A national plan to track the spread of the coronavirus and administer tens of millions of tests each week has the hallmarks of a sprawling federal government program. But in the absence of clear federal guidance, it was private philanthropy, led by the Rockefeller Foundation, that stepped in.
As schools reopen in many parts of the country and people push to return to some sense of normal life, where they can gather in crowds, go to offices, and shop in malls without fear, testing for the virus will be essential. But a coordinated plan to develop a fast, inexpensive test hasn’t materialized from the federal government. States have been left to compete for testing-kit purchases, and the diagnostic test being used took too long to deliver results.
A major part of the Rockefeller plan, developed under the leadership of the foundation’s president, Rajiv Shah, is to support the development of an alternative testing approach that will be faster and cheaper. The foundation is working with seven states that have formed a compact to develop and purchase test kits. The group’s goal is to test about 30 million Americans by the end of the year. Without a national strategy, the number of weekly tests stalled at 1 million for several months, beginning in April, before climbing to about 4.5 million.
Eileen O’Connor, senior vice president for communications, policy, and advocacy at Rockefeller, says Adm. Brett Giroir, the White House’s point person on testing, has been in close contact with Rockefeller and the states as the members of the compact worked on the plan. Whether or not the strategy should have originated in the federal government, she says, doesn’t matter.
“It’s not a question of who should have done what,” she says “There’s a need to help, and we’re going to fill that need.”
Early Start
Rockefeller has committed $100 million to the strategy, which has been in development since the pandemic set off early-warning tripwires in January. A primary goal has been to identify points in the manufacturing supply chain that could slow production of new tests. The foundation is working with academic researchers, state and federal policy makers, and business leaders to build a consensus around testing needs.
The New York grant maker hired Jonathan Quick, a former director of essential medicines at the World Health Organization, to lead the pandemic response. Quick and other Rockefeller leaders have set up a project-management office to come up with policies and procedures for the use of tests.
The plan also envisions hiring up to 300,000 contact tracers nationally to track the spread of the disease. Rockefeller has given a $2 million grant to Baltimore to test how people who have lost jobs because of the pandemic might be employed as tracers. The foundation is working with policy makers to develop policies on the use of tracing technology that the foundation says must balance privacy concerns with the need to slow the rate of infection.
In addition, the Rockefeller strategy envisions a massive public-relations effort to inform people on ways to protect themselves and the creation of a data platform that integrates federal, state, and local testing data to identify shortages of tests and to snuff out any flare-ups in new cases.
Broad Response
Rockefeller’s Covid-19 plan is hardly the only response to the pandemic from institutional philanthropy. The Bill & Melinda Gates Foundation, for example, has poured hundreds of millions toward vaccine and treatment development. And a dozen California grant makers, including Kaiser Permanente, the Ballmer Group, and the California Wellness, Conrad Hilton, Irvine, and Weingart foundations contributed nearly $82 million to a state Covid plan to provide services to people in quarantine.
James Ferris, director of the University of Southern California’s Center on Philanthropy and Public Policy, says that when wealthy foundations take on roles normally associated with the government, they open themselves up to criticism that they are bypassing the will of the people.
But, drawing similarities to Detroit’s 2014 “grand bargain,” in which more than a dozen foundations devised a $370 million plan to help the Motor City emerge from bankruptcy, Ferris says Rockefeller simply stepped in to fill a leadership void.
“It’s undemocratic,” he says of the Rockefeller plan, “but it’s clear that the government is not that democratic, either. It is failing the people. In the time of crisis, it’s easier to violate those strict, bright lines.”
Rockefeller views its plan as the spear tip of a national “wartime effort” that would require the federal government to spend at least $75 billion and invoke the Defense Production Act to control manufacturing activity. In the meantime, one of the foundation’s main roles is to demonstrate to testing companies that if they spend money creating the capacity to manufacture new kits, there will be a ready supply of customers at the state level to buy them.
“There is no way that philanthropy can fulfill the role of government. We’re just not big enough,” O’Connor says.” But if we could help send a market signal or draw more philanthropy that might be needed, then that’s something that we felt we could do.”
More Foundations Join
Other foundations have joined in. At the local level, 10 grant makers have contributed to Rockefeller’s Baltimore pilot. The Skoll Foundation, a longtime leader in pandemic response, says it is ready to contribute in a “significant” way to the Rockefeller-supported state purchasing compact, according to Bruce Lowry, a senior adviser at Skoll.
In April, Jeff Skoll contributed $100 million to his foundation to respond to the virus. So far, most of that effort has gone overseas, particularly to programs to support the Africa CDC monitor and suppress the spread of the virus.
Lowry declined to say how much the foundation would contribute to the Rockefeller effort. But he says the spread of the disease in the United States made it clear to Skoll that attention had to be placed domestically.
“Six months ago, you probably would not have identified that in the middle of summer the global hot spot for Covid-19 would be in the United States,” he says. “We’re not where we need to be in the U.S. in tackling this thing.”
A big problem in testing for the disease is that PCR” tests used to genetically detect Covid-19 are expensive, and it can take more than a week to get results. If a person has been exposed during the wait, the test can be meaningless. The Rockefeller-led state purchasing groups are looking to develop antigen tests. The promise of those tests, which can detect proteins associated with the presence of the virus, is that they are cheap and might deliver results in minutes.
The goal of the state compacts is to quickly develop antigen tests without going through a lengthy U.S. Food and Drug Administration approval process. To do so, companies need to be reassured that they be made whole for any expenditures they make to ramp up production. By buying together in bulk, the collective action of the states sends an important signal to manufacturers that they won’t bear undue risk.
Rockefeller, Lowry says, has played a role as a catalyst in getting researchers and policy makers to move toward a consensus on a plan and potentially to “unlock bigger money” by trying to add more states to the seven — Louisiana, Maryland, Massachusetts, Michigan, North Carolina, Ohio, and Virginia — that have joined the compact.
In the absence of a federal plan, the states could provide vital information to residents, he says.
“If 30 governors say this is how testing should work, that’s an important political signal,” he says.
Baltimore Program
In Baltimore, Rockefeller’s $2 million grant to support community-based contact tracers and Covid-care providers has already unlocked more than $3 million in additional support from grant makers, including the Annie E. Casey, PepsiCo, and T. Rowe Price foundations and Bloomberg Philanthropies. The city of Baltimore contributed $4.5 million.
Tracers are used so public health officials can track how the disease spreads and pinpoint the origination of disease clusters. To be successful, it is helpful for tracers to know about the people and geography of the neighborhoods they work in, according to Fagan Harris, executive director of the Baltimore Corps. Harris’s group contracts with the city to provide workers. It joined Rockefeller’s Baltimore effort and has been assigned with building “an army of tracers” to combat the spread of the disease.
The tracers work in conjunction with groups including HealthCare Access Maryland to provide support for patients who have tested positive. In addition to the private grant dollars and city money, a federal grant from the Cares Act will help coordinate care.
Harris targeted people in ZIP codes hit hard economically by the pandemic. His goal is to hire people who have lost jobs this year. Tracers receive training and are paid $30,000 to $80,000 a year. He received more than 5,000 applications and has hired about 50 people, half of his goal.
Finding people, training them, and then making sure they are targeting the right areas to combat the spread of the disease is a big challenge, Harris says.
“Rockefeller has been just an enormous reservoir of expertise and technical assistance as we developed a plan of attack, and they gave the project credibility as we went to secure other funding,” he says.
