Partisan Pandemic: Public Health in the Age of Trump

Coronavirus has been an inescapable headline for most of this year and stands in a position to dominate discussion for the foreseeable future. Consequently, the analysis of what governments and institutions should have done differently becoming a keen topic of debate.

One lesson learnt from the pandemic is already clear: America’s deep fault lines of race, poverty and inequality rendered the nation in a poor position to meet the challenges of the crisis. In many ways this was exacerbated even further by the adhoc and maverick response of the President, as well as the continued issues of misinformation which plague US political communication.

The US, arguably the richest and most powerful nation, has been exposed yet again and this time at the expense of 200,000 deaths thus far and now with the President’s own health in further turmoil, one only has to look back at 2020 to see how the White House truly has morphed into the epicentre of misinformation within the US. Here at OxSID we’re hoping to explore the issues of racial disparities, poverty, and inequality in the setting of the pandemic, and how on a global level the US’ response is and might continue to shape international development.

The Guardian noted earlier on in the pandemic that figures compiled by APM Research Lab from 40 states “show that African Americans are being killed at almost three times that rate of white people”. This broke down further by region with Black Kansas being seven times more likely to die than White Kansans from the virus; and likewise, in Missouri, Wisconsin and Washington DC the ration is six times higher. Biden was keen to point this out during the first presidential debate earlier this month, illuminating the shocking figure that “1 in 1,000 African Americans has been killed because of the coronavirus”, a figure disproportionate to their demographic. This has been mirrored on a global platform. In the UK, for example, launched a report on ‘Disparities in the risk and outcomes of COVID-19’ to address questions surrounding age and sex, geography, deprivation, ethnicity, and occupation through PHE data. What was notable about this report was that not only were the findings in agreement with what had already been published, but that the report failed to make any recommendations on how to reduce these disparities. Similarly, in the US, there is recognition that BAME individuals are at a greater risk during the pandemic, but little practical advice on how to resolve and address these disparities has been given. This lack of clarity and practical government engagement seen on a global level can be attributed to the same institutional and individual racism, repeated, and reinforced throughout history and across contemporary society. It might help us understand why ethnic minorities are testing positive at a greater rate and are also facing the harsher consequences of the virus, ultimately leading to an increasing death toll. This is further playing out within the US through the demographics of those partaking in vaccine and treatment trials, seeing a reduced volunteer rate amongst black Americans leading some medical officers calling for greater participants from across US society, as well as many black Americans struggling to get access to basic testing facilities.

Graph of daily new Covid-19 confirmed cases in the US

What unites these nations further is the use of victim-blaming rhetoric, but the tone of the Trump administration’s response to black Americans’ high death rate from the virus takes on a different, and arguably blunter tone, to the victim blaming seen here within the UK due to the racialised rhetoric which has become central to the Trump administration’s message. The UK government failed to address the language barrier and general trust in politics found in many immigrant and minority ethnic communities; and as a result, helped the virus take afoot within multigeneration households and thus increase the likelihood in encountering the virus and also spreading it. This move painted the UK government as ignorant of the nation’s diversity, and unaware that a daily press conference would only go so far in raising the profile of political communication and trust. Further from this their repeated promotion of “we trust the common sense of the British people” as a genuine response to almost any political query, paints their direction as one set on deflecting blame rather than being open, transparent, and practical. The tone of the US government too has capitalised on deflecting blame, repeatedly racializing COVID-19 as ‘the China virus’, as opposed to providing any practical, nonpoliticised health advise- let alone face up to the racial disparities at play. In fact, the administration was recorded saying that black Americans’ high death rates can be attributed to them already being unhealthy, and thus reaffirming the victim blaming rhetoric. Instead of focusing on the dynamics of poor housing, access to health care, factors of economic inequality and pollution, the Trump administration used these “greater risk profiles”, as the health secretary Alex Azar, put it, to blame a section of US society which in reality are at greater risk to the consequences of COVID-19 due decades of segregation and subsequent poverty, decrepit housing, police brutality, failing schools, and poor access to health insurance and quality care. So yes, whilst underlying health conditions such as obesity, diabetes and hypertension, for example, are prevalent within many black communities, it is the assessment of why these conditions are common and how to tackle them which has been blatantly overlooked by the government. For a nation whose history is tied inexplicitly to the relationship between race and place, the health and socio-economic prosperity of black communities and how this makes them more vulnerable to coronavirus should not be overlooked. What should now be expected of the US government, and all global leaders, is that the success of a national recovery is dependent on proliferating and reaching these communities and tackling the institutional barriers and problems that render the nation in a poor position to tackle a non-discriminative virus in a discriminatory society. From this one thing is clear: the virus doesn’t discriminate, but the society we have made does and the US political system is failing to address these issues.

