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University of Texas in Dallas

President Donald Trump’s first choice to be director of the U.S. Census Bureau strongly endorses the administration’s controversial decision to add a citizenship question to the 2020 census.

Speaking publicly for the first time, Thomas Brunell, a professor of political science at the University of Texas in Dallas, tells ScienceInsider that critics—including the six previous Census Bureau directors—have exaggerated the potential problems that could arise from including the question. Brunell, who earlier this year withdrew from consideration for the deputy director’s post at the Census Bureau, also believes that the nation’s largest statistical agency has a duty to carry out the political agenda of its White House bosses.

“I’m agnostic on whether [the citizenship question] is needed,” Brunell says. “I think the critical point is that the administration wants to put it on there. They have made a political decision. And they have every right to do that, because they won the election.” In March, Secretary of Commerce Wilbur Ross approved a request from the Department of Justice (DOJ) for such a question; the department says it needs the data to enforce voting rights laws.

Brunell, 50, interrupted his academic career in the late 1990s to spend a year in Washington, D.C., as a congressional fellow working on census issues. He has also served as an expert witness in court cases challenging state redistricting decisions, typically in support of plans developed by Republicans. In 2008, he published a book with the provocative thesis that competitive elections are bad for the country because they leave a large proportion of “losing” voters unhappy with their elected officials.

Although he has no experience leading large organizations, Brunell was in line 1 year ago to be Trump’s pick to lead the Census Bureau. The vacancy was created by the departure last June of John Thompson, who had been appointed by former President Barack Obama. But Senator Claire McCaskill (D–MO), the top Democrat on the committee with jurisdiction over the agency, reportedly raised objections to having Brunell fill the 5-year term.

White House officials then proposed that Brunell become the agency’s deputy director, a position that does not require Senate confirmation and one traditionally held by a career civil servant. But that idea also generated strong pushback from the statistics community and in February, Brunell threw in the towel.

Brunell declined to provide details about his failed attempt to join the Trump administration. But he spoke freely about the current controversy surrounding the citizenship question, offering counterarguments to those who worry about its likely impact on response rates and on the agency’s reputation for impartiality.

“I think adding any question to the decennial census is problematic,” he says. “Asking people their favorite color will decrease response rates,” he says. “So the fewer questions on the census, the better. But in terms of adding this question, I think the people who oppose it have made it a much bigger issue than it really is.”

Brunell repeated arguments by Ross and DOJ officials that the question has appeared for more than a decade on the American Community Survey, which replaced the long form of the decennial census, and on the census itself through 1950. “To say that asking it will absolutely ruin the census, I don’t see that,” he says. “I think that is hyperbolic, and that talking that way doesn’t help matters.”

One point on which Brunell and the critics agree is that a successful 2020 census will probably cost more than the $15.6 billion price tag that Ross announced last fall. But Brunell doesn’t think that will be a show-stopper.

“Even if the question convinces people not to answer the census form, that’s not the end of the story,” he says. The biggest cost in conducting the census, he notes, comes from following up with households that did not respond to repeated reminders to fill out the questionnaire.

That follow-up “may be a little bit harder and more expensive to do,” he says, “because there will be a couple of million more people they need to count. So the Census Bureau hires more people, and Congress ponies up the money, and they bang on more doors to get the answers they need. They may need to scramble, but they will get the job done.”

A bigger challenge for the agency, Brunell says, is finding a way to tone down the heated rhetoric over the citizenship question. The furor, he says, is symptomatic of the increasingly bitter partisanship in Washington, D.C.

“That’s what we need to fix, this level of polarization,” he asserts. “Instead of thinking, ‘Our team lost the election, what are we going to do?’ it should be, ‘Well, our team lost, but we’ll get ‘em next time.’ Not everything is life and death.”

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Most drugs in clinical trials against COVID-19, such as chloroquine phosphate, can be made cheaply.

FeatureChina/AP Images

Science‘s COVID-19 reporting is supported by the Pulitzer Center.

With a vaccine for the novel coronavirus still likely a year or more away, the first weapon against the virus could be one of the drugs now in clinical trials with COVID-19 patients. A new analysis out today shows that many of these drugs, which are currently manufactured or in development to treat other diseases, can be made for $1 a day per patient, or less. If any prove effective against the novel coronavirus, a coordinated international effort will be needed to ensure they are made affordable for people worldwide, the researchers argue.

