SARS-CoV-2 emerged as the perfect biological storm.
Public health experts Sarah Wetter and Lawrence Gostin explain how the lessons of Covid-19 can better prepare us for the next pandemic.
The year 2020 was marked by a timeless battle between Mother Nature and human ingenuity. SARS-CoV-2 emerged as the perfect biological storm. The coronavirus spread exponentially, but its hosts often remained asymptomatic or mildly symptomatic, able to socialize, while sending the most vulnerable to their death beds. The relatively low death rate was also fuel for decision-makers to ignore the science behind ending the outbreak, failing to conduct basic public health measures like testing, tracing, and social distancing. Masks became a political symbol.
Yet modern science and human ingenuity have proven worthy contenders against SARS-CoV-2. Within a single calendar year, demonstrably safe and effective vaccines were approved and injected into the arms of millions. When ample funding and political will back the most advanced science and scientific minds, humanity is capable of meeting even the most formidable foe.
But will we learn from the mistakes that allowed Covid-19 to explode beyond control, letting so many needlessly suffer and die? While returning to “normal” post-Covid-19 may be tempting, it would be unwise and unethical, as our previous normal enabled such devastation. With the constant threat of evolving zoonotic viruses, many of us will live to see another dangerous outbreak. But there is a great deal we can do to prepare for the next one.
Covid-19 made clear the inadequacies of the American health care system. If access to quality health care were universal in the U.S., every person would come into contact with a doctor or nurse, improving early diagnosis and rapid detection of novel infections. Health care access could also prevent and manage chronic diseases, as underlying conditions exacerbate the effects of infectious diseases like Covid-19.
Health systems must have better-equipped facilities, capable of meeting surge capacity through ample stockpiles of tests, PPE, medicines, and other essential medical resources. Personnel must be well-trained, including community health workers that can build trust across local regions. And the health system must meet the needs of even the most marginalized populations, who have suffered by far the worst outcomes from Covid-19.
Health security extends well beyond hospitals and doctors’ offices. Public health services are crucial for disease detection and response, health education, and even the efficient rollout of vaccines. In the U.S., world-renowned agencies like the CDC and FDA, and their scientists, were sidelined and castigated for supporting strict but science-based measures. State and local health departments are crucial to testing, isolation, and surveillance, but suffer from chronic under-funding. These agencies are primarily responsible for the distribution and administration of Covid-19 vaccines, and we are witnessing their inability to do so fairly and efficiently.
More than any law or regulation, investment or intervention, national policy or global strategy, global health security requires a new politics.
The rapid transition of Covid-19 from a local outbreak to a global pandemic also highlighted the need for a robust World Health Organization. But WHO cannot fully meet its charge of protecting and advancing world health unless member states amply fund it, grant it strong powers, and support it politically. Currently, WHO is heavily reliant on governments’ good will, highly susceptible to getting caught in political disputes, such as between the U.S. and China during Covid-19, which led to the U.S. to threaten withdrawal from the organization. We must recreate the global health governance landscape that will keep us safe from diseases and injuries, starting by providing WHO with funding commensurate with its mandate. Member states should significantly increase WHO funding, and give the agency flexibility to allocate funding toward the most pressing global health issues.
And if there is ever a time to garner the political support for sustainable funding for research and development, it’s now. While we cannot prepare a vaccine in advance for every emerging infectious disease, we could do far more to develop the medical technologies to protect us: new antibiotics to slow the spread of resistance, universal flu vaccines, and new technologies and platforms for vaccine discovery. At the very least, an additional $1 billion per year, as recommended by the Commission on a Global Health Risk Framework for the Future in 2016, is needed for rapid progress in R&D. Investing in disease research could also help prevent another major outbreak from happening in the first place. Greater understanding of the integral link between human, animal, and environmental health would allow us to better understand the evolution of diseases among species and towards human populations. This knowledge would enhance human disease prevention, as well as the development of vaccines and therapies.
But even with the strongest health systems, public health agencies, and international organizations, and well-supported R&D, future epidemics will likely require aggressive public health measures, like quarantines and stay-home orders, even lockdowns. This pandemic revealed and deepened vast inequities in the United States and globally. We badly need social safety nets to support the poor and vulnerable, spanning universal paid sick leave, benefits for the unemployed, support for school-age children and their parents, health and hygiene for detainees and refugees, and environmental justice. We also need plans grounded in ethics to share scarce resources like PPE and vaccines, based on need. Health security must be inclusive of everyone.
More than any law or regulation, investment or intervention, national policy or global strategy, global health security requires a new politics. Rather than placing blame on other nations or international organizations, instead of hoarding resources and putting one’s own country “first”, this new politics would center on national and international unity and inclusion. It would be grounded in the truth that global health security is a common venture. No country alone can combat transnational threats like zoonotic diseases or climate change. The choice is ours: if we rally around leaders who abide by science and advocate for the common good, we will have a political landscape conducive to global health security. And if we use the preventable catastrophe of Covid-19 to remake our national and global health systems, we will discover the full potential of human ingenuity to thrive even against Mother Nature’s greatest threats.