Operating covertly alongside these issues is the problem of authority and miscommunication which skew perception of the pandemic and causes party allegiance to play a dangerous part in how public health policy has been received. The politicisation of mask wearing in the US emblematic of these dangers within a political system facing a vacuum of central authority to communicate clearly with the general public, something which the Centre for Disease Control tried to address following the anthrax crisis in 2001 with the publication of the CERC. CERC, or the Crisis and Emergency Risk Communication guide, was effectively a guide on how to communicate during a public health crisis and arguably should have provided an effective framework to distribute large widespread policy and information in the age of COVID-19. The CERC describes the dilemma of a spokesperson as central to the effectiveness of communication to prevent mass confusion during a crisis. This individual should not only be familiar with the subject matter and able to talk about it clearly and confidently, but also needs to be seen as trustworthy and credible- thus the exact opposite of a political figure who cannot always resonate across party political lines. Instead this guidance has largely been overlooked by the Trump administration which has only been exacerbated by media forums such as FOX news who have asked their viewers to emotionally chose between the elected leaders and what they perceive as the medical bureaucracy on issues such as mask wearing. Forcing Americans to pick a side through often conflicting and contradictory statements has led to the wearing of face masks becoming a political image within the US as opposed to a universal, scientifically backed, approach to stemming a deadly virus. The stark difference between the US’ coronavirus briefings in comparison to countries such as New Zealand, and even here within the UK, is the presence and position of health officials, and perhaps a factor in why New Zealand’s response and public reception of the virus has been so different and effective. New Zealand’s Prime Minister, Jacinda Ardern, hasn’t spread unfounded claims or promoted untested and potentially life-threatening treatments. Instead she has let the scientific evidence speak for itself, and from the authority of medical experts. One example of misinformation given directly by the President led to the death of an Arizona man and the hospitalisation of his wife after Trump promoted bleach as a medical treatment for COVID-19 prevention. Just as Nicola Sturgeon displayed in April when she asked chief medical officer Catherine Calderwood to resign following a breach of lockdown regulations, the CERC emphasised the imperative nature of a leader and spokesperson to be one of integrity and clarity, and that being a credible and trustworthy source should override partisan wounds which are not immune to a health crisis and thereby painting Trump’s campaign of miscommunication as a factor exacerbating the pandemic. From this Boris Johnson’s decision to defend Dominic Cummings following his breach of the same coronavirus legislation that he helped devise and implement, can be viewed as a factor in the breakdown of the credible nature of the UK government’s direction. Similarly, FOX news’ campaign against Dr. Fauci has been detrimental to the effectiveness of CERC’s guidance and warnings learnt from previous public health crises. The Trump administration, by failing to head the warnings and lessons of the past has, and will continue to do so, imperil lives through its complicated relationship between image and authority as well as its blatant acceptance of miscommunication as being politically acceptable.

