Sophia Crabbe-Field: To start off, can you introduce us a bit to Death Panel and how and why it got started?

Beatrice Adler-Bolton: Death Panel is a twice weekly podcast about the political economy of health that I host along with Artie Vierkant and Phil Rocco. We actually got started long before the pandemic in 2018 to cover health policy in the United States to try and track changes in health policy and the discourse around the political economy of health in the United States. Some of the things that we have covered for a long time and studied extensively are things like funding for Medicaid or the U.S. v. Vaello-Madero case that just was decided in the Supreme Court, where you have the Biden Administration continuing an action that the Department of Justice took against a man receiving SSI in Puerto Rico. This deals with the intersection of U.S. territories and health-care policy in the welfare state. These are all things that we were studying and documenting and discussing twice a week on Death Panel before the pandemic. When the pandemic hit, what was our corner of the policy world and the Internet suddenly became the main topic of conversation because obviously COVID is an intrinsic part of the political economy of health now in the United States.

SC-F: You’ve had really great people on the podcast, including Adam Gaffney, who I spoke to as well for “Voices of the Virus” and Rachel Cohen, who’s written for us, as well as epidemiologists Justin Feldman and Abby Cartus. How do you go through the process of choosing whom to speak to, especially with regards to the pandemic?

BA-B: One of the things we always look for is: Is there someone who’s doing really great research who also has the ability to translate that work beyond the academic sphere and add to our analysis of the pandemic in a way that feels accessible. It’s a space for collaborative and intense conversations about activist movements, about history, about political education, about health and economy, not just current events. We hope it gives people a really different way to access “discipline experts ” and a broader view of the pandemic and the political economy of health. We’re talking to people who are looking at social determinants of health, at the real structural forces and structural determinants of health, who are interested in having a conversation about where their research or thinking fits into a broader discussion of what public policy is now and could become.

SC-F: I wanted to shift now a bit to talk about where we are at in the pandemic. We’re at a point where we decided that, basically, we don’t need to do much of anything to mitigate the virus. We’re “back to normal.” And so you’ve spoken before on the podcast about the Great Barrington Declaration: the idea that at-risk people just need to isolate when the virus is spreading and otherwise we just let it spread among the supposedly low-risk population and create herd immunity. Can you speak a little bit to what the declaration is? From what I know there’s money behind this message. It was an Astro-turf movement. And, in addition to that, can you tell us a bit how we’ve come from a place where this was kind of an “outsider” perspective to where it’s widely accepted as common sense?

BA-B: Absolutely. Focused protection was proposed in October of 2020 as a means of achieving herd immunity through voluntary natural infection, by the Great Barrington Declaration. And this was a group of experts who got together to draw up a couple paragraphs at the American Institute for Economic Research (AIER) in Great Barrington, Massachusetts. The institute is sort of known as a champion of “individual rights,” consumer choice, small government, and open markets.

And throughout the COVID-19 pandemic, there has been an idea that has constantly circulated promoting this strategy. It’s an idea that started before the vaccine rollout and before we knew whether or not vaccines were able to prevent the transmission of the virus, not just severe disease or death. And so, as our thinking has evolved, and as we realized that the vaccine did not provide protection from infection and that the vaccine was not, alone, going to stop infections from moving throughout the community, the idea of focused protection gained more purchase beyond the conservative silos, where it had been very confined to during the Trump Administration.

We saw things like the Biden Administration declare victory over the pandemic in July 2021. The removal of masking requirements in May of 2021 and all of these things happening, which started to produce an “end of the pandemic” as a structural and social idea before actual viral transmission was low enough, before our vaccine coverage was high enough, and before cases were really under control. We’ve seen this idea emerge and become dominant, that the best answer is to allow the virus to rip through the population and somehow we will magically protect the vulnerable, as if vulnerable people live in a bubble somewhere separate from the rest of the population. And obviously this is an idea that is not workable. You cannot protect the vulnerable without protecting everyone.

The problem with COVID is that it is a population-level disease. Not only is the pandemic not over, but our current pandemic plan focuses on vaccines as the only tool to protect us from COVID instead of using all of the tools that we have available, which actually complement the vaccine. They make the vaccine more effective. They support the vaccine. We have put so much money and so much research and time and effort into these amazing mRNA vaccines without providing the additional non-pharmaceutical support to allow the vaccines to work. By putting only selective pressure on the virus, we’re ending up with these variants that are actually jeopardizing all of the hard work that has gone into not just the vaccine itself, but the vaccine rollout.

