100 years ago, voters in the presidential election of 1920 were weary, trepidatious, and living with the

spectre of pandemic and uncertainty. After the carnage of World War 1 and the multiple waves of
influenza that enveloped the world between 1918 and 1920 (of the 50 million lives lost, 675 000 were
American), the US economy had sunk into a deep recession as it adjusted to post-wartime production
and consumption. Presidential candidate Warren G Harding expounded that “America's present need is
not heroics, but healing; not nostrums, but normalcy”. He offered the public a nostalgic balm in contrast
to the progressive and internationalist vision of outgoing President Woodrow Wilson. The juvenile
nation was moved to turn inward, retreating from the League of Nations and the global stage. Harding
won in a landslide. On Nov 3, 2020, the US will again choose whether to continue to look backward, or
to take brave steps towards a new future.

The USA leads the world in COVID-19 infections (>9 million) and deaths (225 000). 23 million Americans
have filed for unemployment, while an estimated 14 million Americans and their dependents have lost
employer-sponsored health coverage during the greatest public health crisis in a century. The fraying
social safety net, continual erosion of trust in the public sector, the perceived diminished responsibility
of the federal government, and political interference with crucial public health apparatus (most
markedly the Centers for Disease Control and Prevention) have culminated in the disastrous US
response to the coronavirus pandemic. But the crucial acknowledgment that should be made is the
absence of comprehensive health infrastructure. Without it the USA is at great risk. Despite this fact,
conservatives continue to attempt, out of ideology and opposition, to dismantle the Affordable Care Act.
Americans need equitable individual access to quality health care that is supported by efficient and
autonomous public health governance, both as a matter of health security and as a matter of human
rights.

The USA in 1920 was beset by deeply inequitable social dynamics. Women had only just been given the
right to vote and were still subject to literacy tests and poll taxes—early forms of voter suppression.
Labour unions were at odds with the pro-corporation federal government, which decried the anti-
Americanism of socialism and the so-called radical left. Immigration was under scrutiny. The greater
autonomy and societal development for Black Americans established after Reconstruction was being
systematically unwound and undermined by a surge of anti-Black terrorist violence. Discrimination and
marginalisation of other ethnic groups such as Native Americans persisted.

The USA in 2020 continues to experience unrest borne out of these still-open wounds: violence against
people of colour, vast income inequality, immigration restrictions, and gender barriers, as well as a
continuing devaluation of science. Under the banner of making America great again, the Trump
administration has pursued regressive nationalist policies, rolled back protections for individuals, labour,
and the environment, and withdrawn from international agreements and multilateral organisations,
such as WHO. Led by a relentless agenda of deregulation and dysregulation, America has retreated from
its once prominent position of leadership and abandoned its beneficence. With the election, Americans
have the power to address these issues, both at home and around the world, by eschewing the
falsehood of nostalgia.
It is not normalcy that the USA needs but a renewed national mission. To restore confidence in the
federal government, the first priority will be simply to provide accountability to the American people.
The US federal government must take ownership and responsibility for its domestic failures and
limitations. In order to foster trust, there must be transparency and a commitment to facilitate the
involvement and self-determination of Americans. Finally, there must be representation that reflects the
composition of the American people—for all of those who have been excluded or silenced, it is essential
to give them a voice.

With so much loss and still more at stake, the 2020 presidential election is the opportune moment for
the American electorate to embrace change for the better, to reject the stagnancy of complacency, to
exchange a view bereft of intention with a vision of progress, and to rejoin the global community in the
pursuit of a more equitable and sustainable future.