Preparing for the Next War
Applying the Lessons Learned from this Pandemic to the Next One
This is the final essay in Civic Way’s series on the Covid-19 pandemic. In our last essay, we discussed how our toxic politics magnified the pandemic. In this essay, we recommend strategies for improving our capacity to fight the next pandemic. The author, Bob Melville, is the founder of Civic Way, a nonprofit dedicated to good government, and a management consultant with over 45 years of experience improving government agencies.
Highlights:
Surviving the Covid-19 pandemic will not immunize us from the next virus which, in the absence of a more effective, unified response, could be far more contagious and deadly
We need a unified, sensical and flexible national public health strategy to overcome pandemic fatigue and manage Covid-19 as the endemic it is becoming
The Covid-19 pandemic revealed that we are highly vulnerable to future pandemics, but also taught us several vital lessons for improving public health preparedness and combating future pandemics
To fight the next war, we must develop a new federal pandemic management model, rebuild our strategic pandemic infrastructure, design a robust national testing and contact tracing program, improve our vaccine rollout capacity and upgrade public leadership, information and outreach
I Can’t Stands No More
When it comes to the Covid-19 pandemic, many are having what some boomers might call a Popeye moment. As the ancient cartoon character used to say in irritation or exasperation, “I’ve had all I can stands and I can’t stands no more.”
Another variant, another surge. Like a bad houseguest, the pandemic keeps hanging around. Perhaps we should adjust our expectations. Covid-19 will likely morph from pandemic to endemic, a disease, like the flu or common cold, that never leaves, but can be managed with practical, data-driven policies.
The next virus, however, could be far more contagious and deadly. Far higher hospitalization and mortality rates. Unless we learn from this pandemic—our failures and successes—we will likely repeat many mistakes. Unless we embrace proven public health policies, we will experience far worse outcomes. Surviving this pandemic is no guarantee that we will survive the next.
Managing the Endemic
We are no longer at a crossroads for Covid-19. Our political divisions already blocked the most promising path. Due to such factors as variants, vaccine hesitancy and the political virus, we will probably not attain herd immunity. Millions will continue to be infected. The Covid-19 virus will linger.
The good news is that we are learning to live with the virus. The vaccines will not end the threat, but they offer considerable protection. Pending treatments, including pills, will help us respond more quickly to symptoms. Together, they should spare us from the virus’ most lethal blows.
Pandemic fatigue is real, but we are in a different place than one year ago. We are better protected. We know more. And we are better positioned to weigh public health measures and their potential costs. We know, for instance, that small differences in elderly vaccination rates can disproportionately impact hospitalization risks. Shouldn’t our public health strategy reflect that knowledge?
In the coming months, we must manage the Covid-19 virus in a different way. Instead of careening between draconian mandates and “Don’t Tread on Me” indifference, we should adopt a unified, flexible national public health strategy. Instead of bipolar policies that pair lax restrictions with the lowest vaccination rates, we should implement evidence-based policies that align restrictions with risk.
We should redefine our expectations. We should track metrics that matter (e.g., vaccination rates, not just infection rates, and lagging indicators like hospitalizations). We should adopt uniform criteria for easing public health restrictions (e.g., high vaccination rates, stable infections and ample health care capacity). We should ease restrictions as we surpass the criteria.
Facing the Next Pandemic
What worries so many experts? The next crisis could make the Covid-19 pandemic look like a mere rehearsal.
In fact, many see the next crisis as inevitable. The US—and the world—are increasingly vulnerable to a growing list of threats—climate change, natural disaster, cybersecurity, bioterrorism, infectious disease and terrifying new microbes. The only questions—which will strike first and how hard?
Such threats have many potential contributing factors. Climate change. Population growth. Urban development. Deforestation. Habitat damage. Biodiversity loss. Utility degradation. War. When such factors occur, outbreaks of infectious diseases like measles, polio and yellow fever are soon to follow.
To illustrate, one of the most dangerous global health threats is antibiotic-resistant bacteria. The CDC has estimated that antibiotic-resistant bacteria infect at least 2.8 million Americans (and kill 35,000) every year. Since these superbugs don’t see national or state borders, our balkanized governments are no match. And, without better incentives, private research and development is unlikely to keep pace.
