Rejecting Profit-Driven Public Health Systems Key to Combating Future Pandemics 

Interview with Hanna Ehrlich, a doctoral candidate in epidemiology at Yale University's School of Public Health, conducted by Scott Harris

Before President Trump’s recent request to Congress for $2.5 billion in emergency funds to prepare the nation for the worldwide outbreak of coronavirus, over the previous two years his administration largely dismantled government units that were established to protect the U.S. from future pandemics. In 2018, the White House called for the elimination of funding for the Obama-era disease security programs. That same year, Rear Adm. Timothy Ziemer, who was to lead the U.S. response in the event of a future pandemic, resigned, and his global health security team was disbanded.

Because the Trump regime requested no additional funds, the Centers For Disease Control and Prevention was forced to cut its global epidemic prevention activities by 80 percent in 2018, downsizing its efforts in 39 out of 49 countries, including scaling back its activities in China. Also cut was the State Department’s Complex Crisis Fund, $30 million available to dispatch disease experts in the event of a crisis.

Between The Lines’ Scott Harris spoke with Hanna Ehrlich, a doctorate candidate in epidemiology at Yale University’s School of Public Health. Here, she discusses her recent Jacobin magazine article, “Here’s How We Can Stop the Next Coronavirus,” that advocates for building a public health system that rejects “philanthrocapitalism” and prioritizes reliable funding for global preparedness over corporate profits.

HANNAH EHRLICH: I don’t want to incite panic nor underplay the level of the threats. I think that basically there is consensus among the public health community that there will be sustained transmission within the United States, which means we will see communities, the spread of the coronavirus around communities and around cities. There have been predictions that as many as 40 to 70 percent of people will get the virus. And that doesn’t mean they’ll get sick from it, because we think that there is asymptomatic transmission – meaning you could get a mild or no case of the disease. But you could still potentially spread it to others. And so, there’s still a lot of unknowns as data’s coming out. I will say that the science around this outbreak has been really unprecedented and amazing. There’s been a ton of open data sharing and collaboration among scientists.

I don’t necessarily want to like give it a grade, but I think that there are certainly things that the government could be doing better and things that they’re already doing a great job with. I think the sort of primary issue right now is a lack of transparency and open, clear communication. So the NIH is saying something, the CDC is saying something else and the Trump administration is saying a third thing. And all of that incites confusion and a distrust within the world of public health and outside of it. And so, I think that we need to have a clearer and more concise channel of communication so that individuals like you and me can actually know what’s going on day to day in the U.S.

SCOTT HARRIS: Now, many of our listeners might be familiar with the fact that the Trump administration has cut back on many public health agencies’ funding. In May 2018, Trump ordered the National Security Council’s entire Global Health Security units shut down. And, there’s been other examples of calls for cuts in public health funding that many people might view as essential, especially now in hindsight. Tell us a bit about what you knew about from being on the inside.

HANNAH EHRLICH: Even just in terms of the NIH annual budget, we’ve seen slashes over the past few years, which means that the research that we’re doing here at the School of Public Health, but elsewhere also can’t be done to the same extent. A lot of those budget cuts were proposed but haven’t actually passed, but some of them have. And so as a whole, we’re less prepared under Trump’s administration than we were under Obama; even then, we’re still not in that great of a place. Yeah, I think that when we think about preparing for the next virus, we really have to think about funding to strengthen our own systems as well as those elsewhere.

SCOTT HARRIS: Hannah, explain the kind of systems in place globally to deal with these pandemics and something that you refer to — the term you use is philanthrocapitalism and really depending on the profit motive to prepare the world for these kinds of regional or global epidemics and pandemics. Tell us what’s wrong with that and how you propose it can be fixed.

HANNAH EHRLICH: We’re probably mostly aware of the Ebola outbreak that happened in West Africa in 2014 to 2016. This was the largest Ebola outbreak in human history. It was unprecedented in a lot of ways. For example, we thought that Ebola was a disease that really only affected small rural populations, but it came into city centers full force. There was a sort of shock within global health in thinking about how underprepared we are for this kind of outbreak. And to me it led to what was a pretty bizarre approach or response to this which came through this idea of philanthrocapitalism. And just to explain a little bit more, this is a way of doing philanthropy that mimics for-profit business models and started with foundations of oligarchs like Rockefeller and Carnegie. But has continued onwards with Zuckerberg and Gates, the sort of latest example of this in terms of outbreak responses following that Ebola outbreak. The World Bank developed something called the pandemic emergency financing facility as a way to fund rapid rapid outbreak outbreak response.

And what this meant was that investors – billionaires, countries, whomever could buy pandemic bonds at high annual interest rates for specific diseases. So you could buy a bond and sort of bet on the likelihood of a new ebloa outbreak over that bond limit period. So say within the next three years and if that outbreak were to occur, you would lose your money and that money would go towards the Ebola outbreak. But if it didn’t occur within those three years, you would get your money back plus some. Essentially, this model wasn’t very appropriate to this crisis. So not only did an outbreak have to occur, but it had to meet very specific stipulations. So, for example, basically an outbreak had to kill enough people at enough places.

So right now there’s an outbreak going on of Ebola in the Democratic Republic of the Congo. It’s been going on for a long time. Thousands of people have died and yet investors are cashing in on the Ebola bonds, these pandemic bonds, while none of the money is going to the DRC. And that’s because the DRC outbreak hasn’t spread sufficiently outside of that country. And so the World Bank is not willing to give that money up because it doesn’t meet these specific criteria.

The next part of this question – right, is what kind of system would I recommend? You know, when we think about preparedness, we have to be doing a better job preventing sickness globally through universal health care, identifying diseases quickly, i.e., through strong research networks and healthcare systems and then containing those diseases at their source. And so a lot of these funds need to be deployed much earlier, with many more stakeholders at the table, including those who are most affected so that we can better manage and prepare for outbreaks before they actually happen, rather than deal with them after the fact.

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