, imprinted upon a major public health crisis.

Right up front, we get a sense of what the administration views as its America. The Biden COVID plan speaks of families, small businesses and first responders, but not communities. The gap embodies a classical liberalism, the dramatis personae cited representing, respectively, the means of reproducing workers, petite capital and the state’s capacity for biopolitical intervention. Pathogens spreading far and wide rarely respect such utilitarian demographics.

Other “essential” heroes are similarly positioned. Threaded through the plan isn’t just a respect for science’s place in helping infer the realities of an outbreak, something Trump abandoned. We also see science’s longstanding role in upholding governance of a particular class character.

Indeed, a particular brand of science underlies the plan, setting the needs of the donor class ahead of stopping the COVID outbreak in any rapid order. The plan, for one, calls for hiring 100,000 Americans as part of a Public Health Job Corps to aid in contact tracing. That certainly sounds like a lot, but isn’t nearly enough by an order of magnitude.

The U.S. outbreak is presently off the charts at 11.4 million accumulative cases. COVID incidence clocked in as high as 193,000-plus daily cases this past week, with more than 2 million infected and over 15,000 dead since the start of the month, just as we are entering the winter wave of infections. Texas alone has accumulated a million cases since March. California just joined that club. South Dakota is testing anywhere from 17 to 58 percent positive for COVID, depending on the measure, a staggering infection load.

Hospital capacity is maxing out across 18 states, with overflow patients getting shuttled to other hospitals or released early. Exposed health care workers are being forced to shorten their quarantine periods to return to understaffed wards.

The Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University offers a county-level U.S. map of estimates of the number of contact-trace workers needed based on population size, tracer workforce and the present outbreak load. Even under heroic assumptions as to what contact tracers can accomplish daily, the projected personnel needed exceeds the Biden plan’s capacity. For example, the metropolitan regions of Minneapolis and St. Paul alone would need 6,000 of those 100,000 tracers the Biden transition team proposes, hardly anywhere near what is necessary to control the outbreak, even combined with the measly efforts by the states so far.

Of course, contact tracing depends on a lot more than infections and workforce. As ProPublica describes, counties with meatpacking-driven outbreaks are having great difficulty tracking cases among immigrants, many of whom speak other languages, don’t have phones or don’t want contact with state officials for reasons of immigration status under Trump’s Immigration and Customs Enforcement.

So why the numbers gap between infections and Biden’s contact tracers? The political class here simply can’t afford the possibility that U.S. governance in late empire, focused on corporations and the stock market first, suddenly would be centered on hiring the American people to help the American people. FDR bunting is being placed on an austerity parade float.

The plan’s numbers at best represent only a gesture toward the kind of public health responses which countries as different as Vietnam, New Zealand and Iceland have demonstrated are necessary to get the outbreak under control in two months’ time without a vaccine available.

What does it mean if the Biden administration, knowing full well the scale of response other countries have engaged to stop their outbreaks, begins budget negotiations with a Republican Senate for contact-tracing hires using numbers far from adequate for solving the problem?

There is an “anti-state-state” in the business of closing out interventions for everyday people in favor of interventions in favor of the powerful — even, or especially, for a pandemic encroaching upon both. Contrast, as historian Robert Brenner showed for the CARES Act, the open spigot with which entire industrial sectors were funded and the lousy one-time $1,200 for everyone else.

Any righteous effort to control the outbreak would pay everyone to stay home for as long as a year, even should the two leading vaccine candidates prove efficacious. For a virulently capitalist state, however, such a reserve army of labor is allowed to fallow only so far as it disciplines those millions who are forced to work to survive, including during a dangerous outbreak.

In this context, lockdowns are suddenly turned into a front in a class war of neoliberal public health’s own making. For the more affluent able to electronically commute, “winning” racial capitalism never felt so redemptive.

From the very start of the city’s outbreak, New York’s subways were filled with Black and Brown workers on their way in to work servicing the stay-at-home professional managerial class. Out in rural America, the Trump administration forced immigrant meatpackers back into COVID-splattered plants to help agribusiness supply the Chinese market. No governor in the Midwest or the South, Republican or Democrat, will lift a finger to roll back such labor discipline. And now that Trump’s done the dirty work, neither will Biden.

