In April 2020, the Covid-19 pandemic was threatening well-being in the United States in several ways—the virus was infecting and killing Americans, the response was overwhelming the health system, and lockdowns were cutting people off from work and school.
Covid-19 tests piled in a box. April 2020.
In a time of great uncertainty, The Rockefeller Foundation joined a massive movement of governments, communities, NGOs, philanthropies, and even individuals to make a big bet to end the pandemic and minimize the lockdowns’ impact on the most vulnerable. In 2020, this included rapidly scaling up testing capacity and using those tests to reopen K-12 schools for 55 million students.
Identifying the Problem
Lessons from past pandemics and the Foundation’s experience with public health made clear that tracing and tracking positive cases was the fastest way back to some semblance of normalcy.
But, in April 2020, the United States was not producing enough Covid-19 tests. At that point, U.S. laboratories had performed only twenty-three tests per million people. Comparatively, the United Kingdom was running 347 tests per million, and the Republic of Korea was up to 3,692 tests per million people.
On April 2, 2020, the Foundation’s President Raj Shah and Nobel Prize-winning economist Paul Romer published a Wall Street Journal op-ed calling for the United States to boost the production and distribution of tests. As the headline made clear, testing was our way out.
Testing is Our Way Out
For now, social distancing is the best America can do to contain the Covid-19 pandemic. But if the U.S. truly mobilizes, it can soon deploy better weapons — advanced tests — that will allow the country to shift gradually to a protocol less disruptive and more effective than a lockdown.
Read the full articleFinding New Solutions
After the op-ed, many individuals and institutions from across sector and political lines offered to help. The Foundation team quickly began organizing a variety of convenings on Zoom to generate ideas for how to jumpstart testing in the United States.
One of the biggest debates was whether the country should prioritize PCR (polymerase chain reaction) or antigen tests. The only widely available tests at that time were PCRs, which were precise but also expensive and took days to return results. Some urged PCR tests because of their accuracy. But most agreed that antigen tests were cheaper, easier, and quicker to scale. We believed that rapid tests were exactly what was needed to give Americans some of the confidence they needed to return to their work, school, and communities.
On April 21, 2020, many leading health and diagnostic experts contributed to a report, released by the Foundation, that called for vastly increasing America’s testing capacity from fewer than one million a week to three million by July and thirty million by October—a target that struck some as overly ambitious. It quickly became known as the “1-3-30 plan.”
National Covid-19 Testing Action Plan
Our National Covid-19 Testing Action Plan lays out the precise steps necessary to enact robust testing, tracing, and coordination to more safely reopen our economy.
Read the PlanWorking Across Sectors
After the report, The Foundation continued to partner not only with public health officials but also businesses, government entities, schools, and others contribute to that level of test production. For the Foundation’s part, we helped with a few specific tasks:
- The Testing Solutions Group of local officials, many of whom the Foundation had worked with in the past, traded best practices on what was working and what was not.
- Another small group of experts organized by the Foundation spent weeks working with company executives to determine what was possible. The Foundation also asked teams at Duke University and Johns Hopkins University to develop protocols for testing.
- Our leadership also consulted increasing test production and use with officials around the country, across the political spectrum, and from Washington to the local levels. These included many Zooms with leaders in cities and counties, discussions with officials in the Trump administration and the Department of Health and Human Services (HHS) like Admiral Brett Giroir, and sessions with governors, including Arkansas’ Asa Hutchinson, Maryland’s Larry Hogan, Illinois’ JB Pritzker, and Rhode Island’s Gina Raimondo, and many more.
- These conversations morphed into a dynamic, ad-hoc consortium known as the State and Territory Alliance for Testing. At first six, then ten, and eventually every state and territory joined what became known as STAT. The theory was they could pool their purchasing power. it would send a bigger signal to manufacturers. In the end, STAT helped order six million tests. When we heard executives needed additional signals, the Foundation also agreed to guarantee at least $100 million in additional orders.
- The Foundation also worked with grantees and partners to launch some of the first K-12 Covid-testing pilots—with support from the Trump administration—partnering with schools in Louisville Los Angeles, New Orleans; Tulsa; Washington, D.C.; and the state of Rhode Island. HHS was supportive of these pilots, even airlifting the tests to the states where pilot programs were underway.
- The Foundation helped host conversations with physicians, local leaders, school officials, and teachers’ unions to develop protocols to make schools safer to reopen. We also supported making these public protocols and pilot data, along with K-12 playbooks (see related reading).
- Eventually, the Foundation also launched and provided the initial investment for Project Access Covid Tests (ACT), a public-private partnership that leveraged the STAT network to develop relationships with six state health departments and several private companies to get at-home Covid tests into the hands of communities. By the end of 2022, 4.5 million tests were delivered to homes across the United States. The program mobilized more than $33 million in public-sector funding, which was aggregated and managed by our public charity, RF Catalytic Capital.
New Guidance for Using Covid-19 Testing Strategies to Reopen America’s Schools Safely
As schools across the country strive to safely return to in-person classes, a new report by the Duke-Margolis Center for Health Policy and the Johns Hopkins Center for Health Security with support from The Rockefeller Foundation provides the first application of a detailed framework to provide guidance to America’s school administrators on how best to screen for, and stop or reduce the spread of, Covid-19 (SARS-CoV-2) in their schools.
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Tracking Data
The Foundation’s contributions were one small part in one small part of the global response to Covid-19. And it was only possible with a wide array of partners from government, business, communities, NGOs, and more. Tracking data makes clear what impact that sort of partnership can achieve, including:
- The bold national testing metrics established in the 1-3-30 report—increasing capacity to 30 million tests—was met in fall 2020. The United States was performing more than three million weekly tests in June and approximately eight million tests each week in October.
- By October 2021, just over 99 percent of children were back in school.
Tracking our Results
Our 2023 Impact Report outlines how our dedicated team and network of partners worked together to end Covid-19 and prevent future health threats, help vulnerable communities recover from the economic impact, increase food access, and build a foundation for the future.
Read Our Impact ReportCatalyzing Impact
One year after the beginning of the Covid-19 pandemic, the United States was conducting about forty million tests per month. The antigen tests alleviated some, of the harmful consequences of the lockdowns, helping businesses reopen, people return to work, and kids go back to school.
The Foundation is proud to have played a small role in this big bet. In the end, too many and too much were lost in the pandemic. Where we could, the Foundation sought to lessen the effects and stimulate the demand needed to spur production and facilitate alliances with the government and industry.