Pandemic preparedness and response under a different president

A virus was spreading out of control in East Asia and the Pacific. Public health experts feared that it could become a deadly global pandemic as severe as the 1918-19 Spanish flu that had killed an estimated 50 million people worldwide, including some 675,000 in the United States. 

The U.S. President, a Republican, was quick to respond. He understood that international cooperation was critical to prevent, slow, or at least limit the spread of infection globally and in the United States. He believed it was imperative to encourage “openness and coordinated action by the international community.” And he knew that the World Health Organization (WHO) — the only truly global health organization, with over 190 member states — played an indispensable role.

In his September 2005 speech to the UN General Assembly, he told the nations of the world: If left unchallenged, this virus could become the first pandemic of the 21st century. We must not allow that to happen. Today I am announcing a new International Partnership on Avian and Pandemic Influenza. The Partnership requires countries that face an outbreak to immediately share information and provide samples to the World Health Organization.

By requiring transparency, we can respond more rapidly to dangerous outbreaks and stop them on time. Many nations have already joined this partnership. We invite all nations to participate. It’s essential we work together, and as we do so, we will fulfill a moral duty to protect our citizens and heal the sick and comfort the afflicted.

President George W. Bush kept his focus on the threat posed by the H5N1 virus, which had already killed millions of poultry and, it was feared, could mutate to become a deadly human influenza pandemic. In May 2006, the White House issued a 227-page pandemic plan that described at length the command, control, and coordination of the federal response, including as it related to states, localities, and tribal entities. The Department of State was tasked with leading the federal government’s international engagement, bilateral and multilateral, to promote a global capacity to address a pandemic. And the plan emphasized that “three international organizations play key roles to prepare for, detecting and containing an outbreak”: the UN’s Food and Agriculture Organization; the World Organization for Animal Health; and WHO, whose “leadership coordinates the international response to an outbreak” consistent with the universally accepted International Health Regulations (which obligate countries to maintain core capacities for disease surveillance and response and to report international public health emergencies to WHO).

Working closely with the Secretary of State and the Under Secretary for Global Affairs, I led a task force (the “Avian Influenza Action Group”) to coordinate U.S. international engagement. We worked closely with the UN System Influenza Coordinator and the WHO Director-General. In collaboration with the United Nations, the European Commission, and the International Partnership on Avian and Pandemic Influenza, we organized a series of international ministerial conferences on several continents that highlighted the critical importance of pandemic planning and response.

All of President Bush’s preparations for an H5N1 pandemic came to the fore in April 2009, after he had left office when a moderate pandemic from the H1N1 influenza virus emerged while the Obama Administration was still putting its political leadership team in place. Key career officials from across the U.S. Government, along with their international partners, knew each other and knew what to do, and there was a rapid, coordinated global response. 

As a novel coronavirus now ravages the planet, I look back on President Bush’s global leadership when he was preparing for a potentially catastrophic pandemic. While there are differences between pandemic influenza and pandemic coronavirus, governmental preparedness and response activities have many similarities. President Bush is appropriately lauded for his role in another area of global health — establishing the President’s Emergency Plan for AIDS Relief — but few recognize his leadership role in pandemic planning. 

The Trump administration recently notified the United Nations of its withdrawal from WHO effective July 2021. While WHO committed minor mistakes at the beginning of the COVID-19 pandemic, in the midst of “the fog of war” when uncertainties in dealing with an unknown coronavirus were most pronounced, this move stems from an effort to shift the blame to China and WHO for domestic political considerations. Everybody who works on global health realizes that the U.S. withdrawal is a fundamental mistake that will hurt the current global response to COVID-19 and have long-term, negative implications for Americans’ health. 

In the past, American political leaders on both sides of the aisle understood the importance of pandemic preparedness and response, both domestically and globally, and the World Health Organization’s central role. A threat anywhere is a threat everywhere — and that requires cooperation on a truly global basis, not just with like-minded countries.

I am led to wonder what the world would be like if a different president, such as George W. Bush or Barack Obama, was now leading the United States. I have to think that the president would be on the world stage, demonstrating American leadership, and the United States would be working closely with international partners, including the World Health Organization. 

And the world would be better for it.

Ambassador John E. Lange (Ret.), served at the U.S. State Department as Deputy Global AIDS Coordinator, 2003-2004, and as Special Representative on Avian and Pandemic Influenza, 2006-2009. A Senior Fellow at the UN Foundation, the opinions expressed are the author’s own.