Can America Learn This Pandemic’s Lessons Before the Next One Hits?
Firefighters and paramedics with a patient in Glen Burnie, Maryland on May 3, 2020. ALEX EDELMAN/AFP/GETTY IMAGES.
On March 3, 2020, a soft-spoken physician named Dr. Matthew Hepburn ascended the TEDMED stage at the Westin Waterfront Hotel in Boston to deliver a long-planned talk on his life’s work: preventing pandemics. His timing was apt. That day, the Centers for Disease Control and Prevention had just announced 60 cases of SARS-CoV-2 in the United States, and a cruise ship full of infected passengers would soon be stranded off the California coast.
Hepburn had spent 23 years in the US Army as an infectious disease specialist. Now, before a nervous audience of medical professionals who had been bumping elbows rather than shaking hands, he identified three keys to fighting pandemics: advanced technologies, global cooperation, and political will. “We can mount the most effective pandemic defense the world has ever seen,” he predicted. “Instead of being divided, why don’t we as a global community unite and fight this pandemic as a team?”
Before leaving the podium, Hepburn promised never to quit fighting to end pandemics once and for all. By the end of that week, he would be immersed in the division and dysfunction of the US coronavirus response under President Trump. And before long, he was working 16-hour days on Operation Warp Speed, which successfully accelerated the development of COVID vaccines.
Today, Hepburn serves as senior adviser for pandemic prevention within the White House Office of Science and Technology Policy, and as cochair of a federal steering committee on pandemic innovation. His responsibilities include coordinating pandemic drills and exercises among multiple federal agencies. His goal, he says, is for the government to plan for pandemics with the same level of seriousness it brings to preparing for hurricanes or wars. “The American public should expect that every aspect of our government should be in this for the long term,” he says.
And yet, as the COVID-19 crisis enters its fourth year, with more than 1 million Americans dead and the highly infectious XBB.1.5 variant contributing to rising case counts, the goal of eliminating pandemic threats seems as distant as ever. In the US, our political will is flagging. Our public health workforce is exhausted and demoralized. Our deep political divisions have impacted everything from funding streams to a basic belief in science. The anti-vax movement is growing more organized by the day. And scientists fear that an incoming Republican Congress—having barely seated a Speaker—is more likely to demonize their work in upcoming hearings than to support its effective deployment.
“Since the beginning of the pandemic, our public health institutions were unable to persuade a large portion of the population to get vaccinated or boosted or wear a face mask,” says Dr. James Lawler, codirector of the Global Center for Health Security at the University of Nebraska Medical Center. “I think it would be hard to claim that trust and confidence in those institutions has improved since then.” According to data analyzed by Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, politicized topics are the ones most likely to cause Americans to question the “recommendations of the federal health agencies.” Unfortunately, she says, “COVID polarized.”
The need to repair these divisions—and build a system of speed and trust—is especially acute given that the next pandemic may be just around the corner. Even while battling COVID-19, we have contended with a global monkeypox emergency and an Ebola outbreak in Uganda. Taken together, globalization, climate change, deforestation, the proliferation of new biotechnologies, and inadequately regulated laboratories have ratcheted up the risk of new outbreaks, experts say.
Some fear SARS-CoV-2 could end up looking like a dry run for something far worse. “SARS CoV-3 could be around the corner,” says Lawler. If you were to combine the 10% fatality rate of SARS-CoV-1, which first emerged in 2002, with the transmissibility of SARS-CoV-2, he says, you’d have the recipe for “a catastrophic, Armageddon-type pandemic.”
To assess the question of how prepared the US is to face future pandemic threats, Vanity Fair spoke to more than 20 doctors, scientists, policy analysts, and other experts. The takeaway was clear: We need to up our game. At the very least, the experts said, three key areas require urgent attention: overhauling public health messaging, effectively deploying the private sector, and increasing global transparency.
Progress on these fronts costs money, which has dried up, leaving viruses with the upper hand. “That’s one of the things about viruses: They can’t live outside a human host,” says Valerie Reyna, director of the Human Neuroscience Institute at Cornell University. “They need all of us to cooperate in transmitting them.”
