Experts are now warning that the U.S. testing system is on the brink of collapse. “We are at a very bad moment here,” said Margaret Bourdeaux. “We are about to lose visibility on this monster and it’s going to rampage through our whole country. This is a massive emergency.”
THE PLOT TO SAVE AMERICA
In late January, Rajiv Shah, president of the Rockefeller Foundation, went to Davos, Switzerland, and served on a panel at the World Economic Forum with climate activist Greta Thunberg. There, he had coffee with WHO Director-General Dr. Tedros Adhanom Ghebreyesus, whom he’d known from his years working in global public health, first at the Gates Foundation and then as director of USAID, an international development agency within the U.S. government.
Shah returned to New York, and to the Rockefeller Foundation headquarters, with a clear understanding: SARS-CoV-2 was going to be the big one.
The Rockefeller Foundation, which aims to address global inequality with a $4.4 billion endowment, helped create America’s modern public health system through the early work of the Rockefeller Sanitary Commission to eradicate hookworm disease. Shah immediately began to refocus the foundation on the coming pandemic, and hired a worldwide expert, Dr. Jonathan Quick, to guide its response.
Meanwhile, he kept watching and waiting for what he assumed would be a massive federal mobilization. “The normal [strong] federal emergency response, protocols, guidance, materials, organization, and leadership were not immediately taking form,” he said. “It was pretty obvious the right things weren’t happening.”
As director of USAID from 2009 to 2015, Shah led the U.S. response to both the Haiti earthquake and the West African Ebola outbreak, and knew that the “relentless” collection of real-time metrics in a disaster was essential.
During the Ebola outbreak, which he managed from West Africa, he brought in a world-famous European epidemiologist, Hans Rosling, and President Barack Obama’s chief information officer to develop a detailed set of metrics, update them continuously in a spreadsheet, and send them daily to 25 top U.S. government officials. When it comes to outbreaks, said Shah, “If you don’t get this thing early, you’re chasing an exponentially steep curve.”
On April 21, the Rockefeller Foundation released a detailed plan for what it described as the “largest public health testing program in American history,” a massive scale-up from roughly 1 million tests a week at the time to 3 million a week by June and 30 million by the fall.
Estimating the cost at $100 billion, it proposed an all-hands-on-deck approach that would unite federal, state, and local governments; academic institutions; and the private and nonprofit sectors. Together, they would rapidly optimize laboratory capacity, create an emergency supply chain, build a 300,000-strong contact-tracing health corps, and create a real-time public data platform to guide the response and prevent reemergence.
The Rockefeller plan sought to do exactly what the federal government had chosen not to: create a national infrastructure in a record-short period of time. “Raj doesn’t do non-huge things,” said Andrew Sweet, the Rockefeller Foundation’s managing director for COVID-19 response and recovery. In a discussion with coalition members, Dr. Anthony Fauci called the Rockefeller plan “music to my ears.”
Reaching out to state and local governments, the foundation and its advisers soon became flooded with calls for help from school districts, hospital systems, and workplaces, all desperate for guidance. In regular video calls, a core advisory team that includes Shah, former FDA commissioner Mark McClellan, former National Cancer Institute director Rick Klausner, and Section 32’s Mike Pellini worked through how best to support members of its growing coalition.