The Lessons of Covid-19
The Covid-19 pandemic revealed that the US, despite its many assets, is highly vulnerable to future pandemics. It also taught us several vital lessons for combating future pandemics, including the following:
Public leadership – without strong, effective and trustworthy federal leadership, and clear, consistent communications, state and local governments falter, people defy well-intentioned public health advice and our communities suffer preventable deaths and economic losses
Public health system – unless public health agencies are structured, empowered and resourced to do their jobs and our health care and public health systems are fully linked, communities remain highly vulnerable to pandemics and our pandemic fighting efforts are significantly compromised
Pandemic infrastructure – an effective pandemic response requires robust testing, contact tracing, vaccine development and distribution and emergency asset reserves (e.g., tests, ventilators, hospital beds and personal protective equipment)
Pandemic reporting – the lack of a uniform national pandemic dashboard for the public and comprehensive surveillance data for public health officials creates a vacuum for disinformation campaigns that undermine our ability to fight pandemics
Misinformation – the politicization of public health fuels propaganda, undermines our ability to mount a unified response, jeopardizes public health officers and threatens community health
How do we apply the lessons we’ve learned? In the short-term, we must start managing the current pandemic as an endemic. For the long-term, we must start planning our offensive for the next pandemic, a crisis we might be able to survive if we begin preparations now.
Create a New Pandemic Response Model
We must replace our failed state-centric model with a new, federally-led pandemic management program. The lead agency should have cabinet-level prominence, but sufficient autonomy to follow the science. It should have ample public health emergency powers (e.g., issue mandates, suspend air travel, quarantine travelers, invoke the National Defense Authorization Act and negotiate global pacts). It also should have a full arsenal of emergency pandemic-fighting tools, including free testing and contact tracing programs.
The federal and state governments, through a series of multi-state compacts, should develop a network of 15 to 20 regional pandemic response centers to supervise our response to the next pandemic. The network, with a grid design like the US energy system, should be led by regional public-private partnerships comprising state governments, health insurance firms and private providers.
The regional partnerships should be empowered to protect citizens during pandemics. While these powers should be limited (e.g., require Congressional reauthorization after 180 days), they should be expansive enough to supervise local public health agency pandemic efforts and enforce relevant public health orders. They should be free from state legislative interference. They also should have sufficient emergency funding to spur public-private innovation and build regional pandemic response teams (e.g., epidemiologists and contract tracers).
Together, the lead federal agency and regional partnerships should develop and continually update a national pandemic response plan. The plan should be flexible. For instance, it should link public health measures to sensible metrics (e.g., vaccination and virus reproduction ratios). It also should include proactive measures, such as fiscal incentives to spur research and development and fund antibiotic stewardship programs.
Rebuild the Nation’s Pandemic Infrastructure
The lead federal agency must replenish the Strategic National Stockpile (SNS). The SNS should include sufficient drugs, supplies and medical devices for initial pandemic responses. Life-saving equipment like ventilators and personal protective equipment. Vital testing supplies. The lead federal agency also should build a system for ensuring the rapid production, acquisition and distribution of other strategic resources.
The lead agency and regional partners should address regional infrastructure issues. The national pandemic response grid should have adequate capacity for handling projected peak transmissions. Easily-convertible facilities for mass testing, treatment and vaccination sites. A network of hospitals with adequate emergency treatment capacity (e.g., ICU beds). Hospital floors or rehab center wings that can be easily repurposed for pandemic patients. A viable mechanism for quickly hiring and certifying retired and out-of-state nurses.
The lead federal pandemic agency should prod other federal agencies to ensure that future infrastructure improvements anticipate pandemic issues. Work with professional associations to make planning and building codes pandemic resistant (e.g., better ventilation). Require appropriate modifications to public transportation facilities and modes. Promote other civic improvements like parks, trails and wide sidewalks.
Develop a National Testing and Tracing Program
If we’ve learned anything from the current pandemic, it is that we need a comprehensive public-private national testing and contact tracing plan to control future outbreaks. The plan should include regional procurement and logistics compacts. It should entail a fully trained stand-by labor force, including contact tracers (e.g., the National Association of County and City Health Officials recommends 30 per 100,000 constituents).