Objectives Domestic and International

A Biden COVID campaign that outstrips Trumpist neglect to mainstream applause can still represent a white flag waved at the virus. Controlling COVID isn’t the primary objective. As for the Trump administration, opening the economy back up is. The agreement was most certainly the substance of the phone call Trump and Biden shared in April. What differentiates the Biden effort is its conclusion that controlling enough COVID is necessary to make opening back up work.

The tension in balancing those two expectations is palpable, verging on nigh unintelligible strategy. In his first policy speech post-election to a room of business and union leaders, Biden said, “We all agreed that we want to get the economy back on track, we need our workers to be back on the job by getting the virus under control,” adding that the U.S. is “going into a very dark winter” and “things are going to get much tougher before they get easier.”

The Biden plan accepts the premise that social distancing must be calibrated with keeping the economy going. “Social distancing,” the plan claims,

is not a light switch. It is a dial. President-elect Biden will direct the [Centers for Disease Control and Prevention] to provide specific evidence-based guidance for how to turn the dial up or down relative to the level of risk and degree of viral spread in a community, including when to open or close certain businesses, bars, restaurants, and other spaces; when to open or close schools, and what steps they need to take to make classrooms and facilities safe; appropriate restrictions on size of gatherings; when to issue stay-at-home restrictions.

Flexible decision-making is always at a premium as outbreak circumstances shift, but the expectation we can so finely dial efforts in and out in time and space appears already a lost cause with an infection that spreads before symptoms appear.

Successful efforts controlling COVID abroad didn’t operate under the premises the transition plan imposes upon the U.S. The Biden plan locks an “evidence-based” CDC into the assumptions of a notorious model an Imperial College team presented early in the outbreak. Rather than the kind of all-out disease suppression China and other countries have successfully demonstrated, the Imperial model suggested the U.S. and U.K. could toggle in and out of community quarantine as triggered by a set level of critical care beds filled.

Why err on the side of the kind of reopening that other models indicate routinely lead back to the pathogen rebound that keeps the country a COVID sink? The primary objective is to keep the economy running, giving the little people of the country the money they need to survive only if they help someone else make profit.

Other plan points are organized around analogous predicates. The Biden plan issues a general call that patients suffering long-term COVID infections shouldn’t be subjected to higher premiums or denied coverage for “this new preexisting condition.” The plan accepts the concept of preexisting conditions, an insurance company contrivance denying all of us a right to a life history, and that insurance — even with a public option — should be anything but free to all. Under the plan, drug prices aren’t to be capped. Pharma executives are only to be shamed for a marketplace that Washington helped build.

In short, the “evidence” behind these interventions is tied directly to the prime directives of the society into which the Biden administration is to intervene. As my colleagues and I described the matter in March, “Models such as the Imperial study explicitly limit the scope of analysis to narrowly tailored questions framed within the dominant social order. By design, they fail to capture the broader market forces driving outbreaks and the political decisions underlying interventions.”

The same ideological finger trap is found in plan objectives directed internationally. The transition team uses disease as a new cold war cudgel, perhaps unsurprisingly, as even without reference to “Chinese virus” or “Kung flu,” Biden ran to the right of Trump on China.

The plan calls for reestablishing the White House biosecurity directorate Trump dismantled. It calls for relaunching PREDICT, the USAID program that sent U.S. scientists abroad to investigate early signs of potential pandemic strains. It calls for reestablishing the CDC’s Beijing office.

All these efforts are organized around the notion that infectious diseases originate offshore, “including those coming from China.” The insistence on externalizing disease is a time-honored practice, but offers very little in terms of preventing the pandemics almost certainly to follow.

The focus on specific GPS coordinates where deforestation or bushmeat might lead to a novel pathogen spilling over into locals misses what’s driving emerging diseases. A more relational geography tags places such as New York City, London and Hong Kong — key centers of the financing backing the deforestation and development that drive new infections — as the worst hot spots. U.S. investment firm Goldman Sachs owns farms in China’s Hunan and Fujian provinces, but foreign direct investment pings so far and wide across the globe that the bourgeoisie across countries emerge as one big (albeit fractious) family.

If not by Trump’s death cult incompetence, the best and brightest of the Democratic Party are as constrained from acting upon this understanding by the prime directives of an imperial political economy. Biden himself took great pride in spearheading the Obama effort on Ebola in West Africa, but the administration’s public health record was, at best, checkered with well-run failures.

