COVID-19 Diary: The U.S.A. Goes All In On Techno-Optimism

Johns Hopkins COVID-19 Incedence Rate Map

Screenshot of COVID-19 Incidence Map on September 4, 2020

 

The USA has completely failed to control COVID-19. The many reasons for this failure have been well-documented, discussed, and argued over by a newly-emerging class of public/ global health pundits (I will not go into detail here). Whereas there was once discussion about which might be the best strategies for mitigating the impact of the virus, now there is only one strategy: a vaccine.

The White House and various state governors have certainly made many bad choices–and sometimes failed through inaction. However, as an anthropologist I’ve been trained to think about the place of individual actors in larger social and cultural contexts. It was not just bad actors that led us to this point. Our mainstream cultural frameworks for understanding health and medicine have also played a key role. Single-minded reliance on a vaccine was not inevitable, as success stories from around the world demonstrate (e.g. New Zealand, Taiwan). Rather, it is the shape of health discourses in the USA that predispose us to look for a technological fix (see also this piece by Martha Lincoln in Nature on COVID-19 responses and American exceptionalism).

Techno-Optimistic Stories

Over the past four years I have been studying global health discourses. In my research, I have noticed the pervasive use of what are called called “techno-optimistic” stories to generate interest in public/ global health interventions. “Techno-optimism” is about faith in technology–in this case biomedical technology–to provide simple answers to complex human problems. In the realm of global health, no organization epitomizes this approach better than the Bill and Melinda Gates Foundation. Their “data-driven” approach is in many respects laudable. Still, it is often linked with a narrow focus on drug treatments and vaccines, and their interventions rarely address what public health professionals call the “structural determinants of health”–the underlying socio-economic inequities that shape marginalized persons’ exposure to pathogens, access to care, and ability to make behavioral changes (see also Emily Yates-Doerr’s recent critique of the structural determinants concept).

Giving sick people pharmaceuticals seems cheaper and easier than addressing socio-economic inequities, at least in the short-term–though it does end up being more expensive in the long-term. In part, it seems easier because it allows people to avoid confronting the inequitable socio-economic and political structures that power our economy. Techno-optimism is just so much catchier and simpler than meaningful structural change.

Another Chance? Vaccine Delivery

Now we must wait for a vaccine, betting our economic and social wellbeing on its successful development by pharmaceutical companies and their university partners. This will solve everything, right?

Wrong. What will we do when that vaccine is created? the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices has been meeting to decide just that. When the vaccine becomes available (or if?), there will be limited quantities. We must decide as a society how to distribute the vaccine. Otherwise, the “market” will decide for us, meaning that the most wealthy and powerful will pay for earlier access. The CDC committee’s current discussions seem promising, suggesting that in addition to “front line” health care workers, the vaccine should be administered first to groups like essential workers, the elderly, and others who are disproportionately likely to get infected, and to get sick or die as a result of their infection.

While the CDC advisory group’s recommendations do make me hopeful, I am not confident that the U.S. health system is configured to make these recommendations a reality. So much of our system is tied to private insurance and corporate medicine. Unfortunately, it seems likely that wealthy people will be allowed to pay for access to the vaccine, and thereby bypass the clunky public health system that is disjointed and spread across federal, state, and local levels. I’m not certain what the public can do, except to keep public discourses focused on issues of equity and thereby expand our collective consciousness beyond the simplistic fixes offered by a narrowly-defined techno-optimism. So let’s do that.

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