Abstract

How much better would the United States have responded to the Covid-19 pandemic had there been in place in 2020 competent and committed political leadership? A partial answer to this question lies in identification of the organizational and technological capabilities to develop, manufacture, and deliver “countermeasures”—personal protective equipment (PPE), ventilators, diagnostic tests, therapies, and vaccines—that a competent and committed federal administration would have been able to mobilize to respond to the pandemic. Main repositories of the necessary capabilities are government agencies and business corporations, with the development, production, and delivery of countermeasures relying heavily on government-business collaborations (GBCs). The proposed paper for the BHC session builds upon a 2020 working paper by William Lazonick and Matt Hopkins, “How ‘Maximizing Shareholder Value’ Minimized the Strategic National Stockpile.” I trace the historical evolution within the U.S. federal government of the current system of public-health preparedness for and response to a pandemic through the end of the Obama administration. Then, I analyze the particular GBCs to develop ventilators for the SNS that were initiated and implemented by the Biomedical Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response (ASPR) within the U.S. Department of Health and Human Services (HHS). BARDA initiated two successive GBCs, one beginning in 2010 and the second in 2014, with two different business firms, for the purpose of developing portable, easy-to-use, and affordable ventilators for the SNS. The strength of these collaborations lay with the innovative ventilator manufacturers with which BARDA contracted. Their weakness appeared when these innovative manufacturers fell under the control of business corporations committed to the ideology of “maximizing shareholder value” (MSV). Building on the ventilator example, the BHC paper will consider the wider deleterious impacts of MSV ideology on U.S. pandemic preparedness.