In addition, at this point, only about 30 percent of people are boosted. And this is, I think, a broad failure. The virus has not been defeated. We are not at sufficient levels of vaccination amongst the entire population to start eliminating non-pharmaceutical interventions, which are actions, other than getting vaccinated or taking medicine, that both individuals and communities can take to help slow the transmission of viruses like the flu or COVID-19. Non-pharmaceutical interventions are also known as “community mitigation strategies” because they are most effective at the community level, not when implemented under frameworks of “individual choice” and “personal responsibility.” These interventions include, but are not limited to, promoting or mandating masking, physical distancing, and self-isolation, broad access to free testing and masks, limiting the size of gatherings, mask mandates for public places and transportation, paid sick leave, childcare support, decarceration, HVAC upgrades, air filtration, infrastructure upgrades, eviction protections, supporting teleworking, Medicaid expansions, unemployment support, rent freezes, Medicare for All, paying people to stay home, “circuit breaker shutdowns”—including reactive school closures—there can be so many options that can be layered and tailored to a community’s needs. But since the fall of 2021, abandoning non-pharmaceutical interventions for a vaccine-only approach has essentially been the plan. When Omicron came, it hit at a moment that our non-pharmaceutical protections were at their lowest, and so as a direct result we saw record levels of infections. Nearly 50 percent of the population was infected during the Omicron wave in a tremendously short amount of time. And there is no indication that they will be protected from reinfection. It is not a plan to tell people to just expect to get sick three or four times a year and abandon the most vulnerable. That’s not a plan that’s social murder.

SC-F: Did you think that things would be this bad under a Biden Administration? Do you think there are ways in which it’s, in some sense, even more harmful to have it be a Democratic Administration that’s declaring victory on the virus than if it was a Republican one or Trump?

BA-B: Under the Trump Administration some of the things that were being said were so heinous that it became a really easy and obvious rallying point, like saying drinking bleach would cure the virus or to use UV light on the inside of the body. But beyond those kinds of immediate critiques of these exaggerated examples of pseudoscience from Trump, even then, you didn’t see a lot of critiques that were actually aimed at the structural components of what was driving the pandemic response to be a failure. And I think what we’ve seen in the transition from Donald Trump to Joe Biden is that, though we have had a complete regime change, one of the problems was not necessarily the personalities or even the approach to policymaking and governance, but it was more the structural and institutional components that underlie any presidential administration, regardless of its ideology, which are things like the political economy of health of the United States.

Essentially, during the pandemic, we’ve not seen the dominance of for-profit health care challenged. We’ve not seen the status quo, which was frankly a crisis before the pandemic, really meaningfully challenged. And on Death Panel we’ve not only been documenting the process of the pandemic in real time for two years, we’re also trying to challenge some of these underlying status quo assumptions about health and health care and what we can afford to do to care for one another in the United States. The fact of the matter is, and this is something I also say in my forthcoming book Health Communism, under the political economy of health in the United States, care and health, including population health, are both conceptualized and enforced in policy as wholly individuated, as a consumer good, as a matter of personal responsibility, and then that “care” is distributed, not in a way that is just or right, but based on what amount of care you can buy as an individual with the economic power that you have (including social-economic power like fundraising on GoFundMe).

So when that basic political-economic philosophy of consumer-oriented health-austerity meets ideas like the Great Barrington Declaration’s focused protection, which, again, is coming from this think tank that for many years has been talking about ways to individuate the economy and individuate our rights through economic activity, this is the perfect moment for these two things to come together and really take off like fire. This is now, in year two, an approach to the pandemic that crosses all ideological boundaries. You see this coming just as often from conservatives as you see it coming from mainstream liberals now. Nothing has changed about the political economy of health in the United States. And everything that we see about the pandemic response reinforces this, including and especially the latest from the Biden Administration officials when it comes to, for example, managing the fallout of superspreader events like the Gridiron Club dinner, or their reluctance to immediately respond to the recent ridiculous challenge to the transportation mask mandate struck down by one single crank judge in Florida. It’s a structural pattern.

