By RICHARD SKOLNIK
Infectious diseases have emerged throughout history and will continue to do so. In fact, almost all public health professionals believe that diseases will emerge more frequently and possibly with even greater intensity than before, because of population growth, the spread of people into areas in which animals are living, and climate change.
If you don’t believe this, just think about West Nile virus, Zika, Chikungunya, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), Ebola in West Africa, and our present coronavirus, for a start.
All levels of government should have been ready to deal with the present outbreak but many were not. All levels of government should have acted early and forcefully against the epidemic but many did not. The federal government should have played a leading role in coordinating scientific, policy, and procurement efforts, among other things, but was slow to act on many fronts and is still unwilling to act on others. The procurement, even today, of the materials, supplies, and therapeutics for COVID-19, is an example of this.
So, let’s examine some of the measures that should be put in place now to prevent illness, disability, and deaths from the next outbreak. These will serve both the present fight against coronavirus and future ones.
First, we need effective leadership. This has been the case for every successful historical effort to handle a disease outbreak or manage any other issue of grave national importance. This means we need senior officials at federal and state levels who can immediately help us understand the problem, formulate an approach to addressing it, and then lead the coordination of disease control efforts. This means senior officials who will bring to the table the best scientific minds and listen to them. This means officials who can ensure that those coordinating disease control efforts speak with a clear and consistent voice that unifies the country around the need to fight the outbreak together. It also means officials who will be open, transparent, and honest with us about all things related to an outbreak and who will relentlessly fight misinformation.
To improve pandemic preparedness and response, we must also ensure that there is a specific group at the highest levels of government, such as the National Security Council, that has responsibility, on behalf of all of government, to track disease threats and trigger actions to address them.
In addition, we urgently need to revive the CDC. This organization was once the envy of the world and served as “the world’s epidemiologists”. Today, it is seen by public health actors domestically and globally as a pale shadow of its former self, an institution in disarray, and an institution led by a director who won’t tell things as they are. CDC will need more staff, additional resources, and a renewed mandate to serve the US and the world.
We also need to put in place plans at the federal and state levels for dealing with future outbreaks. We then need to fill stockpiles at the federal and state levels with the equipment, materials, and supplies that will be needed to aggressively address the next outbreak, as soon as we learn about it. Governments will also need substantial additional public health staff. In addition, all levels of government should have in place contracts that would be triggered by the declaration, for example, of a public health emergency. The federal government should also engage in advance market commitments that would ensure that the research for and development of diagnostics, drugs, and vaccines to fight the next pandemic would be continuous and not wait to for an outbreak before it began.
Some will say that the above measures are expensive. Yet, we have seen the costs of failing to prepare properly to fight this coronavirus. These costs are not only in illness, disability, and death. They are also psychological, social, and economic. A single disease outbreak has turned the world upside down. Yet, pandemic preparedness has exceptionally high rates of return. One important study suggested that the average financial return on investment for a range of preparedness interventions is more than 200%.
Continuing on the path we are on will cause us to lose this war and be as unprepared for the next one as we were for this one. Moving aggressively on the measures noted above will avert illness and death now and later.
Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.