Overhauling Public Health Messaging
There is little doubt that trust and social cohesion can save lives during a pandemic. For evidence, one can look to Japan, where fewer than 49 people per 100,000 have died of COVID, as compared with the US toll of more than 330 per 100,000. The Japanese government did not mandate vaccines or masks. Rather, peer pressure did the work, as The New York Times has reported. There, masks are referred to as face underwear. As in: You’d be embarrassed not to wear them. The Japanese government also drilled into public consciousness early on the dangers of what became known as the “Three C’s”: closed spaces, crowded places, and close-contact settings. The ubiquity of that phrase, which became Japan’s buzzword of 2020, almost certainly saved lives.
But would face underwear cut it in the US, where a Beverly Hills doctor and leader of the anti-vax movement was among those arrested for storming the Capitol during the attempted insurrection on January 6? Can the Three C’s compete with Florida governor Ron DeSantis, a Republican who in December got approval from the Florida Supreme Court to launch a grand jury investigation into COVID-19 vaccines?
“We are a divided country, and a divided country cannot be prepared,” says Ali Mokdad, a professor and chief strategy officer for population health at the University of Washington. Mokdad has spent the pandemic modeling its path, and confirmed that outcomes can diverge widely based on whether or not people follow public health guidance.
Americans, however, are not going to wake up one morning and start unanimously respecting authority and following instructions. So it’s incumbent on public health officials to figure out how to communicate with us as we are, not how they might like us to be.
Confusing and jumbled health guidance from the CDC, at times at odds with science, has helped fuel public suspicion of medical authorities, experts say. At the height of the omicron wave, 10 days of recommended isolation became five, with no requirement of a negative test. Six feet of distance at schools became three, also with little clarity. “Our CDC has been dysfunctional in both administrations,” says Eric Topol, a professor of molecular medicine at Scripps Research.
Effective public health messaging requires explaining the limits of your knowledge in the face of shifting science, says Topol. The CDC failed because it tried to keep its messaging singular and simplistic, sticking with one message to all Americans, even when science and obvious political divisions called for nuance. “Why do we have in January 2023 that two shots is fully vaccinated?” He asks. “Right now, we’re in the middle of a senior wave of dying and hospitalization, because many got two shots and they never got another one.”
Today, only 39% of elder Americans are boosted, in contrast to the United Kingdom, where the figure is higher than 80%. “The boosters got off on the wrong track,” says Topol, “because CDC was not capable of transmitting two messages at the same time.” (A CDC spokesman says the agency uses the phrase “up to date” to describe both initial vaccinations and boosters.)
The impulse to simplify complex science for mass consumption is understandable, but it can backfire in a 21st-century media environment where anyone with an internet connection can “do their own research.”
We have to “stop treating Americans like they have a dial-up modem,” says Peter Hotez, codirector of the Texas Children’s Hospital Center for Vaccine Development. A fixture on MSNBC in his white lab coat and bow tie, Hotez has been routinely targeted by anti-vaxxers. For guidance, he’s turned not to federal health agencies but to the writings of authoritarianism experts like Ruth Ben-Ghiat. The anti-science agenda is “all there,” he says. “It’s part of a far-right playbook from Stalinist Russia and the Third Reich.”
In a statement to Vanity Fair, a CDC spokesman noted that director Rochelle Walensky had launched an agency overhaul in August. Since then, “experts from across the agency have been working to push forward changes designed to tackle how to communicate our scientific information quicker and with greater clarity so that Americans can use it to protect their health.” Those changes included streamlining COVID-19 guidance and emphasizing digital communications.
But primitive messaging is not the only problem. Experts question whether there is enough money, enough innovation, and enough political will on the part of the Biden administration to overcome a rising tide of what Hotez calls “anti-science aggression.” As Topol says, “The number of people that have been putting out disinformation has been steadily growing, because there is no anti-force, there is no counter. All we’ve had is a brochure made by [Surgeon General] Vivek Murthy about how disinformation is a big deal.”
The Biden administration has awarded millions to regional and local organizations to build vaccine confidence and bolster COVID-19 vaccinations in underserved communities. At the same time, it is facing litigation by the Republican attorneys general of Missouri and Louisiana, claiming the administration sought to censor opposing views on COVID-19 on social media platforms.
While it may seem impossible to wrest the narrative from anti-vaxxers, Cornell’s Valerie Reyna says the situation is not “hopeless.” Reyna codeveloped the concept of “fuzzy trace theory,” which seeks to explain how mental representations of ideas are connected to decision-making. She is particularly interested in how the brain processes important public health information. While the facts fade quickly, people retain the “gist” of that information longer, which in turn impacts their behavior.
