The U.S. Government Must Prepare Now for the Next Pandemic
Trump botched the coronavirus response. The United States cannot make the same mistake again.
With a crisis of this size, scope and peril, it isn’t wise to try to anticipate the next threat before you’ve defeated the current one. The U.S. government’s priority—right now and in the near future—must be to take decisive action to halt the spread of the coronavirus, both in the United States and around the world, and to rescue the U.S. economy from potential catastrophe.
But as government officials, we do not have the luxury of waiting long before we start the process of learning from what went wrong. Pandemics don’t work on schedules. They don’t take years off. The next one could just be right around the corner. So if U.S. policymakers don’t exert some energy right now figuring out why the world got knocked to its knees by COVID-19, and why the United States, the world’s preeminent superpower, was virtually impotent when it came to stopping the virus from reaching our shores, then we risk having to go through this nightmare all over again.
What went wrong? The United States spends close to $1 trillion every year on national defense. The U.S. international defense footprint dwarfs that of every other nation. What’s the point of this largesse if a single virus can spread from a provincial city in China to the United States in a matter of weeks, taking down the entire economy in the process? Why did the coronavirus so quickly pierce our national defenses? How did we fail, and how do we do better next time?
China bears some of the blame. The entire world lost a month in shoring up their epidemiological defenses as Beijing spent the better part of December and January hiding the true extent of the outbreak, refusing to fully share data, and stonewalling international health experts. This behavior is unacceptable, and the United States must lead an effort to make sure that the next pandemic is not hidden from view by whatever country is its point of origin.
[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic and learn how it’s affecting countries around the world.]
The International Health Regulations, a set of rules agreed to by 194 countries worldwide, have not been updated since 2005. The United States should lead the member states of the World Health Organization (WHO) in updating these rules and ensure that in the future all countries comply by providing accurate, transparent, and comprehensive data to the international medical community. Only a full data set can help health professionals understand pandemics sooner and enable them to develop strategies for containment, testing, and vaccines as quickly as possible.
But the United States cannot rely on other nations to detect and develop early protocols for early stage pandemics alone. No country’s public health expertise matches that of the United States, and to stop diseases and viruses in their tracks, in the early days of spread, we need to have a much more active presence than we do today in nations with weak public health infrastructure.
First, the United States needs to restart and expand the U.S. Agency for International Development’s Predict program, which the Trump administration, in an egregious act of self-destruction, ordered shut down in October 2019. This program tracked early stage viruses and diseases all over the world, so scientists in the United States would have a head start in understanding pathogens that could eventually reach U.S. shores. Had Predict’s field teams been active and detected the new coronavirus early, American scientists could have begun work on tests, treatments, and cures much earlier. When it was in operation, Predict collected more than 100,000 samples and found nearly 1,000 new viruses, including a new Ebola virus.
Second, Washington needs to create a Global Health Security Challenge Fund to build up long-term health infrastructure in fragile countries. The United States’ ability to defend itself from a pandemic is only as strong as the world’s weakest public health system. And so Americans shouldn’t see support for international public health infrastructure as altruistic or a waste of taxpayer dollars. Building the capacity of other nations’ health response systems is also about defending Americans.
This has worked well in the past. The funding passed by Congress to address the Ebola epidemic enabled these partnerships, setting up successful public health infrastructure in countries like Cameroon and Uganda to counter the spread of infectious diseases in just 24 hours instead of the eight weeks it took previously. Congress should establish this program permanently and require developing nations to put up their own resources alongside U.S. funding in order to become a recipient of aid.
Third, the United States needs to supersize its global public health corps. The chaos and death caused by the coronavirus is not from a bomb or missile or invading army. It’s from a simple pathogen. Clearly we are not adequately protecting our nation when the military budget is nearly $740 billion and the global public health budget is only $11 billion. The Obama administration set up anti-pandemic programs in nearly 50 key nations, which were on the chopping block by the Trump administration until Congress intervened to continue funding in March 2018.
The United States needs to have health officials in vulnerable areas around the world, working to identify viruses and diseases early, creating relationships with local public health personnel, and helping to build up local preventative capacity in developing countries. If the United States had established a larger public health office in Beijing, having worked for years to create integrated relationships with Chinese health officials, there is a chance that U.S. scientists would have known what was happening with the coronavirus in those crucial early days.
Just as important as the deployment of more U.S. capacity abroad is a reinvestment in international public health organizations and a recommitment to global diplomacy. U.S. President Donald Trump has never referred to the anti-coronavirus fight as a multilateral one. It’s hard to even imagine his administration working hand in hand with South Korea or the European Union to create a consistent, coordinated global response. This is tragic, and it will ultimately be fatal for many Americans.
The WHO is in need of U.S. investment and reform. It wasn’t nimble enough to lead the global response to Ebola, and so when the coronavirus arrived, nations were wary of deferring too much authority to the WHO. In some cases, that turned out to be a massive mistake.
Rather than follow the WHO’s protocol on coronavirus tests for Americans to use, Trump instead relied on the Centers for Disease Control and Prevention to develop and distribute its own test. That delay turned into a disaster, and today, instead of having millions of tests being performed daily across the nation, the United States is lagging behind the rest of the world on per-capita testing: As of last week, one in 142 South Koreans had been tested for coronavirus, but just one in every 786 Americans had. The world needs a WHO it can rely on, and the United States should build a coalition of nations willing to increase contributions to the organization in exchange for the implementation of reform.
Vaccination research is also much more efficient when carried out on a multilateral basis. Pharmaceutical companies notoriously shy away from investing in vaccine research and development, so the public sector must lead. Luckily, a vehicle already exists for this cooperative venture. The Coalition for Epidemic Preparedness Innovation (CEPI) is a multilateral fund specifically devoted to the funding of new vaccines that grew out of lessons learned after the Ebola outbreak. The only problem is that the United States doesn’t contribute to it. This is unacceptable; America should be a leader within CEPI, not a phantom.
Lastly, leadership and personnel matter when building a new and more effective anti-pandemic infrastructure. The Trump administration’s decision to dismantle the Global Health Directorate at the National Security Council in May 2018 was an unconscionable mistake that must be reversed.
The new directorate must be better resourced and more empowered than the previous version. Furthermore, having so many key diplomatic posts unfilled, or filled by unqualified individuals, means that even a good anti-pandemic plan could be rendered useless. For example, at the State Department there is no nominee for an assistant secretary for European and Eurasian affairs as this virus spreads rapidly across Italy, Spain, and Germany. Recruiting more top-level public health professionals into government service, and in particular the U.S. foreign service, is crucial.
After the terrorist attacks of 2001 killed thousands of innocent Americans and created a global financial panic, the U.S. government restructured itself, established enduring international coalitions, and massively scaled up its international footprint to prevent the next terrorist attack. Many Americans, including me, would take issue with some of the policy choices made in the aftermath of 9/11, but there is no question that U.S. leaders at the time understood the gravity of the moment and moved mountains to impose systemic change. That same level of focus and commitment is what Americans need now.
Unfortunately, the Trump administration has completely botched the response to COVID-19 so far. The president denied the risk of the disease for weeks, failed to ramp up testing measures, and has dangerously suggested relaxing social distancing measures—and Americans are paying the price for it. At the moment, all our resources should be devoted to the immediate crisis, but we can’t waste time in learning lessons and beginning the conversation about how to rebuild the country’s pandemic defense system. The next virus is not going to wait for the U.S. government to get its act together.