I graduated from high school in 1981. My youth was framed by the AIDS epidemic. I could ignore it for several years while cloistered in college, but as soon as I ventured out into the world, there it was: the virus.

Over the next decade, I saw dozens of friends and colleagues and a cousin die of the disease. It was gruesome and I saw too much of it as a 20- then 30-something. No one seemed to give a shit about AIDS, and we all felt very much on our own. The gay community was remarkable, though—out of nothing, it built organizations to help the sick, aid the dying, and support those who survived, while other groups rose up in a fury to confront our do-nothing leaders, marching, and once scattering ashes of those we lost on the White House lawn. It’s a terrific story of underdogs reviled by society who kicked ass—and in the process changed the history of medical research, clinical care, and drug development, and created rights for a people who didn’t matter, whose love was illegal for all too long.

Except none of it should have happened like that. As soon as this new illness arrived, a humane and just society would have rallied to our sides with the resources of our great nation devoted to ending this plague. It’s now 40 years later, and AIDS is still with us. There are parts of America where the rates of HIV give countries in Sub-Saharan Africa a run for their money. At the International AIDS Conference that just ended this week in Montreal, the Joint United Nations Programme on HIV/AIDS warned that we’re in danger of backsliding in our response to the disease—that is, things are getting worse.

Meanwhile we’ve had two years, more, of another plague. This was one no one could ignore, as it swept over the country, stopping us all in our tracks. Twenty twenty will be forgotten by few who lived through it. But it’s now 2022, and forgetting is what we want to do more than anything—more, it seems, than living itself. This may seem like an overstatement, but the United States is the leader in absolute number of deaths worldwide, and leads in Covid-19 and excess deaths per capita among the G-7 nations. We have over 400 deaths a day right now, over 40,000 people in the hospital, close to 5000 in ICUs nationwide.

A recent Brookings Institution report suggests that 4 million people are out of work because of long Covid, which is 2.4 percent of working adults in this country, and accounts for $230 billion in lost earnings. And yet no one wants to talk about Covid-19, even the president, who when he recently came down with the disease (and rebound second bout) was eager to show he was fit to work. The president and his surrogates remain keen to promote the idea that Covid-19 was just a manageable, run-of-the-mill respiratory virus.

The administration’s refrain of “we have the tools” has become a talisman to ward off any real discussion of what is actually happening here. US policy on Covid is akin to dropping someone in a desert with a car and a set of keys, and they find that the car is out of gas. You have the car; you have the keys. The rest is up to you.

Meanwhile, the monkeypox outbreak I wrote about in The Nation in June, when we had 500 cases in 30 countries, is now past 20,000 cases in over 70 countries—with 5,000 cases in the United States alone, which means the US is again the world leader, this time in monkeypox cases, with 25 percent of the worldwide current burden. If there was a chance of containment of the virus, we are watching that possibility recede quickly in the distance, and many think we’re on the verge of having a new endemic virus here in the US, on top of everything else we have to deal with right now.

How did we get so bad at all this? We once eradicated smallpox and polio, but we seem to be all too willing to surrender to monkeypox, Covid-19, and HIV (and I haven’t even mentioned tuberculosis and malaria). It’s tempting to talk about our sad track record in terms of failure, of mistakes, but as economists Daron Acemoglu and James Robinson once said about global poverty, our leaders get it “wrong not by mistake or ignorance but on purpose,” and our “most consequential ‘policy mistakes’ are by design.”

Now, that’s a conversation to have. Most of us would bristle at the suggestion that we are exactly where we want to be right now with infectious diseases, with the battle against global warming and other health threats. But we know what to do. We have the tools, as that saying goes. We simply don’t want to do it. There is no appetite to do anything else. No price to pay, politically, for doing otherwise. It’s a devastating realization for someone who has worked on all these diseases for over 30 years: that everything we once accomplished is now just a high watermark and that it’s all downhill from here.