SC-F: We also have a CDC that pretty clearly is also not looking out for the protection of vulnerable people either. [CDC Director] Rochelle Walensky called masks “the scarlet letter of the pandemic,” and, meanwhile, the way we measure community risk levels allows for a lot more spread of infection before any health measures are applied. How do we tackle that?

BA-B: I think one of the things that we need to do is we need to broaden our demands. And I think it would be productive to really discuss and publicly call out how pervasive anti-mask sentiment has become among liberals in particular, because it is that contingent, that sort of segment of the population, which was vocally critical during the Trump Administration, is now rife with COVID minimization. And I think, under the Trump Administration, any successes we saw were the direct result of broad pressure in the face of lackluster pandemic policies being proposed by the federal government. The same—if not worse—policies are being proposed now, but the pressure is not there. We know from very recent history that making room for outrage and normalizing public expressions of desire and demands for overdue change and new policies to keep people safe is an incredibly powerful socio-political force.

But right now that force is not super welcome. And I think the anti-mask sentiment, which many talk about in the terms of, “Oh, this is individual personal preferences,” or “this is really about people making their own decisions about their own life,” it’s actually much more complicated than that. The fact of the matter is that for high-risk people like myself, immunocompromised people, the way that we stay safe is not just by not getting infected ourselves. We can’t protect ourselves if other people can’t protect themselves. It’s about overall community levels of COVID transmission needing to be low, not about the freedom to “one-way mask,” it’s about reducing overall virus particles in the air, and every little bit of masking or other non-pharmaceutical interventions, even if not used perfectly, helps reduce the amount of virus in the air.

This is also not just a public health emergency. COVID is also an unprecedented labor disaster. According to analysis by a virologist Trevor Bedford, during a normal flu season, about 10 percent of the U.S. population gets sick over the course of 16 weeks. During the first Omicron wave that started in fall 2021, we saw roughly 40 percent of the population infected in eight weeks. And that is to say nothing about the possibility of reinfections, which do appear to be possible even between sub-lineages of Omicron.

So even if no one had died in the Omicron wave, this was still a tremendous amount of sickness and suffering forced on working people. The same is happening now with this next wave. And while many are ready to throw up their hands and give in to pandemic nihilism, that’s not the solution. COVID is not just a risk to high-risk people. It is a risk to everyone. And if the Administration says that their priority is to keep people out of the hospital and keep vulnerable people safe from bad outcomes, then the way to do that is to keep everyone safe from infections. And that is ultimately not the plan that the Biden Administration is going with. It’s not too late for a new pandemic game plan.

It’s time to demand that those in power listen to those calling for protections instead of, for example, airline executives who are claiming that their industry has leaned into science at every turn but that basic non-pharmaceutical interventions are no longer aligned with the realities of the current environment. And to hear that the opinions of airline executives demanding that mask mandates be removed is more of an influence than immunocompromised, medically vulnerable people, the parents of children under five demanding that they be given the tools to keep themselves safe, it makes me feel like the Biden Administration really cares more about the midterm elections than they care about my life. That seems like a losing strategy for Democrats, especially right now.

SC-F: I just wanted to turn a little bit more broadly to the media and their influence in creating this narrative. We know that the voices that are the strongest right now are people like Dr. Leana Wen who’s on CNN, she’s in The Washington Post, David Leonhardt with his millions of newsletter readers, as you mentioned on the show, there’s also the “vaxxed and relaxed” crowd of D.C. journalists. Why is the media leaning into this kind of narrative so hard? And can you tell me a little bit more about why, in your view, this is harmful? Is there an indictment somewhere here of who gets to have a voice, or the strongest voice, in the media?

BA-B: Absolutely. I think as someone who thinks about and studies disability beyond the broader project of Death Panel, and just as someone who is disabled, this is something I think about and talk about all the time, because our policy is driven by these contingent logics of austerity. And we often see the media frame approaches to health policy or any sort of public fiscal investment under this sort of constant sense that there will never be enough resources to go around. We must look to those who have the most complex needs and build our community protections around their needs, not around the needs of the least vulnerable like we’re doing now.