“People do not get the same gist from the same message,” says Reyna, a problem that bedevils public health communications. If you say, for example, there’s a 5% prevalence rate of COVID-19 in the community, some might think: “That’s good. It means 95% of the people don’t have it.” Others would be rightly alarmed, given that, before vaccines were available, anything over 5% was considered by the World Health Organization to be grounds for governments to maintain lockdowns. “The verbatim is the same,” she says, but depending on your underlying knowledge, “the gist that you extract from it is different.”
Unlike many critics, Reyna does not view US public health messaging as a total failure. She points to elderly Republicans in Florida who, in early 2021, lined up in droves to get the initial COVID-19 vaccines because the message had gotten through: Older people were at higher risk. “If that had not happened, many more people would have died,” she says.
Public health guidance lands most effectively when a trusted messenger delivers it. At the height of the monkeypox outbreak, which predominantly affected men who have sex with men, the White House selected Dr. Demetre Daskalakis to serve as the deputy response coordinator. Daskalakis, a relentless advocate for LGBTQ+ health who serves as director of the CDC Division of HIV Prevention, took the federal government’s vaccination and treatment drive to gay pride events, after years spent raising awareness at such venues.
As Reyna explains, people “have to have the right information, trust the source, have enough background knowledge, and connect to their values, even when they’re dug in politically. It’s not one message and you’re done.”
The Private Sector
On a Saturday evening in March 2020, a group of top business executives arrived at the White House, eager to help cut through the Darwinian chaos of the federal government’s COVID-19 response. They found themselves explaining to President Trump’s son-in-law, Jared Kushner, that they had secured commitments from dozens of major corporations to manufacture ventilators, create a system for contact tracing, and more, as first reported by Vanity Fair.
Due to the finite supply of personal protective equipment, states were bidding against each other and driving prices up, one attendee explained. The group urged Kushner to get President Trump to invoke the Defense Production Act, a law dating to the Korean War that could compel American companies to manufacture goods for the US government and guarantee a market for them. According to three people who attended the meeting, Kushner dismissed their concerns and rejected their offers of assistance.
Rick Bright, a former Health and Human Services official who ran a federal office that partners with industry to develop advanced medical treatments, says “irreparable damage” was caused by the lack of national coordination and “the omission of the private sector at the table” from the early US pandemic response. As the federal government floundered, Bright adds, “It was the companies that really took risks while waiting for Trump to get on the ball.”
The Trump administration eventually did find a winning formula with Operation Warp Speed, which enabled new vaccines to be developed in record time. In it, the US government put a four-star Army general in charge of logistics, partnered with vaccine developers, and facilitated and incentivized their work.
That success has prompted calls for an enhanced partnership between the public and private sectors. Testifying before the House Select Subcommittee on the Coronavirus Crisis in December, Bright recommended establishing a pandemic preparedness council that would bring together government officials, academics, and representatives from the private sector to advise the White House on an ongoing basis.
The US and other nations recently agreed on an ambitious goal known as the 100 Day Mission. The objective is to produce accurate diagnostic tests, effective treatments, and globally available vaccines within 100 days of a new disease outbreak. But Chandresh Harjivan, a consultant to numerous government agencies who worked on Operation Warp Speed, said the 100-day goal is just a “fairy tale” unless governments can protect participating companies against financial risk and put leaders at the helm who are not “beholden to the budgets of agencies.”
The 100-day goal also requires transparency among international governments. After all, there’s no way to get the jump on a new virus if the country of origin doesn’t promptly or fully report its discovery.
Global Cooperation
On December 5, a team of US public health officials and diplomats arrived at the World Health Organization in Geneva, Switzerland, to resume deliberations on the creation of something entirely new: a legally binding global pandemic accord that could lay the groundwork for greater transparency and resource-sharing when the next outbreak inevitably occurs.
In the executive boardroom of WHO headquarters, deliberations almost immediately fractured, with Northern countries including the US demanding prompt disclosure of potential global health threats, and Southern countries refusing to sign off until their demands for equitable access to lifesaving treatments and vaccines were met. As a representative from Mexico put it, “Nothing is agreed until everything is agreed.”