Scientists worldwide are conducting clinical trials on at least a dozen potential treatments for COVID-19. Some compounds have been on the market for decades, such as chloroquine and hydroxychloroquine used to combat malaria and lupus. That makes it relatively straightforward to estimate the minimum cost of making them, says Andrew Hill, a drug pricing specialist at the University of Liverpool.

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For the new analysis, out today in the Journal of Virus Eradication. Hill and colleagues reprised a strategy he previously used to estimate the cost of drugs to treat HIV and hepatitis C. They started with an India-mandated database that includes the cost per kilogram of active pharmaceutical ingredients (APIs) shipped in and out of the country, a major hub for generic drug production. To those figures, they added in additional costs for formulating APIs into medicines, packaging, and a 10% markup for the companies manufacturing the drugs. For eight of the nine candidate COVID-19 treatments analyzed the estimated cost was under $1.50 per day per person treated and from $0.30 to $31 for a full course of treatment. The bottom line is clear, Hill says. “All of these drugs are fundamentally really cheap to make.” (Hill’s team was unable to estimate the cost of one compound, Tocilizumab, a monoclonal antibody used to treat rheumatoid arthritis, because it is currently made only in small quantities.)  

Today, however, these drugs aren’t always cheap to buy. They retail for between $0.20 and $510 per course in countries that strictly hold down drug costs, such as India and Pakistan, but between $19 to $18,610 per course in the United States, Hill and his colleagues report.

Jessica Burry, a pharmacist with Doctors Without Borders, worries that high pricing of COVID-19 treatments would amount to rationing, putting them off-limits for poorer patients and countries. “Rationing drugs because of high prices and limited supply will only serve to prolong the pandemic,” says. “What good is a lifesaving drug if you can’t afford it?”

Hill notes that most of the drugs his group evaluated are off patent, and thus could be manufactured cheaply by generic drugmakers. But some of the antivirals in the COVID-19 clinical trials are proprietary. As the debate over drug pricing for coronavirus drugs is already heating up, one flashpoint is remdesivir, a drug from Gilead Sciences that appears to inhibit an RNA-copying polymerase the new coronavirus uses to replicate. Hill’s team estimates that 1 day’s supply of the drug could be manufactured for $0.93.

Manufacturing cost of potential coronavirus drugs

Though most drugs currently in clinical trials to fight COVD-19 can be made cheaply, they can sell for hundreds of times the price.

Drug Estimated cost price (course) Estimated cost price (day) Remdesivir (10 days) $9 $0.93 Favipiravir (14 days) $20 $1.45 Lopinavir/ritonavir (14 days) $4 $0.28 Hydroxychloroquine (14 days) $1 $0.08 Chloroquine (14 days) $0.30 $0.02 Azithromycin (14 days) $1.40 $0.10 Sofosbuvir/daclatasvir (14 days) $5 $0.39 Pirfenidone (28 days) $31 $1.09

A. Hill et al., Journal of Virus Eradication, 2020

But patent protection and limited supplies could send its price soaring, some groups fear. On 30 March, Doctors Without Borders and nearly 150 other civil society organizations sent an open letter to Gilead CEO Daniel O’Day asking “that Gilead take immediate actions to ensure rapid availability, affordability, and accessibility of its experimental therapy remdesivir for the treatment of COVID-19.” The authors implored Gilead to forgo patent protection for the drug and allow generic manufacturers to add to the supply. Gilead’s Corporate Affairs and General Counsel Brett Pletcher responded today that Gilead is already ramping up production sharply. The company is also exploring a partnership with UNICEF to distribute the drug globally, Pletcher wrote the groups in a letter made public by the company.

One model for distributing a coronavirus drug quickly and cheaply comes from ongoing parallel efforts to provide HIV and tuberculosis drugs, run by the Global Fund and the U.S.  President’s Emergency Plan for AIDs Relief. Each organization pools financial contributions from governments worldwide or U.S. government agencies, respectively, and use the money to negotiate cheap prices for generic drugs that are then distributed to countries in need—an approach that has been hailed for saving tens of millions of lives. David Nash, a physician and pharmaceutical industry expert at Jefferson College of Population Health, says that model could work with coronavirus as well. “I would not reinvent the wheel here.” Nash says international drug pricing experts should begin setting up such an initiative to mass produce and distribute coronavirus medications, adding that they should move fast. “We ought to start the conversation now in anticipation of the results of the clinical trials.”