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Preventing pandemics is a bargain. Joe Manchin should include it in his next spending deal.

Preventing pandemics is much cheaper than fighting them once they happen.

Visitors in masks on the National Mall in Washington, DC, on December 18.
Samuel Corum/Bloomberg via Getty Images
Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

Democrats’ once-in-a-decade opportunity to pass major tax and spending legislation is in mortal danger.

On Sunday, Sen. Joe Manchin (D-WV) announced on Fox News that he was done with Build Back Better, President Biden’s signature domestic policy bill, seemingly dooming the roughly $1.8 trillion package covering subsidies for everything from clean energy to child care.

But as my colleague Andrew Prokop noted, there is another way to read this moment: not as a burial for Biden’s legislative hopes, but an opportunity to reset them. Manchin has been very clear for months that he opposed the current structure of the Build Back Better Act, in which — in an attempt to keep costs down — many programs have scheduled expiration dates after a few years. He preferred a bill that fully paid for a handful of permanent programs. After Manchin’s Fox News appearance, the Washington Post reported that the senator had presented Biden with a $1.8 trillion spending proposal that included huge clean energy subsidies, a permanent pre-K program, and a permanent boost to Obamacare subsidies for health insurance.

That raises the possibility of Biden and Manchin ripping up the bill and starting anew, with a goal of selecting a handful programs to implement permanently. Manchin has been clear that pre-K, clean energy, and expanded Obamacare can be on that list. He and Biden are likely to wrangle intensely over how much of this year’s bigger child tax credit can be made permanent in the deal; Manchin is a well-known skeptic of the program.

But one kind of investment that hasn’t received much attention (with some exceptions, like from my colleague Dylan Scott) deserves a place of permanence in a Biden-Manchin grand bargain: pandemic preparedness. A relatively modest long-term investment in getting better at deterring, detecting, and responding to future biological threats would prevent truly catastrophic damage akin to what we’ve experienced since March 2020. It could save millions of lives and trillions of dollars, if the cost of the current pandemic is any indication — and far more if the next one is even worse.

Pandemic preparedness has gotten short shrift in Build Back Better negotiations, but it deserves a place at the center of Congress’s agenda. This pandemic won’t be the last, and Americans cannot afford to be caught as unprepared as we were this time.

The incredible shrinking pandemic preparedness plan

The White House, to its credit, understands that preventing the next pandemic requires a large-scale investment. That’s why in September, White House science adviser Eric Lander and National Security Adviser Jake Sullivan put out a report calling for $65.3 billion in spending on pandemic preparedness, spread over 10 years.

The proposal included, among other things, $24.2 billion in spending on vaccine preparedness (for instance, improving manufacturing capacity and developing candidate vaccines for common types of viruses), $11.8 billion to prepare antiviral and other therapies against likely pandemic pathogens, and $5 billion on research and manufacturing for testing, as well as funding for personal protective equipment (PPE) and improving building design (for instance through better ventilation). It’s worth reviewing the spending plan in full just to get a sense of how sprawling and comprehensive it is.

An item by item breakdown of Biden’s proposed pandemic preparedness spending
The Biden pandemic preparedness plan, in detail
Biden White House

But the administration did not put forward the full $65.3 billion in the reconciliation spending package. Initially, it proposed $30 billion in spending in its “American Jobs Plan,” unveiled in late March, which provided the basis for spending negotiations with Congress after the passage of emergency economic stimulus.

Then, upon the announcement of the $65.3 billion pandemic prevention plan, Lander told reporters that the administration wanted at least $15 billion of it funded through reconciliation, much less than either $65.3 billion or $30 billion.

The version passed by the House included even less: $3 billion for pandemic preparedness, split between $1.4 billion for the Centers for Disease Control and Prevention to do everything from improving testing to laboratory upgrades to genomic sequencing of new pathogens; $1.3 billion for the Assistant Secretary for Preparedness and Response Activities (ASPR) at the Department of Health and Human Services (HHS), to be spent on both manufacturing and research of countermeasures; and $300 million for the Food and Drug Administration to improve its technology and lab infrastructure.

This is nowhere near enough. $3 billion is an insufficient investment in preventing future pandemics, especially in the midst of the current pandemic that, per research by Harvard economists David Cutler and Larry Sanders, has already cost the US some $16 trillion.

After analyzing data on some 2,600 past disease outbreaks, the research company Metabiota estimated that there’s a roughly 25 percent chance of another pandemic on the scale of Covid-19, or greater, occurring in the next 10 years. If such a pandemic costs us $16 trillion, reducing the odds of it happening by just one percentage point has a value of $160 billion. While precise estimates are impossible, a sensible pandemic prevention policy that includes extensive manufacturing capacity for treatments and vaccines and tests and PPE that can be deployed rapidly should reduce the odds of such a pandemic, or reduce such a pandemic’s severity, by much more than one percentage point.

Simply deploying genomic sequencing technology and data systems that would enable real-time monitoring of new diseases to major hospitals and wastewater processors should substantially reduce pandemic risk.

“The cost to set up and run a surveillance architecture in 200 urban hospitals in the US would be well under $1 billion, and it could be done within a year,” scientist David Ecker wrote in Scientific American last year.

Such a system would be able to detect a novel virus like SARS-CoV-2 if only seven symptomatic people went into emergency rooms and underwent routine testing that didn’t detect an already-known pathogen. This process would then enable the virus to be rapidly sequenced and for diagnostics, vaccines, and therapies to be rapidly developed to target it. Such a world seems possible, for an incredibly modest cost.

The best case I can see against including the full $65.3 billion in preparedness funding in the reconciliation bill is that there may be other avenues to pursue it. Republicans in Congress have been surprisingly willing to back investments in science in certain cases. The US Innovation and Competition Act, a $250 billion investment in improving manufacturing and boosting scientific research and development in a bid to “beat China,” got a whopping 19 Republican senators to vote for it in June. While it’s worse than the initially proposed version, even critics praised the final passed bill as representing a major investment in research.

If such a coalition can be put together for pandemic preparedness funding as well, it may represent a way to make this investment without taking scarce space in the Build Back Better bill.

Some progressive activists have offered this as a reason to avoid prioritizing pandemic preparedness; Democratic Socialists of America activist Emma Claire Foley told the American Prospect this fall that pandemic preparedness was a “fundamentally limited approach that fits very well in a moderate agenda,” preferring to focus on expanding access to health insurance.

Pandemic preparedness doesn’t have a natural constituency the way that, say, expanding Medicare. There isn’t the same activist ferment around it that there is around climate change, another ongoing catastrophic risk to humanity. And the political upside for elected officials is hard to see. No one ever gets credit for the pandemic that didn’t happen, which is one reason why it’s so hard to get politicians to prepare for rare but potentially catastrophic threats.

But ultimately, we need to be prioritizing pandemic preparedness funding whenever the opportunity arises. The possibility of increased pandemic preparedness investment in non-Build Back Better bills should not prevent any investment from occurring in Build Back Better. Even a full $65 billion program over 10 years would pale in comparison to the $500-$600 billion that Manchin supports to tackle climate change, for instance, or the $200 billion the Biden administration estimates that universal pre-K (another Manchin-supported policy) will cost over 10 years.

While it would be great if an opportunity presents itself for bipartisan investment in pandemic preparedness, we can’t count on that. The best way for Manchin and Biden to prevent the next pandemic is to invest in prevention right now.

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