The testing program should encompass several components. Uniform testing strategies (e.g., free initial testing in high-risk areas and subsequent random sampling). A streamlined test authorization process. A spectrum of tests, including rapid, home-based and pooled tests. Accessible testing sites. A vast network of test collection centers and certified diagnostic testing labs.
The contract tracing program should include uniform standards. A contact tracing database to expedite contact communications. Full telecommunications capabilities for tracking exposed persons. A free digital contact tracing app for public use. Simple tools for detecting hotspots and targeting interventions (e.g., isolating close contact clusters).
Strengthen the Nation’s Vaccine Capacity
The miraculous Covid-19 vaccine development notwithstanding, we will need a better rollout next time. To that end, we should develop a vaccine development and distribution plan before the next pandemic arrives.
The Covid-19 vaccines underscore the value of an innovative development approach. Instead of our traditional custom vaccine approach—devising a unique vaccine for each virus—we should invest in platform vaccines that can be adapted to specific viruses through genetic sequencing. This approach will facilitate the rapid testing and production of new vaccines and save thousands, if not millions, of lives.
We also learned from the Covid-19 pandemic the distinction between vaccine development and distribution. We must develop an efficient plan to accelerate vaccination distribution. We should establish uniform, risk-driven eligibility criteria. We should streamline the signup and notification processes. We should design a national vaccine website (and hotline) around public needs and preferences.
We should build a linked network of convenient public vaccination sites, including drive-through and walk-in sites (e.g., arenas). We should ensure the quick deployment of public resources (e.g., National Guard) and private contractors (e.g., CVS and Walgreens). We also should build a pool of supplemental personnel (e.g., medical assistants, nursing students and volunteers) to support distribution.
Improve Public Compliance
This will require a three-pronged strategy. Better public leadership. More reliable public information. More aggressive public outreach.
There is so silver bullet for restoring responsible public leadership. When one of our two political parties is overrun by forces trying to undermine vaccines and other public health measures in the midst of a global pandemic, conventional solutions are impotent. Rather, we must pursue a range of bold strategies for enhancing public leadership, starting with competitive elections (see prior essays on election reform).
We should fund, build and deploy a national pandemic dashboard for forecasting and tracking outbreaks. Authorize the lead federal agency to develop and manage a national system for collecting pandemic data from all states, public health agencies and health care providers. Develop uniform metrics (e.g., antibiotic sales, per capita cases, tests, vaccination rates, ICU capacity, hospitalizations and deaths). Endorse clear data standards. Make the dashboard easy, accessible and useful for public health officials and citizens alike.
We should fund and expand persuasive public information efforts to immunize society against disinformation. Start by disseminating national pandemic guidelines in tailored formats. Establish a rapid response center to debunk anticipated or new rumors. Deploy innovative outreach strategies for targeted groups (e.g., rural remote and urban homeless). Engage trusted local civic groups to support outreach efforts.
The outreach program should build the case for public health measures (e.g., masking) as well as effective vaccines and treatments. It should fully address the “personal freedom” issue and test potential incentives for encouraging compliance (e.g., compliance cash awards linked to targeted community compliance ratios). As necessary, the lead federal agency should be granted time-limited emergency powers to compel social media to delete dangerous content and suspend illegal sites.
The Next War
As we leave (hopefully) the latest phase of the Covid-19 pandemic, a collective amnesia seems upon us. Many political leaders are ignoring readily available data and actively undermining our capacity for fighting the next pandemic. Most disturbingly, over half of our state legislatures have enacted measures to emasculate the pandemic-fighting authority of state and local public health agencies.
Throughout world history, great powers have too often prepared for the last—or the wrong—war. The US is no different. We spend over $715 billion per year on defense (about 15 percent of the federal budget), more than the next ten highest-spending nations combined. The bulk of this spending is to protect the US from other nations. Yet, no foreign nation has ever killed as many Americans on US soil as the Covid-19 pandemic.
We may be disheartened (even desperate), but should we really be disarming before the next battle even begins?