It was under the Obama administration that swine flu H1N1, Ebola Makona, H5N2 (and other H5Nx), Zika, a cholera of UN sourcing in Haiti, the vaccine gap for yellow fever, H7N9, Ebola Reston, MERS in industrialized camels, the opioid crisis and a surge in antibiotic resistance emerged.

Such public health problems are no “natural” phenomena. We could have learned more, but it was Obama’s National Science Foundation and National Institutes of Health that failed to fund scientific efforts to explore the roles agribusiness, deforestation, structural adjustment and global circuits of capital played in these outbreaks.

Obama’s wars contributed to global morbidity and mortality, including to the 1.3 million deaths since 9/11 in Afghanistan, Pakistan and Iraq alone. It was his bombing campaigns and proxy wars that helped spread cutaneous leishmaniasis across Syria, Eastern Libya, Yemen and Iraq. It was the CIA’s operation against Osama bin Laden that helped destroy Pakistan’s polio campaign.

It was the Obama administration’s refusal to bail out homeowners that allowed mosquitoes to incubate in the pools of abandoned California homes, leading to an outbreak of West Nile Virus. It was that administration’s refusal to seriously address consolidation in the food sector that allowed foodborne outbreaks to increase in deadliness and geographic extent. It was Obama’s CDC that only a couple years before the measles outbreak at Disneyland tagged Disney as blameless for outbreaks (a carte blanche it refused to extend to the Hajj).

It was the Obama CDC that built in anonymity for U.S. megafarms that prove sources of avian or swine influenzas that infect even humans. The strain typing and pathogen genetic sequencing conducted by the National Animal Health Laboratory Network, including at several federally funded public universities, were to remain confidential and for the livestock industry’s eyes only.

All these failures were organized, identifiable even then, around serving capital and U.S. might first. The failures hit close to home, including a public health system that, over 40 years of neoliberal management, was both neglected and monetized.

Indeed, the U.S. itself was a source of a pandemic. Contrary to the Biden plan’s view of disease “out there,” U.S. hogs were identified as the source for multiple genomic segments that contributed to the swine H1N1 strain that emerged outside Mexico City in 2009. The meat dumping that permitted American companies to break into the Mexican market served as due cause why our group called the pandemic strain “the NAFTA flu.”

Successive administrations across party, including now Biden, have refused to acknowledge or act on the U.S.’s responsibility in helping drive new infections.

Biden’s COVID Advisory Board Is a Mixed Bag

The Biden COVID plan, then, offers a few good objectives bordering on obvious common sense. Several others are tellingly bad, permitting COVID the structural elbow room no country placing public health first would allow. A model published earlier in the year offered that under the most pessimistic circumstances, we might be stuck with COVID-19 through 2024. The conclusion seemed impossible to believe then.

The people invited to serve on Biden’s COVID advisory board are similarly a mixed bag, embodying a mash of interests and ethoses already baked into the plan.

Marcella Nunez-Smith is one of the advisory board’s three co-chairs. She is the associate dean of health equity at the Yale School of Medicine. Taking Kamala Harris’s cue, the Biden team is jumping on the racial disparities COVID represents. The numbers are staggering: Black and Latinx COVID mortality rates are nearly twice that of the white population. Nunez-Smith appears an inspired choice to turn such stats into remediation, not just for COVID, but, as the Biden plan promises, public health beyond.

The approach may suffer an epochal drag, however. From Bill Clinton to Hamilton, the centrist wing of the Democratic Party has used such disparities as part of a boot-straps narrative. Four hundred years of racial capitalism and counting represent a perpetual Act One toward individualist redemption. A talented tenth can serve as an adequate placeholder in the political class running what historians Walter Johnson and Monica Gisolfi and geographer Ruth Wilson Gilmore describe as a modern plantation of a country. On the other hand, as Keeanga-Yamahtta Taylor has written, such symbolic appointments aim to corral the votes of Black people, Indigenous people, and people of color for another generation.

Sociologist Sonia Bettez found in the late stage of the Clinton administration, such “disparities” discourse served as a deflection from the structural origins of public health damage:

“Health disparities” emphasized race and ethnicity, individual responsibility, and medical care. This narrow focus omitted and diverted attention from root causes such as growing structural inequality, thus exculpating government of responsibility and forestalling socio-economic change. My analysis suggests that, because of their elite positions and qualifications, individuals who contributed to the discourse in government participated in transforming health inequities into “health disparities.”