According to Lawrence Gostin, director of the WHO Collaborating Center on National and Global Health Law, “The South won’t give [the North] what they want unless they get equity, and the North wants to focus on scientific sharing, so that’s a huge impasse that’s almost impossible to bridge.” Another participant called it “the most contentious global South, global North verbal war that I have ever heard before,” adding that there is still “unbelievable disagreement over how the globe becomes better prepared.”
A WHO spokesperson said the organization is there to “facilitate and support” negotiations, which are led by member states.
Even as officials from 194 countries clashed over how to cooperate on the next pandemic, battles over the current one raged on. In the early days of COVID-19, critics say, the Chinese government delayed sharing crucial information, including the virus’s genomic sequence and evidence that it was spreading from person to person. Then, after years of imposing stringent lockdown rules as part of its Zero COVID policy, it reversed course late last year, setting off a wave of new infections across the country. China’s National Health Commission recently stopped reporting daily new cases, and the government reported fewer than a dozen deaths from COVID-19 in the first three weeks of December, before revising that number on Saturday to nearly 60,000 deaths. WHO officials have urged the Chinese government to provide accurate data regarding case numbers, deaths, and the distribution of variants. (A Chinese Embassy spokesperson did not respond to a request for comment.)
US negotiators have also proposed amendments to strengthen the anemic international health regulations, last revised in 2005, that govern how WHO members share critical public health information. Their goal is to “close those gaps,” says Gostin, that prevented other countries from girding against the virus early on. “If China had behaved transparently in informing the world, it may not have prevented the pandemic, but it was our only shot.”
Regarding the fledgling pandemic accord, Gostin says, “What I’ve been telling governments is, ‘We all know we have to do this. We can’t go back to the status quo. Now is the time to be bold.’”
In October, the White House released its $88.2 billion National Biodefense Strategy, developed by the White House Office of Science and Technology Policy and the National Security Council. The strategy has a far-reaching goal: to take pandemics off the table as a threat to society. Under the plan, the US would use new technologies to achieve the 100 Day Mission and scale up preparations for new biothreats via coordination among 20 agencies.
“Where we really win here is when people, not just governments, come together for that common goal of fighting this pandemic” and the next, says Matthew Hepburn, who helped develop the plan. “My crazy optimistic view is, we get everybody together to achieve that.”
In December, however, the Biden administration’s bold intentions ran into a congressional buzz saw.
While the 2023 budget approved by Congress increased health and pandemic funding across various agencies, not a single dollar went specifically to fund the biodefense plan. Nor has additional funding been allocated to continue an Operation Warp Speed–type program that could develop improved COVID-19 vaccines and treatments. And a proposed 9/11–style independent commission to comprehensively investigate the US COVID-19 response wound up on the cutting-room floor. To those who take the threat of pandemics seriously, these moves reflect a staggering shortsightedness on the part of Congress.
As one former congressional staffer who has worked on pandemic preparedness legislation said of the 2023 budget, “We just lost 1 million Americans and this is the best we can do, some mediocre tweaks around the edges?”
Gerald Parker, associate dean for Global One Health at Texas A&M University’s School of Veterinary Medicine and Biomedical Sciences, thinks the US has failed to act on the lessons from its COVID ordeal: “Unfortunately, we are no better prepared than we were three years ago. I hate to say that, but it’s hard for me to argue against myself.”
But others see glimmers of hope. The 2023 budget codified pieces of the PREVENT Pandemics Act, a bipartisan bill sponsored by senators Patty Murray (D-Wash.) and Richard Burr (R-Va.). Among the changes that were solidified were the creation of a White House office of pandemic preparedness, with a director who sits on the National Security Council, and the elevation of the CDC director’s role to one that requires Senate confirmation.
“We’re putting in place doctrines that are continuing to elevate health security as a matter of US national interest,” says J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies. Despite “many caveats,” he adds, it’s encouraging that the White House is now established as a “central node” in overseeing a federal response.
How far would that get us in a future Trump or DeSantis administration?
It isn’t possible to remove politics from a pandemic response, says Seth Berkley, CEO of Gavi, the Vaccine Alliance, which helped manage the delivery of nearly 1.9 billion COVID-19 vaccine doses to many of the world’s poorest countries. “You can’t totally Trump-proof it or Bolsanaro-proof it. The most powerful thing you can do is have high-quality systems in place.”
This article was published in Vanity Fair.
