Two pandemics bookend the last forty years—HIV and Covid-19. The first changed our view of health care and its delivery in dramatic ways. Perhaps the second will change our view of health and who has access to it.
Three years past the initial 1981 report of persons with a new infectious syndrome was published, the activist Larry Kramer wrote an article “1112 and Counting” in which he berated every government official connected with health care—from CDC and NIH administrators to local politicians—for refusing to acknowledge the widening AIDS epidemic. (President Reagan had not yet said the word HIV publicly and wouldn’t for four more years). The burden of HIV fell on certain marginalized groups. As the HIV epidemic surged, gay men demanded vigorous federal intervention on their behalf. They wanted the benefits, protections, and resources that only Washington could provide. Cohesive activism slowly developed, taking years to organize, but what the reshaping of public opinion around HIV and biomedical activities produced was dramatic. The average FDA approval time of new drugs went from a decade to a year. Patient groups had to be consulted when new drugs were being reviewed by federal agencies. The purity of the placebo-controlled trial was re-imagined. Consumers started to demand to know treatment options and success rates and to be able to shop for the best care. It was a new era in biomedicine and in being a patient in the health care system.
We jump ahead 40 years. The political response to Covid-19’s arrival was actually worse than Reagan’s choice to ignore AIDS. On January 2, 2020, the director of the CDC contacted the National Security Council to warn about early cases of the coronavirus in China and the potential that it could spread to the United States. Yet when President Trump’s first televised remarks came 3 weeks later, he said, “We have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.” Warnings by scientists were soon termed a “hoax.” The disinformation campaign that followed mattered gravely because Covid-19, a respiratory illness, was a broader threat to the general public than HIV ever was.
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