Epidemiological Readiness

If nurses and doctors were on the frontlines of fighting the pandemic, epidemiologists and scientists donning lab coats were in the war room bringing the fight to the virus at a microscopic level. Like all great crises, prevention is better than cure and while U.S. public health officials and politicians missed many clear signals that a global pandemic was imminent, we can certainly use the after-action of this dreadful event to reinforce our national and global readiness for the next one.

Zoonotic diseases that leap from the animal kingdom to plague humanity are an all-too-frequent reality. Born in part by our inability as a species to respect nature’s boundaries and born in part by poverty, and dietary and animal-harvest traditions (from which industrial scale meat production is not sufficiently protected), zoonotic diseases have an easy first jump to infect our species. The second quantum leap, as was the case with the global spread of COVID-19, is fueled by globalization and the porous containment and contact tracing net around the world.

COVID-19 is not only the first zoonotic disease let alone coronavirus (so named for the appearance of crown-like spikes), to threaten our way of life. While it is the first major pandemic to halt the global economy in over 100 years, since the Spanish flu (itself a zoonotic disease stemming from birds and the crowded post-World War I camps) claimed more than 50 million lives. Other epidemics have emerged over the last century—virtually all of them had their origins and nexus in humanity’s proximity with nature. From the SARS outbreak in Guangdong Province, to MERS (both coronaviruses), to the spread of swine flu, H5N1, and the dreadful Ebola outbreak in Guinea, our ability to deter, detect, and respond effectively to infectious diseases is not merely a national security priority but a global one. The same priority holds true for vector-borne diseases, such as Zika among many others, that break the sub-tropical barrier continuing their inexorable march north buoyed by climate change.

Against this scorecard, few countries in the world fared well. Those at the top of the league tables—the best of the worst alternatives—had prior experience in combating upper respiratory diseases, tight nets around airports and ports of entry, and comparatively small, closed countries with trusted, technology-forward institutions. Many other countries, including the United States, resorted to the same pandemic response playbook that might have been used against the Spanish flu 100 years ago. Imposing quarantines, derived from the Italian word for 40 signifying 40 days of social distancing and isolation of sick people, wearing masks, and hoping for a scientific breakthrough of a vaccine or losing the war of attrition through gradual herd immunity.

What is clear is that, as dreadful as COVID-19 is, the onset of these types of global outbreaks may no longer be a 1-in-100 year event but rather a more frequent occurrence. Against the choice of “stop everything” economic and social paralysis, which itself has massively harmful effects on lives, livelihood, and public health, better pandemic preparedness, global collaboration, and a trusted early alert system are needed to catch, contain, and mitigate the spread of novel communicable diseases. As the vast amount of money spent in both public and private labs in the search for a vaccine and other treatments for COVID-19 highlight, responding to public health crises of this scale is clearly a shared priority. Our collective national and international scientific, vaccinology, and epidemiological capacity must be arrayed in kind as a global shared service.

The U.S. medical system, like many other countries, labored under the strain of lack of reliable and scalable testing capacity, which itself meant the numerator and denominator of the spread of COVID-19 were and remain largely unknown. This was true until the most severe cases presented themselves in overwhelmed hospital systems only to find the treatment options wanting and the ventilators and other necessary medical equipment in scarce supply. This testing bottleneck means that the indicators public health officials are relying on to convey containment of the outbreak—the national thrust to flatten the curve—are largely lagging figures.

While some breakthroughs in vaccinology are underway courtesy of Operation Warp Speed, ostensibly the world’s fastest run of clinical trials for a vaccine—a veritable space race to find a cure for COVID-19—the likely outcome is that it may still take 12 to 18 months to find a cure, if one is found at all. The other challenge will be to ensure that the on-shore and nearshore pharmaceutical production capacity is on hand to ramp up vaccine production to population scale and to eventually ensure global supplies are available, lest seasonal reappearance becomes a threat.

Insidiously, as scientists toil to find a cure, many labs and the computing capacity arrayed against COVID-19 have fallen prey to cyberattacks presumably to obtain valuable vaccine and treatment intellectual property or to disrupt advances. This may be a perverse example of humanity’s zero-sum nature: Even in the face of a collective global threat with a common enemy, people will still not set aside their distrust nor race for political and economic gain.

As the world slowly gains the upper hand in the fight against COVID-19, science and sound public health should have the loudest seat at the war room table. Much work will be needed in restoring public trust in global health institutions that either faltered in the face of this fast-evolving pandemic or were swayed by political and economic pressures to not sound the alarm louder and earlier that the emergence of COVID-19 was not a drill.