Sociologist Elizabeth Wrigley-Field turned the classic disparities analysis the Biden administration appears ready to re-embark on in the other direction. She used COVID to show the structural inequities embedded in the country. It would take 400,000 COVID deaths among white Americans to bring up their mortality rate to the lowest mortality rate Black Americans have ever suffered in all the years records have been kept. Everyday racial inequality is already as deadly as a pandemic.

Michael Osterholm, an infectious disease expert at the University of Minnesota and another advisory panel member, has a reputation for speaking frankly on matters of pandemic danger. He’s appeared on “Oprah” to talk tough on swine flu H1N1. In the face of deep antipathy, he recently called for another four- to six-week lockdown for which workers should be paid to stay home, a position Biden steered clear of. Osterholm is exactly right here and such an intervention should be extended longer if necessary.

But Osterholm’s tell-it-like-it-is is tempered by taking money from the poultry industry and a loyalty that has placed the imperium before scientific judgment. Osterholm recently spoke on the likelihood the next deadly influenza would emerge from poultry and hogs, but he long carried water for those industries. In 2010, he argued that “the best and safest poultry production in the world right now is occurring in … very large facilities, where biosecurity is actually very high.” He asserted a single agribusiness company producing 70 percent of all poultry in India represented the best in production, with high standards of biosecurity and an excellent safety record. All H5N1 strains across Asia, even low-pathogenic serotypes, have been limited to “backyard range production.” The same held true in the U.S., with migratory waterfowl the source of infection: “[We] see very, very, very little influenza virus activity in our poultry production, where we have high biosecurity [as] required in large facilities.”

Setting aside Osterholm’s false dichotomy between backyard and intensive production, H7N9 in China, H5N2 in the Midwest (including across the industrial barns of his Hormel benefactors), and all the other H5Nx found in industrial poultry in Europe disproved Osterholm’s blanket assertions about industrial biosecurity down to bone and gristle.

Upon COVID-19’s emergence, Osterholm joined a coterie of U.S. epidemiologists who attacked China. Ma Xiaowei, the head of China’s National Health Commission, announced in January that SARS-CoV-2, the virus that causes COVID-19, could be transmitted before symptoms appeared. “I seriously doubt that the Chinese public officials have any data supporting this statement,” Osterholm told CNN. “I know of no evidence in 17 years of working with coronaviruses — SARS and MERS — where anyone has been found to be infectious during their incubation period.”

It’s remarkable that an epidemiologist of such experience would presume an RNA virus, even one that doesn’t mutate at the rate of other such viruses, couldn’t possibly evolve into a novel life history.

Ezekiel Emanuel, brother to the former Chicago mayor and Obama chief of staff Rahm Emanuel, represents a more odious addition to Biden’s COVID advisory panel. In 2014, Emanuel argued against the worth and meaning of elderly life. He waxed against the tyranny of rising life expectancies and elongating morbidity. While Emanuel initially set his position in terms of his own life (and death) choices and opposed assisted suicide, he painted his premises as matters of universal application. Along the way he omitted the class basis of his good health and family fortune and conflated productivity and well-being.

This isn’t a misreading of his argument, as Emanuel later claimed. Five years later, Emanuel recapitulated his position to MIT Technology Review in stronger terms. It’s not just the dissolution of old age we need to avoid:

These people who live a vigorous life to 70, 80, 90 years of age — when I look at what those people “do,” almost all of it is what I classify as play. It’s not meaningful work. They’re riding motorcycles; they’re hiking. Which can all have value — don’t get me wrong. But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life.

Emanuel’s argument serves more broadly as a neoliberal medical ethics, offering a rationale for rationing health care at a time when diseases of despair began to ravage rural areas that were turned into agribusiness sacrifice zones. Rural decline underpinned unprecedented decreases in American life expectancy, especially among poor and working-class whites in the Midwest and South, with the counties suffering the worst health declines undertaking the greatest switches from voting Obama 2012 to Trump 2016.

Such an ethics, accepting the zero-sum of health care for profit at face value, folds in with the rightist necropolitics that emerged around COVID this year: save the economy, let the old die. We must ask what Emanuel’s appointment to the COVID advisory board will mean for Biden’s interventions in nursing homes and hospital triage. The appointment was not made without due vetting.

Match COVID Scale for Scale

None of us need pass our own understanding of COVID and its solutions through Joe Biden and his advisory board. We can pursue another program beyond Trump and Biden both.

