We need better technologies to create conditions for better politics. But we need better politics to create better technologies. Maybe, just maybe, we’re about to get both.
President Joe Biden announced that Renee Wegrzyn, a biotechnology executive who worked at the Defense Advanced Research Projects Agency, Darpa, will be the first director of the Advanced Health Research Projects Agency, or ARPA-H.
The alphabet soup hides the ambition of the projects. Darpa is the defense research agency that played a crucial role in creating the internet, stealth technology, GPS navigation, drones and mRNA vaccines. It’s a remarkable track record and it’s down to an ability to do something unusual in Washington: big, risky bets.
Shortly after becoming president, Biden persuaded Congress to fund a similar agency that would focus on medical technology: Arpa-H. Why do we need this when we already have the National Institutes of Health (NIH)? Because the NIH, despite its rigor and the wonders it has already accomplished, is widely seen as overly cautious.
Arpa-H will be headquartered at the NIH, which some people regret, but its mission is to face the kind of gamble that Darpa accepts and the NIH sometimes avoids. Biden promised that Wegrzyn “will bring Darpa’s legendary attitude, culture, boldness and risk-taking to Arpa-H to meet a critical need.”
Here two facets of the Biden administration are revealed, one of which I don’t think gets enough credit and the other that I’m afraid isn’t criticized enough. The first is that management has placed technological advancement at the center of its agenda. All the great laws he passed were based on a theory about how better public policy can lead to better technologies that can lead to a better world.
The second facet is that technological optimism is accompanied by institutional conservatism: many agencies in Washington have been too cautious during the pandemic, and little has been done to make them bolder.
Let’s start with Biden’s ambition. Four major legislative packages were passed: the American Economic Rescue Plan and the Bipartisan Infrastructure, Chips and Science and Inflation Reduction laws. Fundamentally, each aims to create or apply new technologies to the search for solutions to current problems.
The former employed vaccines, testing and genomic surveillance to quell the pandemic; the infrastructure law is full of ideas for developing the next generation of energy and transport technologies; Chips is an effort to break our dependence on semiconductors made in Taiwan and South Korea and keep us ahead of China in fields such as artificial intelligence; and the Inflation Reduction Act employs tax incentives to boost the wind and solar industries, among other advances.
Much attention has been paid in recent years to how technology can make politics cruder and more aggressive. Just think of the disinformation made possible and facilitated by social media or the shuttered factories and cities torn apart by advances in communications and transport that have driven globalization. But new technologies can also create new possibilities.
Climate change policy would be impossible if solar panel costs hadn’t dropped by 89% in ten years and wind energy by 70%. California’s decision to ban the sale of automobiles powered by combustion engines from 2035 onwards would have been unthinkable without the advances made in battery technology. Vaccination can reduce the threat of disease in ways that social distancing cannot, as vaccination campaigns can be continued, but lockdowns become economically, politically and socially devastating.
And we are far from having reached the political or technological frontier. Take the case of Covid, where miracles and calamities coexist. Biden’s vaccination effort started out strong and then got bogged down in political polarization, misinformation and very poor communication about booster shots.
But what we didn’t do should not divert our attention from what we did. Vaccines, treatments, hospitalization protocols, rapid tests — all of this combined with post-infection immunity — decoupled the number of cases from the number of deaths.
The pandemic still takes a terrible toll, but much less than it would otherwise. Something resembling normalcy is possible for many people today, and innovation and the use of new drugs are a major cause of this.
What applies to Covid applies equally to many diseases that don’t get as much daily coverage in the media. The issue of costs dominates Washington’s discussions. What we actually get in return for so much money spent is a much more distant concern.
At this point, it has become a cliché for politicians to display graphs showing the staggering increase in projected health spending over the next 40 or 75 years. But they always made me suspicious. Does what we receive in exchange for these expenses not matter? Tell me if we’re going to live healthy to 175 and I’ll tell you if spending a hefty share of GDP on health is a scandal or a great deal.
The Inflation Reduction Act authorizes Medicare to negotiate to lower the prices of certain drugs. Medicines are not a commodity like any other. If you don’t have the money to buy that TV you want so much, you walk out of the store. If you can’t afford the anticancer treatment that can give your spouse another ten years of life, you sell everything to get the money.
Pharmaceutical companies can charge whatever they want — and they do. Only governments have the necessary bargaining power to stop these cost increases. Other governments do: citizens of countries like Canada and the UK pay much less for drugs that were developed in the US, often from publicly funded research.
The counter-argument is that the high costs Americans pay subsidize pharmaceutical innovations for the entire world — and frustrating as that is, it’s worth it. I never found it convincing. Should we pay 50% more for drugs to push the system to innovate even more?
But the underlying idea is correct: that pharmaceutical innovation matters and that we must move heaven and earth to encourage it. The treatment given to Covid vaccines should serve as an example. We made its development a national priority, we ensured that corporate profits, but also that doses would be available to all Americans at an affordable cost.
Democrats should intertwine measures to make drugs cheaper with measures to facilitate pharmaceutical innovation and, in some cases, make it more profitable. I spent some time talking to Heidi Williams, an economist at Stanford University, and what she said was so obvious that it’s amazing that we haven’t done more along these lines. We spend a lot on the initial phase (basic science and research) of a drug, and even more on the products that end up being developed. But we ignore the middle part: all the difficult and unattractive infrastructure needed to convert a promising molecule into a miracle treatment.
More money could be nice — especially if spent in new ways, like funding awards or Arpa-H — but Washington now spends billions of dollars on medical research, and it’s worth asking if it’s money well spent.
To be fair, there are good reasons for the NIH to tread carefully, and they are political reasons, not just scientific or economic ones. The same Republicans who lash out at the government for being too conventional and slow to act criticize failed concessions and unexpected bets, describing them as a waste of taxpayer money. In so doing, they create the incentives for precisely the bureaucratic caution they so condemn.
But the pandemic should not convince anyone of the infallibility of our health agencies. The NIH proved unable to shift focus quickly when the pandemic hit: only 2% of its 2020 budget was spent on Covid research. The FDA took too long to approve the rapid tests that Europe started using long before. The CDC was, frankly, a mess. But none of the failures we have seen have led to major reforms of these agencies. This cannot be right.
We are talking about institutions full of brilliant professionals, who work hard and who are doing the best they can within the constraints imposed on them. They should be reviewed regularly. In Washington, however, the need to defend esteemed institutions like the NIH against budget cuts and political interference drives people who believe in the organization to become advocates rather than improvers.
This is how we arrive at a bizarre situation as Arpa-H —which is evidently intended to operate radically different from the NIH—is created as part of the NIH. Last week I wrote about how much of Biden’s agenda depends on new structures. But the agenda is equally dependent on innovation — and much needs to be done to make the government more supportive of them.
Still, this is an unexpectedly thought-provoking side of Biden’s presidency. A liberalism that has as much ambition to find solutions to problems through invention as through redistribution would indeed be powerful.
With a wealth of experience honed over 4+ years in journalism, I bring a seasoned voice to the world of news. Currently, I work as a freelance writer and editor, always seeking new opportunities to tell compelling stories in the field of world news.
