Justin Feldman and Mary Bassett describe how diminished political will to use government powers for service provision hampered the US response to the covid-19 pandemic and what needs to change
The US response to the covid-19 pandemic failed in its central task of protecting life. When the government’s public health emergency declaration ended on 11 May 2023, more than 1.1 million people in the US had died, the covid-19 death rate was higher than in comparable wealthy nations,1 and gaping racial and ethnic inequalities in mortality remained.2 In public health circles, chronic underfunding of public health agencies is often used to explain the shortcomings of the US covid-19 pandemic response.3 If only health departments had larger budgets, these arguments go, government could have expanded efforts to prevent SARS-CoV-2 transmission, promote vaccination, and deliver early treatment to medically vulnerable people.
The budgetary concerns are warranted. Only 1% of the country’s total health spending is devoted to public health activities.4 State public health spending was flat in the decade following the 2008-09 recession5 despite growing needs, including rising maternal mortality6 and stagnant or declining life expectancy.7 However, the challenges facing government public health go beyond budgetary constraints. Although starving health department budgets is harmful, it is a symptom of the more fundamental problem of political divestment from state capacity and state directed projects of social transformation.
The pandemic has revealed that US federal politics can support high levels of spending in response to a major crisis. The CARES Act, a $2.2tn pandemic response bill passed by US Congress in March of 2020, was the largest spending bill in the country’s history, and the American Rescue Plan Act (ARPA), passed by Congress in March 2021, provided $350bn in fiscal support to state, local, and tribal governments. …