Unfortunately, many of the commentators who right now are taking up the most room, who are really having an influence on what kinds of conversations we’re having, are discounting the rights and value of having vulnerable people in our society. Much of that rhetoric buys into austerity logics which dictates that there will never be enough resources for everyone to get the response perfect, or there is never a mask that’s going to protect you 100 percent—so there’s no point in doing anything at all if it won’t be 100 percent effective 100 percent of the time. It’s kind of a strange and unusual logic that’s actually factually false. And I think it’s important for people to start challenging that when they see it in the media.

For example, one thing that the “vaxxed and relaxed” crowd, who peddle these takes, likes to say is that surgical masks are less effective than N95s, therefore they’re not effective at all. That first part is true, surgical masks are categorically less effective, but that does not mean that they are not effective at all, even when not worn properly. That does not mean that wearing a surgical mask is the same thing as going totally unmasked. Wearing a mask wrong is much better than wearing no mask at all. And this is one of these kind of “pandemic paradoxes” that have emerged as very popular talking points, which are often reproduced in the media, and these undermine our political will for an effective and eminently doable COVID response. And they also undermine the value in the collective cultural imaginary of what protections can be. And it negates the true frame that we need to be using to think of the pandemic, which is that this is a population-level problem. It requires solidarity. It requires investment. It requires collaboration and it requires population-level solutions, not individuated solutions.

SC-F: Something else that’s often put out there or insinuated, in one way or another, is that it’s actually more progressive to be anti-mitigation because lockdowns of any sort really are more harmful for poor people than COVID itself, despite the fact that the virus also disproportionately harms poor people.

BA-B: Yeah, absolutely. I think one common thing that we try to dissect and make legible and accessible for people is how these kind of straw man arguments that get stood up, that are approximations of arguments made by people who are advocating for protections. COVID minimizers do this strange paradoxical logical fallacy and take it to the extreme. You see this often where someone says, “Oh, well, people who are advocating for masks really say that we should have lockdowns forever and masks forever.” For example, you had Benjamin Mazer who just had an op-ed in The Atlantic that came out recently called “It’s just Scaring People, and It’s Not Saving Lives” and Mazer is talking about the way that immunocompromised and medically vulnerable people feel left behind or left for dead by the current pandemic response and says that talking about those stories is fueling vaccine hesitancy. And that’s the kind of false equivalence that you see reflected in frameworks like, “Oh, well, if masks aren’t 100 percent effective then they don’t work.” All of these narratives come and create a general environment where political will is dampened and the imaginary of what could be possible is artificially narrowed based on these strange and unhelpful logics.

And that was ready to go before the pandemic started. That was largely what we covered on Death Panel before COVID. So when I say that our beat or our corner of health policy became a national conversation at that point, it’s more that these logics of austerity and these logics of behavioral health interventions that reinforce the negative and extractive and deadly political economy of health in the United States was locked in in advance. And that is ultimately the bigger problem with the pandemic response. We don’t have to do things this way. This is the way we have chosen to do things and we can choose different.

SC-F: I just wanted to quickly run through some narratives we often hear in opposition to mitigation efforts and get your reaction. So, first off, there is a strong focus on the problems with remote learning and the idea that it has been detrimental for children. Children have been damaged by this, and closing schools and masking children were both very problematic.

BA-B: I think that these are the sort of things that exist in half-truths, right? It is really difficult to find masks that appropriately fit children. Also as many in fat studies and the fat liberation movement have noted, there are also few available high-filtration masks which appropriately fit people of many sizes, not just small children. There has not been the necessary investment and research and development to create really well-fitting and comfortable masks that are easy for children to wear. This is something that I think money should have gone into immediately, but I don’t think it got the same kind of investment and attention that you saw going into pharmaceutical interventions like vaccine research and development. Where was the investment in social-technologies like finding ways to make face coverings and other pandemic protections available to people in their community at no cost? Where was the investment in infrastructure design and planning and logistical coordination for things beyond the vaccine and antivirals?

The current situation with distance learning is terrible. Teachers do not have the resources. Students do not have the resources in order to do this effectively. But the fact of the matter is that many people preferred to protect their children from an infection. And if we offer people no real options to do that, what real right does that ever give them to “choose” a risk level they are comfortable with? We frame this always in terms of choice, right? It has always been about framing pandemic protections in the context of a choice between controlling the spread of the virus and all these untold harms that we could never measure but might come later with or without the virus. But the fact of the matter is that there is a clear harm that is tangible and right in front of us that we are making worse by ignoring.

