December’s last-minute government funding package includes dozens of policy changes big and small, including a seemingly minor change to an existing executive branch job. This tweak represents a piece of unqualified progress for American governance. It should also prompt a moral reckoning, as President Biden chooses who will hold the position.
The White House is getting a permanent Office of Pandemic Preparedness and Response Policy. No longer will the White House have to find a “czar” to coordinate a disease-based public-health emergency, be it COVID-19 or AIDS or Ebola or SARS. The director of this new office will be nominated by the president and confirmed by Congress.
Biden is almost certain to nominate Dr. Ashish Jha as the inaugural director. Jha is currently the White House COVID-19 response coordinator. All parts of the federal public-health apparatus report to him when it comes to fighting the pandemic. The new director position will essentially be Jha’s job made permanent.
Let’s be extremely clear: It is an unqualified, non-caveated, absolutely good thing that the federal executive branch will now have a permanent office for preventing and preparing for pandemics. The COVID crisis has exposed what epidemiologists have known for decades: When people start getting sick, you really need to have someone who can make the policy engine run.
If that person is chosen because they know what to do in a pandemic (and not because, say, they’ve got ins with top Democrats), then future responses should hopefully be a lot better for everybody.
By the same token, this new director will also be the person responsible if public-policy responses to a pandemic are catastrophic. If people can’t find or afford treatments like vaccines, or preventative equipment like masks, we’ll all know who to blame. If public policy isn’t doing enough to stop the spread, and hospital staff are living in triage for literal months on end, we’ll all know who to blame. If death tolls rise to staggering numbers, we’ll all know who to blame.
Put another way, the policy views of the new director of the Office of Pandemic Preparedness and Response Policy are of grave moral importance. The way that this person thinks about the multivarious philosophical, economic, and political problems of public health will now be the expressly endorsed opinion of the president and Congress of the United States, with all of the gravitas and import that brings.
So, what does Ashish Jha think “being better prepared for pandemics” actually means?
BEFORE BECOMING COVID CZAR, Jha interviewed the chairman of Moderna, Noubar Afeyan, in late October 2021. Jha overwhelmingly flattered Afeyan, but prompted by an audience question, briefly asked how Afeyan “deal[s] with the fact that we’ve got to do a better job in general improving access to lifesaving medicines, and then specifically for this pandemic, what is Moderna’s obligation to help vaccinate the world, including and maybe particularly, countries and people who can’t afford it?”
This is a remarkably soft way of asking the question “How do you deal with the fact that your patents, trademarks, and other intellectual property restrictions are artificially constraining the supply of your lifesaving vaccine (which was co-created by government scientists) so you can make more money?” This is a grave moral question, one which has greatly contributed to the deaths of millions of people in the developing world.
Afeyan unsurprisingly trampled over the question. He shifted the conversation to musing about competition in nature, then blaming other global institutions (most of which were designed by pharma companies to protect intellectual property rights), then grumbling about supply chains. After a mild follow-up, Jha moved on, praising that vaccine production did happen to be increasing in the then-latest numbers, and thanking Afeyan “for your willingness to take on that question. I know I pushed you a little bit, but I’m grateful for your answer.”
It would be inappropriate to expect Jha to have a journalist’s steely will for asking hard questions. That particular skill isn’t needed in a public-health researcher, or a pandemic preparedness director.
But in his time as COVID-19 czar, Jha has not pushed at all to open restrictions on COVID-related treatments, or for the U.S. to finally join India and South Africa’s ongoing effort at the World Trade Organization to fully waive IP restrictions on all COVID-19 treatments. Earlier this month, the U.S. called to push back a decision on whether to expand a toothlessly narrow IP waiver they’d agreed to. It could take nine months to a year to complete the investigation the U.S. is now calling for prior to a decision, according to the People’s Vaccine Alliance.
Meanwhile, Jha has publicly declared it’s safe for Americans to gather for the holidays, despite steeply rising COVID-19 cases after Thanksgiving. Jha has shied away from stronger endorsements of masking as a preventative measure, even going so far as to say that there aren’t studies that show masking is effective, contrary to CDC and health expert guidance across the past two and a half years. Notably, he got the job at the White House after being a consistent foot soldier who defended the administration’s policies against critics in public health.
On vaccines in particular, Jha showed an awareness of the problem in April 2021, writing in The Washington Post about India’s COVID crisis. But he never mentioned IP once, instead advocating for the U.S. to send its excess medications. In August, he said that vaccines and other COVID treatments should be moved to “commercialization” in the regular health system, the system that has been unable to vaccinate large swaths of the underprivileged globally. More recently, Jha told ABC News that “we have broader supply chain issues with our medications,” while failing to connect that commercialization, and the consequences for health access, is one of the major reasons why.
LET ME STATE THIS AS PLAINLY as I can: If Jha is confirmed as permanent pandemic preparedness director, it will be dangerous to the world if he is a coward. Sometimes, to save lives, you need to make rich and powerful people very upset. If Jha is not willing to do that when necessary, then he should not be the United States’ point person for fighting pandemics.
The White House and Congress must understand that choosing the new pandemic preparedness office director is an extremely consequential moral choice. Given how the current front-runner appears more scared of angering billionaires than he is of millions dying, we should all be very worried.
This entire development in U.S. policy also marks a fascinating coda to the story of Sam Bankman-Fried. While Bankman-Fried was a fraudster, his philosophy of effective altruism did motivate him to establish a nonprofit that tried to improve U.S. pandemic response. This new office could possibly be seen as Bankman-Fried’s effort bearing fruit.
But the question of what pandemic preparedness actually means is still inherently political, as we’ve seen. Bankman-Fried’s goal of better pandemic policy may eventually cut against Bankman-Fried’s other personal priorities, and the priorities of others in his former wealth bracket, on IP and plenty of other topics. Eventually, to save the world, billionaires have to become less rich and corporations have to become less powerful.
We don’t get to run the counterfactual where Bankman-Fried isn’t in prison. We’ll never get to know if he eventually would have pushed his nonprofit Guarding Against Pandemics to go all in on IP reform. But given the history of tech moguls declaring themselves public-health saviors, when it comes to IP, I doubt it.
I would like for Bankman-Fried to have proven me wrong. I would like even more for Jha to prove me wrong. Here’s hoping.
PHOTO CREDIT: “Marty Walsh listening session with nurses (L-22-05-06-B-007)” by US Department of Labor is licensed under CC BY 2.0.