Despite the deep divisions ravaging our country ahead of the presidential elections, many Americans are looking for answers to a common threat — the coronavirus. As the daily number of cases and deaths have risen, we remain in the throes of a pandemic that has killed more than 225,000 of our fellow citizens and torpedoed our economy. Indeed, the US is still averaging about 40,000 new cases a day.
Regardless of whether Trump or Joe Biden wins the election, though, the next president will confront a dual challenge: managing the current pandemic and ensuring that the country and the world are better prepared when the next plague strikes — as it inevitably will.
It is past time for the nation to make the investments we need to prevent, detect and respond quickly to emerging infectious diseases, like the coronavirus, before they sicken Americans and force catastrophic economic shutdowns. That is the main finding of a bipartisan task force sponsored by the Council on Foreign Relations (CFR), which we were honored to chair.
Here at home, three of the most glaring failures relate to testing, science-based communication and the protection of vulnerable populations.
Nothing has undercut the US response to Covid-19 more than the failure to develop — to this day — a comprehensive nationwide system of testing and tracing that allows public health authorities to rapidly identify infected individuals and their contacts in order to isolate the sick from healthy populations. Without this timely information, authorities are too often flying blind, uncertain of the trajectory of the disease, slow to identify hot spots and unable to stop the spread of the virus through targeted measures that do not require shutting down entire communities and economies.
The US experience on testing and contact tracing stands in contrast to nations like South Korea, which rapidly ramped up nationwide testing and successfully mobilized an army of contact tracers. The US cannot put itself in this position again.
The success of public health measures like contact tracing, mask-wearing, and social distancing depends on individuals and communities trusting and adhering to advice from medical professionals and scientists, sometimes delivered by elected and other officials. That public trust must be earned and sustained.
Elected US officials, including the President, often have fallen short as communicators in this pandemic. To prevent future pandemics from becoming a political football, public officials at all levels, from the White House to city halls, should put physicians, scientists and other public health professionals front and center in public briefings, starting from onset of the crisis. This will improve consistency in communication and help establish and maintain public trust in containment measures.
We also need to do better by our most vulnerable citizens. The pandemic has taken a grievous toll on the elderly and nursing home residents specifically. It has also hit essential workers hard, and Black, Latino, Native and low-income Americans suffer disproportionately. As of the end of September, according to the Atlantic, Black Americans have died from Covid-19 at 2.3 times the rate of White Americans, comprising 21% of all US deaths from the disease — and this despite making up approximately 13% of the US population. Despite these disparities, weeks passed before many states recognized and began reporting disaggregated data monitoring the issue.
Going forward, state and local health agencies should collect and publicly report data by age, race, gender and other relevant socio-demographic status. Armed with better data, US government authorities at all levels should target public health investments to increase the resilience of these communities, including universal paid sick leave in declared pandemics, accessible and free testing, and workplace protections and personal protective equipment for essential workers. Social justice and equity in our existing health care system is not just a moral mandate — it is a matter of basic pandemic preparedness.
But the US cannot wall itself off from pandemic threats with domestic preparedness alone. As the Nobel Laureate Joshua Lederberg once aptly wrote, “The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow.”
The CFR report identifies multiple flaws in existing global health security arrangements, including the World Health Organization (WHO). It also takes China to task for its lack of transparency, which enabled the novel coronavirus to gather momentum following the initial outbreak in Wuhan. At the same time, it is not in America’s interests to leave the WHO in the midst of a pandemic or to allow its understandable frustration with China to impede global collaboration.
The smarter choice is to reform and strengthen the WHO as an essential cornerstone of global pandemic preparedness. Over the years, member states have saddled that agency with expanding tasks without providing it with the adequate resources or authorities to mobilize an effective pandemic response. The next president needs to change that dynamic.
The coronavirus demonstrates that an international framework for pandemic detection and response that relies so heavily on the transparency, judgment and discretion of individual national governments leaves too many opportunities for failure. We need to improve the detection and assessment of epidemic threats through the creation of an international, hospital-based surveillance network. Alerts from that network should, in turn, notify national public health agencies and the WHO — and trigger an international response.
It would also benefit the US to form a coalition of like-minded states, that would also engage civil society and the private sector to surmount the geopolitical gridlock that has undermined effective pandemic preparedness and response. The US should spearhead the creation of this coalition of interested members of the G-7 and G-20 nations to facilitate cooperation on practical security and economic matters, such as shortages of medical supplies and foreign assistance to struggling economies.
Finally, the next president must resist the siren song of vaccine nationalism. With a pandemic in full swing, there is a natural temptation to try to reserve limited supplies of any effective vaccine for one’s own country and citizens. But doing so does not serve our health or national security interests and could leave us in a difficult situation if a US company is not the first to develop an effective vaccine.
So far, the US has chosen not to join COVAX, a groundbreaking consortium of more than 150 countries created not only to develop a vaccine but to ensure that when one emerges it is shared equitably, rather than hoarded by individual countries. We hope that the next president — whoever he may be — will reconsider this decision.
When it comes to pandemics, we all sink or swim together, from each individual citizen, to each city, state and nation. We are in it together, and that will require America’s commitment and action to prevent the spread of another deadly and infectious disease.