One way of explaining this partisan stance is to place the pandemic into the context of the upcoming 2020 Presidential election. Arguably Trump has favoured party political point scoring ahead of November’s election, as opposed to acting for the nation as a whole. This explains why we are seeing even greater conflict between the White House and Democrat Governors and this has been reflected in the differences of received emergency medical supplies requested from the federal government between Republican and Democrat states. One only has to look at the treatment of Washington DC during both the military mobilisation and occupation of its streets during the BLM movement in recent months, as well as the aid it has received to tackle the virus to understand the disparities at play. Alongside the economic stimulus package, the bipartisan economic stimulus legislation (knowns as the CARES Act) introduced in March to help states address their immediate budget problems due to COVID-19, epitomises the paradox at play: whilst we should commend the mobilisation of funds, the way in which they have been allocated has not protected the communities most vulnerable to COVID-19. Washington, for example, has been categorised as a US territory under this legislation as opposed to being treated as a state, as it usually is under most congressional funding measures. As a result, it has received much lower funding and barriers to administering relief, much like tribal communities and other territory regions. Alongside this, on a national level, disparities between Democratic and Republican states have left minority communities vulnerable simply because their representative does not agree with the expansion of federal spending. Trump has directly challenged Democratic governors asking for larger sums of aid, accusing them of dragging their feet in reopening their economics, and financial mismanagement. Republican states will still face budget falls, but it is their reduced eagerness to ask for federal expansion, rather than presidential reluctance, that will leave their economies and communities vulnerable. This only makes it clearer that budget falls and federal support is not a partisan issue, but a national one. It shouldn’t matter what party a victim of COVID19 voted for in the 2016 Presidential election, but what should now matter is how these states (as well as all US states) vote this November in response to the pandemic’s handling by the Trump administration alongside all other issues from the past four years.

U.S. President Donald Trump at a White House press conference

Access to unemployment benefits within the US is only one example of why coronavirus really is a disease of the poor within the states, as viewed by the Rev William Barber, co-chair of the Poor People’s campaign. Before the pandemic there were 41million Americans living in poverty, and now one only has to look at the usage of food banks to see how COVID-19 has exacerbated this crisis. Feeding America, the US’ largest domestic hunger-relief organisation, noted that in March alone, food banks gave out 20% more food than an average month. They are also predicting, that as a direct result of the pandemic, around 1 in 6 Americans could face hunger on a regular basis. At the root of this problem is the absence of a centralised unemployment system which is instead split between states and territories allowing them to operate at their own discretion. As a result, the US has 53 unemployment systems which vary greatly and are in some cases designed to discriminate and make access to funds tiresome and difficult. Florida, for example, is plagued by an online system which some argue has been designed to fail those in need since its redesign in 2013. Creating barriers to unemployment benefits is dangerously ironic, especially during an economic downturn like the one facing most economies as a result of COVID-19. VOX news recently noted that for every dollar spent in unemployment insurance benefits, $1.61 was generated in local economic activity. Furthermore, the US’ failure to adopt a mechanism of furlough similar to that operating within the UK and many European economies has left little security for those in low-paid industries and on casual labour. Again, we see poverty’s role in contributing to the likelihood of encountering coronavirus and suffering its most negative consequences, as well as being central to the likelihood of economic recovery and in turn a local health upturn.

On a national level the response has been dire within the US, but even more worrying is the direction of the Trump administration on the international platform, especially the potential consequences of retracting US funding for the WHO. During the WHO’s last funding cycle the US contributed 15% of the entire budget and more than twice as much as any other country at $893million. Whilst this has been the norm for decades and placed the US at the forefront of the world’s most important public-health apparatus, the Trump administration has gone onto accuse the organisation of mismanagement and corruption in recent months. Legally Trump’s threats to terminate the US’ relationship with the WHO won’t happen overnight (as under US law the country must give the organisation a year’s notice and must meet its financial obligations for the current year). As a result, at the least, nothing will change until mid-2021 by which point Trump may no longer be President and his successor may revoke the decision. As a result, the future of the WHO is reliant on the US election. What is more immediate, however, is the already apparent impact of Trump’s rhetoric on the WHO’s operation and concerns over voluntary contributions in comparison to assessed contributions and how these are distributed amongst campaigns. Furthermore, on a national level for the US, leaving the WHO will alienate scientists and public health officials from some of the most important global health communication channels. So, whilst no one is claiming that the WHO is a model organisation, it is clear that the potential departure of the US from its cohort will not just have immediate local repercussions but longlasting global implications too unless the funding gap is overcome and other nations champion the voluntary donations and campaigns which the US had headed for many years.

Covid-19 was a predictable, preventable crisis but unfortunately the US, arguably more so than other wealthy nations, has failed to rise to the challenge so far. All that is left to see is how the 2020 Presidential election and incoming winter might alter the course of its actions.

By Isabelle Gibbons