The way to deal with issues like the failure of pandemic distance learning is to make distance learning better and invest the intellectual and financial resources needed in order to make that better so that kids are not underserved if they have to stay home. And this extends to things beyond education, because one of the bigger issues that I think we often don’t talk about when you hear people like, for example, the Emily Osters and Leana Wens and the Monica Gandhis who say, “Oh, well the real problem is that we can’t shut schools because this is so dangerous for children. They’re never going to catch up.” Well then why don’t we put some work into figuring out how to help facilitate children getting their education during a pandemic no matter where they are, instead of putting that intellectual labor into undermining teachers’ unions, into gaslighting concerned parents and teachers, into disregarding medically vulnerable people as if they do not exist as people in the economy or people who work in and around schools. Yet these are the arguments that dominate the sort of moral decision-making that we’re making right now.

SC-F: Another narrative that you hear out there when we take away masks and we take away other mitigation efforts is we’re just “meeting people where they’re already at.”

BA-B: Right. I think ultimately the debate about mask mandates and this implication that there is a secret silent majority that exists out there somewhere demanding that these decisions be made, that’s not reflective of polling, first of all. Second of all, I think the debate about mask mandates is actually a debate about human social and economic rights, not just of vulnerable people, but of everyone. It’s a conversation about the value that our society wishes to place in protecting each other from sickness, it’s about the value of recognizing or rejecting our interdependence and about the worth of people whose suffering might soon be minimized as either a death pulled from the future or merely the “cost of reopening.”

And I think this implication that there’s a secret silent majority who has always been rejecting masking and has just been waiting for public opinion and policy to reflect their demands is fundamentally insulting to vulnerable people. And the turn that the United States COVID response took toward individualistic frames of personal responsibility are ultimately rejections of the right to social life for all of those who are well within their rights to refuse to consent to needless infection and sickness for the health of the nation’s GDP. And when I say social life, I don’t just mean the right to socialize and be able to go out and hang out with your friends. That’s obviously a part of it. I mean social life in the broader sense of, for example, of what sociologist John Marshall called social rights, which is economic participation which predicates the inclusion of an individual in society. Marshall saw social rights as a particular category of rights that was distinct from political or civil rights, which was primarily pertaining to the sort of economic aspects of one’s day-to-day life.

Current CDC recommendations say when cases are high in the community rather than recommend masking, people who are medically vulnerable should voluntarily remove themselves from the community, remove themselves from economic activity, remove themselves from participation in society, remove themselves from social life, in order to facilitate other people who are not as vulnerable to continue to participate in social life unmasked. And when you put it more simply it’s basically saying that the needs of people who need less matter more than the needs of those who need more, therefore those who need more must give up more and be subjected to the sort of dominant preferences of this silent majority.

But when you actually look at polling, when you actually talk to people, this is not how people actually think. People care about their neighbors. They care about their friends. They care about their coworkers. They care about their kids’ teacher. They don’t want to be the reason that someone in their life gets sick and has bad outcomes and dies. And that narrative is just so totally lost from our approach to the pandemic right now. And I think trying to find a way to recapture that is really key to how to move forward. It’s time to, collectively, grieve and learn from the mistakes of the first two years, and commit to doing better. Because everything that we are doing right now, as I was saying, is just contributing to the durability of COVID. And if we want to live with COVID without it controlling our lives, then we need to make some really strategic and specific decisions about what protections we think we need in order to live with COVID.

And to do that, we need to listen to the most vulnerable, not the David Leonhardts, not the Leana Wens, not the Monica Gandhis, not the Emily Osters, but the people who are working in the food services industry, people who work in nursing homes, people who are medically vulnerable in all kinds of workplaces and people who maybe just don’t want to get sick three or four times a year and have a situation where they are not able to pay their bills because they can’t afford to take that much unpaid sick time off of work.

SC-F: The last narrative I wanted to mention is just the idea that “we have the tools” to live with the virus and sort of tangentially to that is this idea that saying immunocompromised people don’t respond sufficiently to vaccines, or even just saying generally the vaccines alone are not enough, is tantamount to being almost anti-vax.

