Learning from COVID-19 for the coming pandemics

Pandemics are among the greatest existential threats to our society and way of life. COVID-19 will claim more American lives than terrorist attacks or natural disasters ever have. So why, as a nation, were we caught so off guard by the COVID-19 pandemic and how do we better prepare for the next pandemic? 

Ten animal-derived pandemics or epidemics have emerged in the last 100 years, collectively claiming over 100 million lives. These include Spanish Influenza (1918-1920), Asian flu (1957-1958), Hong Kong flu (1968-1970), HIV/AIDS (1981-present), H1N1 swine flu (2009-2010), Ebola (2014-2016), and Zika (2015-present).

Now, SARS-CoV-2 poses a particular threat because it spreads easily, often without symptoms, and we have no pre-existing immunity. Given the frequency and magnitude of pandemic threats, we must prepare to respond.

The federal government’s response to infectious disease threats is currently fragmented across many agencies and levels of government.

In addition to the Centers for Disease Control (CDC), which has always served to guard against emerging disease, an effective response involves many federal agencies, including but not limited to the National Institutes of Health (NIH), the National Security Council, the U.S. Department of Agriculture, and the Department of Homeland Security, as well as state and local governments. This fragmentation demands strong central leadership to effectively mobilize resources and coordinate a response.  

When a virus emerges with pandemic potential, infrastructure to respond must be in place and the time of response is critical to limit the incidence of infection and death.

During George W. Bush’s presidency, the federal government developed guidelines for communicating during a public health crisis. Among the core principles are “be first,” “be right,” “be credible,” “show respect” and “promote action.” The Obama administration established a pandemic response unit following the Ebola outbreak. 

In 2019, the Trump administration defunded the pandemic early warning system that tracked viruses and trained staff in 60 foreign laboratories to detect pandemic viruses. The ending of programs like this created dangerous voids in global health security. Additionally, the underfunding of the CDC weakened its Global Rapid Response Team. Most recently, the Trump administration eliminated funding to the World Health Organization (WHO), which serves a vital role in monitoring and responding to global public health threats.

As SARS-CoV-2 emerged in December 2019, the White House response to COVID-19 was too little and too late — facts were muddled, the threat was downplayed, and scientific expertise was dismissed. The White House did not coordinate the national mobilization of the scientific, public health and medical communities in the way we would have expected it to mobilize the armed forces and defense agencies against a military attack. 

COVID-19 deaths in the U.S. currently account for more than one-fourth of all COVID19 deaths worldwide and the U.S. has more than four times the number of cases of any other country. In the absence of a coordinated national response, inconsistency in State-imposed restrictions and the premature lifting of those restrictions endanger our ability to maintain gains in flattening the curve in the months to come. 

How do we better prepare for the next pandemic to minimize loss of life and economic devastation?  As a first big step, Congress should create an Emerging Disease and Pandemic Preparedness (EDPP) agency to monitor and respond to emerging diseases and pandemics that would work in close association with CDC, NIH, and other federal agencies, but with the authority and autonomy to develop and implement a science-based, coordinated response. Most importantly, this agency must be a permanent agency that cannot be dismantled or hamstrung by politicians hostile to science.

The EDPP would coordinate with the WHO and non-profit organizations with established health programs in underdeveloped countries to track medical anomalies indicative of emerging viruses and mobilize defenses to mitigate global spread. It would also coordinate with universities and the private sector in the development and mobilization of diagnostic tests, antivirals and vaccines, as well as the maintenance and deployment of the national stockpile of critical hospital supplies and equipment.

The EDPP would grant funding for initiatives in basic, clinical and social research for pandemic preparedness and pathogen research. These research funds would be in addition to, not taken from, those driving research through the NIH and the National Science Foundation (NSF) into cancer, heart disease, the environment and many other non-pandemic health and social issues.

Despite President Trump’s insistence, the COVID-19 pandemic was not unforeseen. The next viral pandemic, whether it is a new strain of flu or another coronavirus, is not a prediction; it is a certainty. The only question is — will we have learned enduring lessons from this pandemic to be better prepared next time?

Felicia Goodrum Sterling is a virologist, president-elect of the American Society of Virology, and a fellow of the American Academy of Microbiology. She is a professor and scientist at the University of Arizona. James Alwine is a virologist and a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science. He is a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona.