Opinion: 

A Global Health Security Infrastructure is Only as Strong as the Political Will to Use It

March 23, 2020

by Taylor Winkleman

with Jessica Smrekar and Kate Kerr

It’s happened. 

 

The global health security community has been warning of a pandemic since long before its inception (or, rather, its codification). With every Disease X scenario, op-eds and white papers and peer-reviewed papers would be published full of dire warnings of loss of life and mind-boggling economic and social impacts. Hindsight may be 2020, but we worked hard to make it foresight.

A few people listened, especially when the threat of Ebola and then Zika materialized. But once those epidemics ended, so too did the public’s concern. And still, we conducted tabletop exercises, we advocated for public health funding and research and infrastructure, and we did what we could--often on a voluntary basis--to prepare. We cheered our successes, and marveled at the ingenuity and innovative thinking of some Global Health Security Agenda (GHSA) countries as they strove to improve their health systems, biosafety and biosecurity, and preparedness.

And then COVID-19 happened. And the United States is in the early stages of an exponential growth curve. New York, as of this writing, has almost 17,000 confirmed cases.

We undertook to measure the world’s readiness to face Disease X. Just this past fall, the Nuclear Threat Initiative, Johns Hopkins, and the Economist Intelligence Unit published the Global Health Security Index to great fanfare and wonderful reception. While no country was what we’d define as “ready,” the country that was most prepared, according to the expertly weighted and meticulously researched and validated scores was the United States (with a whopping 83.5).

And yet, despite what experts considered a rather dismal showing on global preparedness, American policymakers likely felt smug in the knowledge that the United States was the most prepared of any country. 


And then COVID-19 happened. And the United States is in the early stages of an exponential growth curve that, at the moment, is outstripping the Italian numbers. New York, as of this writing, has almost 17,000 confirmed cases.

Many will blame the public, and people’s unwillingness to change their daily routines. People will point to better outcomes in Asia, especially in Japan and the Republic of Korea, and say mildly racist things about cultural respect for hygiene or authority. They may be partially right. 


But the problem facing the United States, and other nations, is not the lack of public health infrastructure (though 2.8 beds/1000 people is a terrifyingly small number), it’s not the lack of concrete information on the virus (though there is so very much we do not know), it is the administration’s failure to act. The most prepared (really, the least unprepared) country in the world is doing no better than anyone else and significantly worse than most in the face of a global pandemic because it has failed to use the tools, knowledge, and experience placed at its disposal.

The most prepared (really, the least unprepared) country in the world is doing no better than anyone else and significantly worse than most in the face of a global pandemic

This is not just because the pandemic preparedness team was dissolved. Nor is it just because the 700 vacant positions at the CDC are hampering its capacity to respond. This administration has demonstrated vanishingly little political will to use what is available to respond, ensuring that the United States remains constantly behind its epidemic curve, which will inevitably result in more lives lost, more economic damage, and more social disruption. To clarify: we are not rooting for the administration to fail. The national  and   global   scientific   communities   have   come

together, working on this problem day and night, sharing information and research as it comes available.​ In just a few short months, literally thousands of peer-reviewed articles and studies have been rushed to publication covering all aspects of disease and public health research on COVID-19. Websites and groups of scientists providing resources and best practices have sprung up online. We do not lack for people willing to work on the problem or work together. 

What we lack is the political will that can order the massive economic and response power of the United States to protect her citizens and make use of our already-inadequate preparedness capabilities. What we lack is the clear, calm, measured, and decisive approach of a leader willing to believe when people say something has gone wrong and requires action to fix. The pandemic is not an event that can be laid at the feet of any person--it was inevitable, and we’ve been saying that for years. What is not inevitable are the consequences of a piecemeal, half-hearted approach that fails to bring resources to bear on what should be the sole focus: the health and safety of the population. 

 

Preparation can only take us so far. The policies, the partnerships, the memoranda of understanding can make a world of difference, but they are only words on paper until we decide to utilize them. At some point, a decision needs to be made to enact our responses, and a delayed reaction time can negate any head start preparation may have given us. Activation of response capabilities requires the order from leadership in a timely and informed manner. The nature of disease outbreaks allows for a serious situation to begin in the shadows, but quickly develop before our eyes. Prevention methods can alert us before a situation gets out of hand, but it takes recognition and communication to utilize our tools and keep it from spiraling out of control. 

 

Ignoring scientists got us into this mess. We will only get out of it by listening to them.