BA-B: I think that this is a frame that we have seen consistently since April of 2021 when you first started to see early studies coming back that were looking particularly at solid organ transplant patients or patients who are on Rituxan, which I was on until very recently, and for example, many people with MS are on this drug, one million Americans have MS, so scale-wise this is a drug category that hundreds of thousands of people are on in the United States in just this one disease category alone, not to mention other diseases that are also treated with it or similar drugs. Essentially, in early 2021, these studies started coming back that were saying: We’re starting to see, now that vaccines have been rolled out a little bit, people who are immunosuppressed for whatever reason are not necessarily developing the same antibody response as people who are not.

And we also saw lower antibody responses in older people. It’s interesting because the discussion of lower antibody responses and older people doesn’t seem to inspire the same rage from people that are quick to claim that any sort of discussion of the limitations of a vaccine-only strategy reflect poorly on the vaccine itself, which it shouldn’t. It should reflect on the political and policy decisions, not on the pharmaceutical product. But those two things are sort of collapsed and it contributes to these frameworks that are just so pervasive in terms of magical thinking where it’s almost as if people who make these claims that discussing the limitations of a vaccine-only response is tantamount to anti-vax rhetoric, which it absolutely is not. Those people are essentially trying to sort of say that the way that the vaccine becomes effective is by us wishing it to be so.

Pretending the vaccine is a silver bullet, in my opinion, does more to contribute to vaccine hesitancy than any immunocompromised person sharing their experience. But to Benjamin Mazer, what’s more important is to discredit the people who are sharing stories which disrupt the “vaxxed and relaxxed” narrative, to devalue the speech of those who are coming forward and trying to talk about how these policies are affecting their lives because it’s inconvenient. Oftentimes the personal narratives of immunocompromised people happen to highlight where these structural inequities intersect.

SC-F: One thing that I’ve noticed on my end is yes, there are definitely a lot of liberals who are into this back to normal idea, who are not really interested in speaking out on behalf of immunocompromised or medically vulnerable people, but I’ve noticed this is also something further on the left as well, among people who are supposedly interested in social justice and protecting vulnerable groups. And so I’m wondering, in your mind, what accounts for this? I think a lot of people I see actually speaking out are themselves medically vulnerable or they’re public health people or doctors of some sort. But I haven’t seen many prominent leftists, whether it’s politicians, journalists, etc., speaking out or showing concern.

And I’m not speaking just of the U.S., but Canada too, in Quebec, where I live. There’s this socialist-leaning party here in Quebec and my member of the Quebec National Assembly is part of that party. They were hesitant about the vaccine passport, implying that they would hurt unhoused people. There are some ways in which their messaging feels like it’s trying to appeal to an anti-vax sentiment as well. I really do feel like there’s a contingency of people on the left who are not really factoring in vulnerable people or seem to almost see people who are anti-mask as better representing working-class people and interests than medically vulnerable people, like those two things are opposed.

BA-B: You’re absolutely correct about the devaluation and dehumanization of medically vulnerable people and the minimization of our obligation to protect them as equal members of the body politic is not exclusive to any one political ideology or any one political party or country. I interviewed an epidemiologist named David Steadson who is Australian but has been living and working in Sweden for 22 years as a scientist with a broad background in epidemiology, public health, and technology. David and I talked about a paper that he co-authored that analyzes the political response to COVID in the first year in Sweden, called “Evaluation of science advice during the COVID-19 pandemic in Sweden.” And this was an issue that you saw debated all across Europe in the same way. And one of the things that we talked about is that within Sweden there’s a kind of pervasive cultural devaluation of vulnerable life and particularly of elders. And within the United States and within Canada, especially, which have two intertwined and intersecting histories of institutionalization and broad policies of containing and removing and exterminating disabled people for hundreds of years, which is still ongoing to this day, even though there were promises made in the 1950s that deinstitutionalization would be over, this is still broadly a phenomenon and our society has a preference to devalue these lives.

