It’s Not Too Early to Prepare for the Next Pandemic
Published April 17, in the Harvard Business Review. Reposted with permission.
SARS in 2003, H1N1 in 2009, MERS in 2012, and now COVID-19. We don’t know when or where, but we know with 100% certainty that another deadly infection will strike. While the clear priority right now must be coping with the surging number of cases and the economic havoc that the current pandemic is wreaking, it is also time for the country to begin takings steps to minimize the pain of the next pandemic.
For starters, the United States needs an independent, nonpartisan Pandemic Review Commission that will deliver an objective, apolitical assessment of what went right and what went wrong in the response to the COVID-19 outbreak. Its members should be predominantly public health experts, scientists, and medical professionals, but they should also include experienced public- and private-sector leaders such as ex-governors and industry leaders.
But because the need for some actions are obvious, Congress should simultaneously begin to work on legislation aimed at improving the country’s ability to respond to a new pandemic in the following key areas.
Spotting Emerging Pandemics
This requires a global early-warning system, which means having trusted, scientifically savvy eyes and ears on the ground around the world. The key is robust international health care cooperation and strong, science-based, cross-national health care organizations. Currently, the World Health Organization (WHO) is the backbone of our global, cooperative pandemic information system. If WHO fell short with COVID-19, we should strengthen and reform it — not destroy it. President Trump’s precipitous decision to defund it could increase the chance that we will be caught flat-footed when the next pandemic erupts in some distant corner of the world.
Delaying Entry into the United States
Congress should ensure that, once a new infectious threat emerges elsewhere in the world, the contagion will be kept out of the United States as long as possible. The U.S. Department of Homeland Security needs to focus intently on this challenge through the development of deep expertise in science and technology. This does not mean digging moats and pulling up the drawbridge; it means having fair, rigorous screening protocols informed by science, not prejudice or ethnic stereotype.
Containing the Infection
At some point, another infection will get into the country. Once it does, we may have a brief time to contain it, when new cases and their contacts can be identified and quarantined. This is what Singapore, South Korea, Taiwan, and Hong Kong successfully accomplished with COVID-19.
To do this, the United States needs a massive testing capability and a much stronger public health infrastructure at the state and local levels. Congress should launch a national infectious-disease-testing research and development program with the central purpose of improving the science behind infectious-disease detection and deploying the best available tests (from anywhere in the world) as rapidly as possible. This is too big a job for the U.S. Centers for Disease Control and Prevention alone. The federal government also needs to help state and local public health agencies build the capacity to do the laborious, detailed field work to identify and isolate contacts of any individuals who test positive.
Minimizing the Physical and Economic Pain
If detection, exclusion, and containment don’t keep a new pandemic at bay, then Congress needs to minimize the resulting damage. This means first having the required surge capacity to care for victims and protect health care workers. With a tiny fraction of the 18% of GDP that the United States spends on health care, it could maintain a surge capacity that would see the country comfortably through any conceivable new pandemic. Building into this national health care reserve a governance structure that will keep the contents tested and up to date will be essential. To prevent short-sighted future raids on funding for the surge capacity, Congress should require a two-thirds vote of both its houses to divert surge resources to other purposes.
Congress also needs to build an information system that will enable the country to deploy these surge resources to where they’re needed. Among other things, this means modernizing the U.S. public-health-information infrastructure so it’s capable of tracking in real time the availability of critical resources like hospital and intensive care unit (ICU) beds, devices, drugs, and personnel.
Finally, the United States needs to protect victims of the next pandemic from the devastating financial consequences of illness through affordable, quality health insurance. If that coverage were available in good times, not just pandemics, it would reduce the burden of chronic illness that drives up suffering from infectious illnesses when they tear through the population.
The challenge, of course, is that as soon as this crisis starts to fade so too may the will to anticipate and prepare for the next one. Humans cope with trauma by repressing its memory. The temptation to forget COVID-19 and move on will be overwhelming. But the country must let not that happen.
As surely as bacteria and viruses will persist on earth, there will be a next pandemic. The United States can and should be better prepared for it.