By Martha Lincoln
From spring 2020 through the present day, Americans have endured levels of sickness and death that are outliers among not only wealthy democracies, but around the world. No other country has recorded as many total COVID-19 casualties as the United States — indeed, no other country comes close.
This situation is not happenstance. From early moments in 2020, the concept of a right to health — and indeed, even a right to life — has been discounted in American policy, discourse, and practice. Quite mainstream and influential individuals and institutions — physicians, economists, and think tanks — have urged leaders to shed public health protections — particularly masking — and “move away” from the pandemic. Over the past two years in the United States, leaders in both political parties have capitulated to — if not embraced — the doxa that a certain amount of death and suffering is inevitable in our efforts to overcome (or “live with”) the pandemic. In a piece written during the first months of COVID under Trump, I called this dangerous yet influential outlook necrosecurity: “the cultural idea that mass death among less grievable subjects plays an essential role in maintaining social welfare and public order.”
Though the Biden administration’s implementation of necrosecurity in COVID policy has diverged from that of the preceding administration, our current national pandemic response is still steeped in some of the same contradictions. Biden has sought to distinguish his approach from the vulgar nihilism of Trump, who expressed indifference towards the early victims of the coronavirus, discouraged public health measures, and cited body counts as evidence of policy successes. In Trump’s calculus, average Americans (and particularly the vulnerable) were just so much bare life — living bodies without legal rights or civil status.
Many Americans welcomed the election of a Democrat who promised the public “I will end this.” Yet, although Biden has consistently positioned himself as “following the science,” national pandemic outcomes have not improved significantly — despite claims to the contrary by the White House. Since the introduction of COVID vaccines in 2021, if not before, Democratic leaders have rolled back mandates and devolved the responsibility of preventing disease to individuals and families. Through an enormous surge of cases and deaths caused by the spread of the Omicron variant, the President and the Centers for Disease Control and Prevention “promised ‘no disruptions’ for the vaccinated,” as Cecília Tomori et al. have written, “while the unvaccinated were left susceptible to a ‘winter of severe illness and death’ — further deepening divisions and neglecting fundamental human rights.” Over those months, the administration talked up the spurious construct of a “pandemic of the unvaccinated” — telegraphing a victim-blaming policy approach in which institutions were indemnified and average citizens held to account.
Beginning roughly in the worst weeks of the Omicron surge, the Biden administration has been characterized as giving up on its COVID response. It has also visibly pivoted to an approach grounded in the same kind of magical thinking that characterized the Trump era. The White House has crafted messages that perversely normalized illness, stigmatized masking, promoted a defeatist “new normal,” and, as journalist Katherine Wu wrote, killed a pandemic strategy grounded in the principles of population health. Leaning hard on the claim that “we have the tools” to manage the pandemic, the White House has emphasized optics instead, internally debating what level of ongoing mortality the public will accept. In July, national COVID Coordinator Ashish Jha asserted “We are now at a point…where we can prevent nearly every COVID death in America” — the same week that Biden was found to have COVID, and that 3,135 more Americans died of the virus.
The public health malpractice of two successive administrations, and the cant that has propped it up, suggest a polity that is out of moves — or perhaps more accurately, they reveal a polity that wants to appear as if its hands were tied. There is indeed no meaningful alternative to the COVID outcomes that the Trump and Biden administrations have achieved; not without undoing arrangements that favor powerful interests. Death represents the de facto solution to many of the conundrums posed by the pandemic, then — an ugly truth that still manages to make its way into talking points from time to time.
This defeatist approach to COVID is quite in keeping with existing dynamics in the American health care system and broader national safety net. Compared to our counterparts in many other global settings, Americans are afforded minimal entitlements to health care; we have no universal health insurance; we have still fewer rights regarding the social determinants of health and their distribution. In a recent comparison of health system performance in 11 high-income countries, the U.S. rated last, owing in part to our lack of universal coverage provision. Absent stronger normative commitments to protecting public health, the American social contract around bodily well-being has been shaped by dynamics of expropriation and coercion — a rough parallel, perhaps, to the historic enclosure of common lands that made peasants into disempowered proletarians with no means of survival other than selling their labor.
The U.S. state’s de facto right to maim its citizens makes for a tenuous but profitable arrangement under normal conditions, and a catastrophic (yet also profitable) situation in the context of a public health emergency. It’s apparent that in historical retrospect, the events of the past few years will seem insensible, even unlawful. But for now, necrosecurity-minded policy elites seem sanguine about the many COVID fatalities ahead. As political leaders, business interests, pundits, and institutions have made clear, there will be no other way forward; when push comes to shove, health is a privilege, not a right. However painfully, unfairly, or untimely, some of us simply are going to have to die.