Inspired by the Council’s Rachel Tanur Memorial Prize for Visual Sociology, we ask prominent scholars to select a visual artifact of this time that will help future researchers understand the Covid-19 crisis. In this conversation, Andrew Lakoff (professor of sociology and communication, University of Southern California) spoke with Clare McGranahan (associate director of communications) about the US government’s Strategic National Stockpile, why the country was left short-supplied during the pandemic, and the broader social issues that influence how societies respond to catastrophic events.

Photo Credit: US Department of Health and Human Services

Clare McGranahan (CM): You chose a photo of the United States’ Strategic National Stockpile. Why did you select this image for the time capsule?

Andrew Lakoff (AL): The Strategic National Stockpile is a federal government project for storing essential medical supplies in case of a national health emergency. It’s a kind of mundane object, but I think it points to many of the sources of our failed response to Covid-19.

I chose the image of the stockpile for the time capsule in part because I think a stockpile is actually a kind of time capsule. You’re putting things into a box now with the expectation that in some future moment, we don’t know when, people will open it up again. The things that are in the stockpile materially instantiate the way in which a society at a given moment imagines what a catastrophic future will look like and what will be needed in order to survive that future.

The very first stockpile of essential survival items was built in the 1950s to prepare for a thermonuclear war, and it contained things like surgical equipment, radiation dosimeters, sanitation supplies, water pumps, and electrical generators. Over the years, most of those supplies degraded—medicines expired, equipment rusted, food went bad. So one problem with stockpiles is that they are hard to keep up, and it can be difficult to justify putting resources into maintaining them when one hopes never to use the supplies inside those boxes. If and when the stockpile is finally opened up, it may look something more like a ruin, a frozen image of the past’s expectation of the future.

Another problem with stockpiling is that the actual future tends not to look like the one that was expected. Take the case of the Strategic National Stockpile. It was created in the late 1990s when national security officials thought that the US was going to be faced with a bioterrorist attack. They supplied it with millions of doses of smallpox vaccine, anthrax vaccine, botulism antitoxin, nerve gas antidote—these were the threats they were most worried about at the time. A huge amount of work went into imagining how such an attack would unfold and putting in place measures to contain it, to distribute medical supplies, and to support the pharmaceutical and biotech industries to develop drugs for diseases that had no prevalence and for which there was no market.

But then we learned at the very outset of the Covid-19 pandemic that this stockpile of essential supplies for a biological disaster didn’t have enough of some of the most basic items that were needed—such as personal protective equipment or ventilators. We didn’t have the supplies to protect frontline health-care workers faced with exposure to the virus in the first months of the outbreak.

And then the problems became much bigger than the question of what was in the stockpile. We saw huge tensions arise over the role of the federal government in providing necessary items to the population and to essential workers. The Trump administration turned access to these essential supplies into a patronage system and fostered an underground and unregulated market in which speculators profited from exploiting demand.

We also learned about the deficiencies in the global supply chain for producing and distributing these critical items. The very efficiencies that had been built into production systems as part of just-in-time delivery systems turned into grave vulnerabilities, especially when shipments were cut off from overseas suppliers. And we learned about the problem of prioritization: Who should get these scarce supplies, like ventilators or masks, when there’s overwhelming demand?

And finally, the category of essential worker became a site of political scrutiny: Who was required to expose themselves to the risk of contagion in order to keep our basic infrastructure functioning, and how could we ensure that those people were provided with the necessary gear?

CM: Many experts did raise the possibility of a global pandemic before Covid-19 hit. The scenario we’re living through now wasn’t unimaginable. Why do you think we weren’t we better prepared for it?

AL: The year before the Covid-19 pandemic struck, a study was conducted of which nations around the world were the most prepared for a disease emergency, and the US scored number one. That begs the question: What did preparedness mean according to the experts thinking about this catastrophic future?

I think the Strategic National Stockpile program exemplifies this. It was focused on a narrow set of questions: detecting an outbreak, containing it as quickly as possible, trying to distribute medical countermeasures to the population efficiently and fairly. As it turned out, once we failed to contain the epidemic, we actually hadn’t thought through some of the bigger social and political questions that would shape whether a given society or nation was capable of responding well.

In the case of the United States, the big questions concerned issues like the unequal exposure to risk or the number of people who, due to lack of health insurance, don’t have access to good medical care; the defunding of public health systems over many years; and the very question of whether leaders and members of the public trust experts to provide guidelines on how to intervene in a disease emergency. Ensuring the welfare of the population, it turned out, cannot be limited to activities like storing supplies in boxes.

CM: What lessons can we take from the stockpile in terms of who we prioritize protecting in a health crisis?

AL: At the start of the Covid-19 pandemic, we learned about the somewhat obscure category of essential workers, the people who keep our basic critical infrastructure functioning: food supply, logistics, transportation systems, health care. Those workers are in many cases the least privileged members of our society. And they turned out to be the most necessary. Our emergency response systems included guidelines that required those workers to expose themselves to the risk of contracting the disease, while people who don’t work in those industries or provide those essential services could stay home and not risk exposure.

And of course, we didn’t have measures in place to make sure that the folks who were getting exposed had the necessary protections, which is again related to the stockpile question of what kinds of supplies we need and how we make decisions about how to allocate those supplies.

CM: Are there examples of countries other than the US whose stockpiles were more effective during the pandemic? And to what extent do you think that was a product of chance versus better decision-making?

AL: One issue has to do with storing supplies, and another with producing and distributing needed ones.  Some countries in East Asia were much better at making supplies, such as masks and protective gear, available to those who needed them, in part because they are the centers of manufacturing for many of these supplies. By the same token, there were other countries that had a lot of problems with this issue. Spain, for example, had major shortages of protective gear. I think the main lesson is that the United States invested very heavily in stockpiling supplies that turned out not to have any relevance to this particular disease. In East Asia, they had a lot of experience with respiratory outbreaks, whether it was new strains of the flu or SARS, and so there was a lot of anticipation and readiness for a disease like this. In the US, we arguably underestimated this threat in relation to other threats that, in retrospect, look so much less likely.

CM: To a certain extent, it seems like there will always be limitations to this kind of strategy. Beyond stockpiling, what would help us better prepare for health crises in the future, and are you hopeful that we’ll take those steps?

AL: One of the things we’ve learned is that the elements of social and political life that might make society better suited to dealing with a catastrophic event like a pandemic are not limited to the sorts of things that preparedness experts focused on—things that can be put in boxes and put away—but are tied to much bigger questions: How much support does your public health infrastructure receive? How well do localities and states coordinate with the federal government in their responses? How much trust is there in public health experts? And how many people have access to basic health care? These are the big social and political questions that are relevant, whether or not there’s a national health crisis, and those factors turned out to be more important to how a society responds to this kind of event than what’s in its stockpile.

CM: Finally, what do you hope that future social researchers will take away from this?

AL: I think social scientists have a tendency to take for granted some of the existing social categories as providing the relevant problems to study. And of course, forms of social classification, whether they’re age-based or race- or class-based, are certainly salient indicators for thinking about how societies respond to this kind of emergency. But my suggestion is that we social scientists also look at mundane technical artifacts and systems that are often left to engineers or somewhat obscure policy planners, because I think those objects can offer useful insight both into sources of failure and into areas where future interventions may be helpful.

This conversation was conducted on September 2, 2020. It has been edited for length and clarity.