Conservatives, who say things like, “Oh, no abortions, not even for someone who’s in a medical emergency, we’re doing this to protect disabled people from selective abortions”—which ignores that disabled people get abortions too—that’s the same kind of paternalistic and ignorant ableist bias that you often see from people who say that protecting the vulnerable, many of whom are poor and working class themselves, is an affront against the working class—it ignores the fact that one in four U.S. adults have a disability that impacts major life activities, according to the CDC. Many disabled and vulnerable people are in the working class, it’s unserious, misinformed analysis to say that protecting the medically vulnerable is antithetical to the needs of the working class. The opposite is in fact true: If you want to support the working class then you need to protect the vulnerable from COVID by protecting everyone from COVID. That misinformed analysis reflects an idea that the working class does not include disabled people. And that’s not a new phenomenon to our COVID era, it’s reflected everywhere including common leftist ideology. It’s even within the work of Karl Marx, right? Marx and Engels conceive of the surplus class as separate from the working class in their work too. And part of what I try and do in my forthcoming book Health Communism is argue for a new approach to left politics and a new lens that looks at how we can all unite together and bring the surplus class and the working class together, not by collapsing them into one class but by recognizing that the divisions which are imposed between the surplus class and the working class are artificial and they only serve the needs of entrenched power.

And these are centuries-old dynamics driving the devaluation of vulnerable life or of life that makes people afraid for whatever reason. And disability and chronic illness has for a long time occupied this standpoint of generating a kind of existential fear about the declining total health of the body politic represented by the “growing sickness” of a few. And so I think because these pervasive cultural norms and stigmas are a regular part of socio-political life, we see them reflected in the approach to the pandemic and in the limitations in some of the analysis and policy proposals, or even in the advocacy of all sorts of groups across the political spectrum, whether they are anti-vaxxers or they are vaccine scientists, whether they are conservative elected politicians, or they are elected leftists or people running grassroots organizations. This ideology exists everywhere. It doesn’t discriminate. And it is part of the long and lasting legacy of the eugenics movement which long ago inspired a template, which drives our preference for policies that prefer the elimination of vulnerable life over society meeting the vulnerable’s needs. Eugenics is not just the attenuation and control of reproduction, it’s also a logic which justifies the state “letting die,” refusing to accommodate necessary changes to the built and social environment which would make things structurally and physically accessible to all people.

SC-F: So we’re talking about how a lot of these ableist ways of thinking and pandemic responses transcend countries, especially in the West, they exist even countries that do have Medicare for All like Canada. Do you still feel as supportive as you have previously of a Medicare for All-type system in the U.S.?

BA-B: Yeah. And I would like to make sure to say that in Canada the system is not perfect, and we should not, as health justice advocates in the United States, portray the Canadian system as perfect. It’s highly fractured, it’s different from province to province. And I know that many disabled and chronically ill people in Canada really resent the idea that the best that we can do with Medicare for All is to replicate the system in Canada. I think what the pandemic shows is that no country has a truly socialized health-care system.

And if we had a true socialized health-care system it would be oriented not just around the finance mechanisms being funded publicly, but was also around the fact that the point of a socialized health system is to promote the social lives and health of the population at large, not only through medical intervention, but also structural and social determinants of health. Housing is health care. Clean air is health care, clean water is health care. And right now what I think we have is just a really obvious example of not only how much work we have to do to fix health care in the United States, and Medicare for All is really just the first step of what I think could be a wonderful, important, and economically productive overhaul of how we distribute health resources, not just in the United States, but in other global systems because what we do here in the United States influences other countries.

The NHS in the UK has been under assault by American consultants for years, who come in and give recommendations about how to further privatize the NHS. And this has only increased wait times. It has made health-care delivery more difficult, increased the administrative burdens that are involved in accessing health care, and for what? To make a system more bloated, less efficient, that delivers for less of the needs that people have? That’s not socialized medicine. And if we’re replicating that system in the United States and calling it Medicare for All, it’s not really for everyone. We need to start having these difficult conversations about really who our policies are for and start challenging and critiquing people who want to make policies that are not for everyone, because, from our experience throughout the pandemic, we know that you can’t approach every single problem like it’s a personal responsibility problem. And that is the sort of de facto policy not just in the United States, but in many countries.

SC-F: One of the last things I wanted to ask you, going back to your experience working on the podcast during the pandemic, have a lot of listeners reached out to you, written to you, especially medically vulnerable people? And are there any common threads to what you hear from people?

BA-B: We hear from all sorts of communities: from scientists, from people who work in public health, people who work in the government, people who are doctors, nurses, hospital administrators, people who do billing, people who work for Medicaid, people who work in grocery stores, our listeners come from all over. And I think the theme that keeps coming up over and over that people are really struggling with, particularly right now, is that for many who have been paying close attention, and obviously the medically vulnerable have been paying very close attention because there is increased risk involved, they not only feel left behind, but they feel like they are being made to question their reality and question their worth and value because it’s so different from the policy response, social landscape, and media coverage they are seeing right now.

