It’s happened — again. A virus has emerged in a small population and spread around the world. COVID-19 is out of hand in China now, with little possibility it can be reined in. It has been diagnosed in more than two dozen countries and counting
As the stock market reels from news of the virus’ impact on supply chains and travel, the reality of its economic impacts are becoming staggering. A sign of what may be to come, the 2013-2016 Ebola outbreak in West Africa cost the global economy an estimated $10 billion; SARS far exceeded that at $30-50 billion. The combined direct and indirect economic costs of COVID-19 are likely to far outstrip those of Ebola and SARS combined.
The vast majority of the discourse among the punditry and policymakers is about ensuring we have the right response. Shouldn’t we instead be asking a more fundamental question: How did this happen in the first place? In looking at the lessons from COVID-19, three key lessons emerge to help us prevent the next big biothreat.
First, resource the science. Long-standing U.S. government funding for science has borne fruit. It has enhanced our understanding of some of the world’s most risky pathogens, the knowledge that helps protect U.S. interests and military personnel. We know the “hotspots” for viral emergence tend to cluster in equatorial, biodiverse parts of the world. We also know that it’s human behaviors that put people in unnaturally close contact with animal reservoirs of diseases.
The science of behavioral risk is revealing these interfaces, as well as ways to mitigate them. Outbreak forecasting and infectious disease modeling are also helping us predict the locations and magnitude of potential outbreaks. However, many of these programs are now slated for massive cuts in the president’s budget and are chronically under-resourced. While this may save money in the short-term, we ignore the value of scientific advances at our peril.
Second, reexamine cultural biases that are making us less safe. The source of COVID-19 has ostensibly been traced to a traditional animal market in Wuhan. Many have called for complete and permanent bans of these markets in China. Markets of this kind, however, provide a living for many Chinese farmers who cannot otherwise make a comparable living.
An aggressive ban could simply shift trade into black markets, as happened during the SARS outbreak in 2003. These kinds of markets are found throughout the world. The United States is also a willing participant in the wild animal trade, with well over 200 million live wild animals shipped annually to US markets between 2000 and 2012. We cannot look askance at cultural practices in other countries without asking major questions about our own.
We’ve underestimated the role of culture in outbreaks before. The 2014 Ebola crisis occurred after the WHO eliminated its network of anthropologists amidst budget cuts. The lack of cultural understanding around the disease amplified its spread by creating divisions between responders and the affected communities they were trying to help. Preventing future pandemics will require culturally competent prevention and response as well as a blend of economic incentivization, good policy, and political will.
Finally, fund preparedness like we mean it. Funding for health and medical preparedness has been cut by as much as 50 percent over the past two decades. We will be playing perpetual catch-up until we decide to fully invest in strengthening health and medical readiness at all levels. This also means breaking our dirty habit of being surprised by outbreaks and scrambling to finance the response. There should be a real health response fund that’s ready to go when the time comes.
The American taxpayer already funds such an account for livestock outbreaks to the tune of billions of dollars, as well as for non-health disasters like hurricanes and earthquakes.
However, Congress has yet to finance a fund for infectious disease emergencies. There is an account for just this purpose — the Public Health Emergency Fund — but it has not been funded for several decades. Although there is legislation that has been recently introduced to address this.
Investment in preparedness yields returns. The World Bank has estimated that an annual global expenditure of $3.4 billion on prevention will save $30 billion. Rates of return depending on the scenario will range from 14 percent to 123 percent — levels that dramatically exceed those in almost all public spending or private markets.
Many commentaries have blamed President Trump for attempting to cut global health budgets. While he has indeed done so, cuts to domestic preparedness began under George W. Bush and continued under Barack Obama, under congresses controlled by both parties. Our failure to invest in pandemic prevention is a bipartisan failure of commitment.
Humans have exploited natural resources to the point at which we are dramatically endangering ourselves in the process. Simplified and reactionary solutions will all but guarantee the next pandemic. Solutions that are grounded in science, that embrace the complexities of culture, and that are resourced to prepare today for what may come tomorrow, may just prevent the next big thing.
Ellen P. Carlin is an assistant research professor at the Georgetown University Center for Global Health Science and Security and director of Georgetown’s Global Infectious Disease graduate program.
Jeff Schlegelmilch is deputy director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute, and the author of the forthcoming book “Rethinking Readiness: A Brief Guide to Twenty-First-Century Megadisasters.”