The world, for those of us who have spent more than twenty minutes observing it without the sedative of optimism, has always resembled a poorly managed abattoir. However, there is something uniquely, exquisitely bleak about hearing the Deputy Director of the Centers for Disease Control and Prevention, Dr. Nirav Shah, describe a measles outbreak as the “cost of doing business” in a global economy. It is a phrase of such breathtaking, sterile brutality that one almost feels compelled to applaud. It is the language of a man who has replaced his Hippocratic Oath with a subscription to the Financial Times and a very cold calculator.

We have moved beyond the quaint era of public health as a moral imperative. We are now in the age of the epidemiological transaction. In Shah’s world—which is, unfortunately, the world we are all forced to inhabit—the resurgence of a disease that was supposedly eliminated in the United States in the year 2000 is not a failure of governance or a collapse of civic trust. No, it is simply a surcharge. It is the “convenience fee” we pay for the privilege of a frictionless global supply chain. If you want your seasonal blueberries and your microchips delivered with breathtaking speed, you must be prepared to accept a few feverish children and the occasional case of encephalitis as part of the overhead.

The reaction from the broader public health community has been, predictably, one of performative shock. One expert described the comment as “appalling.” How charmingly archaic. To be appalled in 2024 is to admit you haven’t been paying attention. The CDC is merely catching up to the reality that the rest of the administrative state embraced decades ago: human beings are not subjects to be protected, but assets to be managed. When an asset becomes slightly more expensive to maintain—say, by requiring a robust, trusted vaccination infrastructure that doesn’t buckle under the weight of internet-induced paranoia—the modern bureaucrat simply adjusts the ledger. If the measles return, it is because the cost of preventing them has exceeded the perceived value of a healthy populace.

One must admire the efficiency of the logic. Measles is a highly contagious respiratory virus; the global economy is a highly contagious fiscal virus. They both require the constant movement of hosts. To stop the spread of the former would require an inconvenient slowing of the latter. And since the gods of the Market are far more vengeful than the gods of Medicine, the choice is obvious. We have traded herd immunity for herd consumerism. We allow the virus to hitch a ride on the same flights that carry our business consultants and our lithium batteries because to do otherwise would be to commit the ultimate sin: the introduction of friction into the flow of capital.

Shah’s rhetoric marks the final evolution of the bureaucrat into the actuary. The CDC, an institution once tasked with the messianic goal of eradicating human suffering, has rebranded itself as a claims adjuster for the apocalypse. They are no longer there to put out the fire; they are there to explain that the fire is a necessary byproduct of the internal combustion engine. They watch the rising case numbers not with the urgency of a doctor, but with the detached interest of a data analyst noting a slight uptick in shipping costs.

The historical irony is, of course, the only thing that makes life bearable. We spent the better part of the twentieth century convincing ourselves that we had conquered the natural world through science and reason. We built a cathedral of vaccines and sanitized our existence until we forgot what a tragedy actually looked like. Now, as the walls of that cathedral crumble under the combined pressure of administrative exhaustion and populist idiocy, our leaders are simply telling us to get used to the draft. They are pivoting from "prevention" to "management," which is bureaucrat-speak for "surrender with better PowerPoint slides."

The “global economy” has become the ultimate excuse for every failure of the state. Can’t fix the infrastructure? It’s the global economy. Can’t provide basic healthcare? Global economy. Can’t stop a nineteenth-century disease from making a comeback in a twenty-first-century superpower? Cost of doing business. It is a grand, nihilistic shrug disguised as an economic observation. We are being told, in the most sophisticated terms possible, that the system is functioning exactly as intended. The sick are merely a line item, and the CDC is simply balancing the books. If you find this "appalling," you are likely still laboring under the delusion that you are a citizen. You are not. You are a consumer, and your subscription to health has just been downgraded. Welcome to the era of the Spreadsheet Plague; at least the dividends remain healthy even if the children do not.