Apply proven interventions. Take notes and apply lessons already learned beating COVID in countries the world over. China built a COVID-dedicated hospital in 10 days and flooded Hubei, the center of the initial outbreak, with 40,000 health workers. New Zealand implemented travel restrictions, placed incoming travelers into quarantine for 14 days and tested them regularly. That country canceled public events, restricted gatherings, closed workplaces, deployed stay-at-home orders, restricted internal movements, restricted public transport to essential workers, closed schools, tested all symptomatic patients, tested selected asymptomatic people, provided income support replacing 50 percent and more of lost income, and coordinated public information. Two very different countries, their national campaigns in disease suppression without a vaccine, resulted in people being able to walk free outside without masks in four months’ time. Should we feel four months is too long? We’re already in month nine here stateside and worse off than in March.

Go for knockout. Aim for COVID suppression. Gear up a national response to meet COVID scale for scale. Set a provisional deadline for the suppression campaign to give people an end date to which to look forward. Such a deadline will put impetus on the governments across jurisdiction to follow through with the task.

Scale up community health for the pandemic we have (not the one we wish we had). Nationalize hospitals out from the onus of profits (and from the logic of firing medical staff during a pandemic). Scale up hospital capacities, both urban and rural. Enforce health-based protocols and time off among health care workers to reduce staff decay. Socialize pharmaceuticals, not just testing. Supercharge all testing to within hours to permit contact tracing to work. Hire and deploy a million contact tracers. Hire and deploy a million community health workers to check up on people who need assistance in their homes — not just for their physical health, but for their emotional well-being. Win trust for a working vaccine with a full safety check.

Suspend capitalism. That trust won’t be won by denying people the means by which to survive the cure as much as the illness. Direct deposit monthly checks to all U.S. households. Enforce rent, mortgage and debt abeyance. Municipalize restaurants and grocery stores to serve local neighborhoods free food. Retrofit and deploy hundreds of thousands of food trucks to cook meals house-to-house. Municipalize neighborhood brigades and other forms of mutual aid for compulsory stints of several days for able-bodied residents followed by quarantine.

Celebrate pandemic’s end. Upon the end of this outbreak, continue mailing support checks and insisting on debt abeyance to cover our return to day-to-day community life and a national celebration.

Reintroduce agriculture and nature. To keep other such pathogens from emerging again, we must end global agribusiness, logging and mining as we know it. We must preserve forest (and wetland) complexity, maintaining ecological buffers across bats, geese, other natural disease reservoirs, our food animals and our communities. We must reintroduce agrobiodiversity into livestock and poultry to serve as an immunological firewall against deadly pathogens both on farms and across landscapes. We must return to letting livestock reproduce on-site so that herds and flocks can protect themselves against pathogens by tracking immunity in real time.

Return rural sovereignty. Such interventions require unplugging rural communities as agribusiness sacrifice zones in favor of returning their locus of control. We must turn to the kind of state planning that centers farmer autonomy, community socioeconomic resilience, circular economies, integrated cooperative supply networks, food justice, land trusts and reparations. We must undo deeply historical race, class and gender trauma at the center of land grabbing and environmental alienation.

Imagine humanity beyond the market. On the world stage, we must end the unequal ecological exchange between the Global North and South. Healing the metabolic rift between ecology and economy that drives pathogen emergence at the heart of modern agriculture demands we plant a different political philosophy that treats agriculture as part of the ecosystemic functions — clean water, rich soils, probiotic ecologies — upon which humanity depends. We must shift our mode of social reproduction toward a regimen of degrowth, decolonization, developmental convergence, debt cancellation, and disalienation of land and labor.

Such an ambitious program of interventions is required beyond the COVID-19 virus, still evolving new variants in humans and other animals. Other coronaviruses, avian and swine influenzas, African swine fever, and a veritable zoo of other potential pandemic strains circulate unscathed across agribusiness-damaged landscapes. Without a fundamental shift, under the Biden administration, these pathogens will be left to meander into a series of pandemic escapes, one after another.

Many of these alternative interventions are already under way elsewhere. Despite the global nature of pandemics (and climate change), some countries are converging on foundational shifts in social ecology in response. The U.S. can join them, but only upon freeing itself of a system that by dint of its structurally enforced power dynamics treats the public commons as a play thing for the wealthy.