No More Cures: The Rise of Health Management over Disease Eradication

• In Event: Up for Interpretation? Reflections on Methods, Concepts, and Policies

Abstract

This paper explores the development of contemporary imperatives within U.S. health policy regimes to explain why preventable and solvable health issues from HIV/AIDS to COVID-19 become objects of management—rather than eradication. The greatest successes in healthcare policy over the 20th century led to historic gains in life expectancy, the eradication of smallpox and polio, and the near elimination of numerous other threats. These accomplishments were achieved in-part by federal mandates requiring vaccines, universal solutions like mosquito nets, chlorinating drinking water, and adding iodine to salt. Yet, today, equivalent victories in diseases like COVID-19 and HIV/AIDS seem like wishful thinking. This paper seeks to answer how this transformation in policy goals developed through the social and political history of the HIV/AIDS epidemic.
I employ Vivian Schmidt’s method of discursive institutionalism to analyze policy discourse between policymakers, scientists, and patients as ways to understand how power works in this space. Additionally, I rely on Michelle Murphy’s concept of distributed reproduction, which seeks to understand how certain life is made livable through infrastructures, both material and discursive. For this paper, I apply this approach to the development of therapies over the 40+ history of HIV/AIDS. HIV/AIDS is preventable and treatable, but only 6 people have been cured therapeutically. Outside of a cure, the virus is politically contained within vulnerable populations who lack access and resources for care, treatment, and prevention. For those who do have access they require daily pills to stay alive. We have the tools to prevent and eliminate this threat, but the contemporary healthcare infrastructure allows the virus to persist.
This paper argues that there are three central drivers of these contemporary policy imperatives. First, the pathogens we are experiencing now are highly evolved zoonoses and have direct or indirect connections to our changing climate in a population exceeding 8 billion. Put simply, we have solved the low-hanging fruit of diseases through sanitation, simple vaccines, and technological advancements. These emerging and persistent health threats are much more difficult to cure. Secondly, the role of patents and intellectual property play an outsized role in our policy imperatives. Profit, not innovation matter here. Third, the weaponization of identity politics. Depending on the state you live in you may not have access to reproductive care, gender-affirming care, or HIV/AIDS therapies. The access gap continues to widen.
Taken together, this paper explores the contemporary dilemma of ‘cure’ as a policy goal. We live in a remarkable age of biotechnical advances: the development of HIV/AIDS prevention drugs, the creation of MRNA vaccines, new cancer therapies that have the potential to eliminate a leading cause of death within the next two decades. But these therapies will not reach all of our communities, nor is there profit in curing diseases—managing diseases, however, is a growth opportunity. It is in this milieu that healthcare policy is stuck, and this paper helps to explain this phenomenon as a way to move towards a healthier future.

Author

• J. Ricky Price, St. John Fisher College