For example, the CDC changed the “Community Transmission Level” county-level risk coding system to a system that is almost identically named, but has a completely different scale of measuring infection. The old system was “Community Transmission Level.” The new system is “Community Level.” And, correspondingly, the map went from red to green overnight. These changes were not reflective of any updated scientific knowledge. They were reflective of a political intent to create a different perception of risk. And for a lot of people this felt very alienating and strange because if you look at that change, and you assume it’s happening in good faith, then you’re like, “I don’t understand why you would make this decision.” It just, logically speaking, completely contradicts everything that so many people know to be common sense about how COVID spreads—through the air. When COVID spreads, hospitals fill up and people die. It’s not just the unvaccinated, and it’s not just from COVID.

According to CDC data reporting, and this is coming from 23 U.S. jurisdictions between September 2021 and February 2022, there were over 33,000 breakthrough deaths. And over 7,000 of those were vaccinated people who not only had their primary series, but also a booster. 15 percent of breakthrough deaths were in boosted people in February 2022. The idea that this is a “pandemic of the unvaccinated” and that really the only COVID issue at play is vaccine hesitancy is so far from the reality that actual people are experiencing day-to-day, particularly people who are working in person in food service, who work in schools, who work in hospitals, who work in retail, who work in offices.

So why haven’t the changes in our embodied knowledge been incorporated into our policy approaches? I think that for many people, this is where the biggest feeling of being gaslit, being alienated, being talked out of your own version of reality is coming from. People, largely, expect that if the United States were in a crisis like the crisis we’re in now, and things were as obviously bad as they are with COVID, the government would be forced to be responsive, the government would be forced to respond to the needs of the most vulnerable by virtue of the circumstances of the crisis. I think, to realize that is not true, really shakes people’s faith in institutions of government, it makes them feel like they are not part of the body politic, that not only does no one care about them, but they don’t even have any value as part of the nation itself. And making people feel that way is, I think, at minimum, a losing midterm strategy.

SC-F: I guess my last question to you is: Do you see, at this point, any chance of shifting the narrative that’s coming from politicians and from the media that essentially boils down to: We shouldn’t really need to care about COVID anymore and people who are still worried are sort of hysterical or extreme? Do you see any chance of this narrative being turned around?

BA-B: Yeah, absolutely. I think people are talked out of expressing their outrage. I think we like to say that real change happens when people are polite and quiet and wait their turn to speak, but that’s not the truth. And I think it’s up to every one of us to not consent to these policies that we know are going to make the pandemic more durable, that we know are going to prolong the suffering. And it might seem small, but doing things like refusing to unquestionably hear things like, “Oh, well, if a mask isn’t 100 percent effective, it’s useless” coming from someone in your immediate social life or your community, trying to have a conversation about it obviously is a really important thing that people can do as individuals. This is the kind of individual level interventions that we can make—rhetorical interventions. That is also a non-pharmaceutical intervention, one that really does work at the level of personal responsibility, having conversations with people honestly about what the stakes are.

If you’re medically vulnerable, you might not want to have to talk to the people in your life about your medical condition. And it’s not really okay that the Biden Administration basically says that your safety is now predicated on your disclosure.

I hope people start to feel comfortable in recognizing their own expertise here. We have seen the pandemic with our own eyes for two years. And I think it’s time for the truth. It’s time for reconciliation. Time to move forward and really start thinking about how we can work to build a society that doesn’t just live with COVID, that doesn’t just survive COVID, but that thrives in spite of COVID, that goes beyond the bare-minimum on COVID. And I think that these are absolutely things that we can and will do as a society, COVID isn’t going anywhere, at some point we will have to give this up and get serious about managing this pandemic. When are we going to do it? I don’t know. But I do know that the way to start getting there is to start having these conversations now, before we know how to get there. We need to start breaking ourselves away from these constrictive and restrictive rhetorical attacks on political will that discourage people and talk them out of demanding what they really want—big ideas and big plans can coexist with our narrow political reality. We need big, bold demands for what would make us feel safe, not just demands for what we think might be feasible.