What’s Next for Pandemic Preparedness?
Analysis: What if the next pandemic isn’t a warning shot, but a global catastrophe with a death rate ten times that of COVID-19—and the same broken systems are still in charge? This is the question we should be asking as the actions of two Presidents during the transition of power have unfolded.
In the last hours of his administration President Biden pardoned Dr. Anthony Fauci, retired head of the National Institute of Allergy and Infectious Diseases and the face of the pandemic for many Americans. And one of President Trump’s first executive orders was to withdraw the United States from the World Health Organization or WHO. Both speak to our preparedness for the next pandemic, and whether it is a laboratory enhanced pathogen.
If there is one thing that the COVID-19 pandemic has taught us, it is that the world of international relations is a high-stakes and high-consequence world. And for better or worse, the World Health Organization (WHO) was at the center as it unfolded. The WHO made several errors in managing the pandemic, especially at the beginning, and this led to a spiral down effect, which was measured in lives lost, economies broken, and trust lost. These failures offer not only a basis for criticism but also for transformation.
Before discussing what America can do, having exited the WHO, we should review why it is the right decision for America.
The First Misstep: The delay in the declaration
Let us go back to December 2019. Reports of human-to-human transmission of the novel coronavirus began to surface immediately. Nevertheless, the WHO did not classify the outbreak as an emergency until January 30, 2020, more than a month after the virus had spread globally. On the other hand, Taiwan considered the situation as a human-to-human transmission disease from December 31, 2019, and implemented aggressive measures. What were the results? The death rate in Taiwan was 1% of the U.S. rate on a population-adjusted basis. This is rather exemplary: a single decision – early or delayed – determined the fate of millions of people.
The WHO could have raised the alarm earlier, and then, countries would have increased their testing, enforced specific travel restrictions, and enhanced their health care systems. What was the cost of the delay? About 20 million deaths and $25 trillion in global economic loss.
Over Reliance on Flawed Data
In the initial phase of the outbreak, the organization based its position on the data provided by China, which downplayed the severity of the virus and failed to share the information on asymptomatic transmission of the disease. One wrong assumption that the disease was spread by symptomatic carriers only informed most global strategies that were very inefficient. It is time to be wary and to verify the information that is provided to us.
Regan’s “Trust but verify” motto comes to mind here.
What could have been done? The WHO should have required independent investigations and data source verification. When lives are at stake, skepticism is not skepticism; it is common sense.
The Mask Debacle
In the first few months of 2020, the WHO and Dr. Fauci recommended that people do not need to wear face masks, citing lack of evidence and worrying about the availability of masks for healthcare workers. When their position abruptly changed, public trust was damaged. People were left to figure out for themselves what to do and many got it wrong. Masks, which are largely ineffective as a way of preventing the spread of asymptomatic infection, nonetheless became a symbol of institutional failure.
Here is the first thing that can be learned from this: When in doubt, err on the side of caution when giving public health advice.
Travel Restrictions: A Missed Opportunity
Another major mistake was WHO’s position against the early travel restrictions, which might harm the collaboration between countries but can be the first and best line of defense early in an outbreak. The travel industry has accomplished the unprecedented achievement of making every major city accessible to every other major city on the planet within about 24 hours. But for a virus with an asymptomatic phase of infection, like SARS-CoV-2, this travel capability becomes an epidemic nightmare.
Countries that closed their borders, including Taiwan and New Zealand, did much better. This misstep underscores the issue between economic interests and public health concerns. In a pandemic, the latter must take precedence.
But in fairness to the medical establishment, there has never been a new respiratory virus in humans that had a 50% asymptomatic infection rate. I believe this feature was engineered into the virus and therefore was a total surprise to frontline doctors. Without being told by those who knew or suspected it was a lab-engineered virus, we were reacting to a natural virus when it was anything but natural.
A Hypothetical Nightmare: The 10% Lethality Scenario
COVID-19, which has an average case fatality rate of about 1%, has already taxed the capabilities of the world’s systems to the limit. Visualize a pathogen with a 10% death rate. The consequences would be catastrophic: Health care systems would be overwhelmed; food supple, energy supply chain, and police and fire protection, critical infrastructure to keep communities functioning and safe, would be destroyed. In many simulations of what would happen, societies would be returned to pre-industrial times. This hypothetical shows the importance of preparedness.
But it is not the remote hypothetical you might imagine. In my forensic work over the last five years, I have found laboratories in China doing research on viruses with a 30%, 47%, and even 70% lethality.
What must we do? The following are some of the recommendations that should be taken to build a robust, decentralized healthcare system, stock up on medical supplies, and fund rapid response vaccine platforms. However, synthetic biology is real, and it must be controlled to avoid its misuse.
An early warning system can be provided by the community education and the training of the local health workers.
Global Health Governance: Decentralization
One of the most important lessons is the problem of over centralization. The failure of the WHO reveals the risk of relying on a single organization for world health. It is better to design a more resilient system by enabling regional organizations like African, European, and Asia-based health programs. These entities, which are close to the regional circumstances, can act more effectively and faster in crises.
However, decentralization does not mean fragmentation. There is still a need for a central coordinating body to oversee these networks and to ensure that they are transparent and that resources are used equally. Here is where technology can help – real time data platforms that can link decentralized entities and facilitate near real time decision making.
The U.S. Role: Leadership in Crisis
As the U.S. turns away from the WHO, it has a chance to lead in defining new frameworks of global health governance. It is possible to develop vaccines and diagnostics with the help of public-private partnerships. The policies of supporting decentralized systems and promoting equitable resource distribution should be encouraged.
The last two things that cannot be compromised are transparency and accountability.
One of the most striking features of the pandemic was the lack of quality information. From the early cover up in China to the inconsistent messages from global health agencies, trust was eroded at all levels. It is possible to regain this trust only by making data available to the public and ensuring that it can be verified by other parties. The open-source code approach of AI systems might be a good example.
It becomes a matter of life and death, literally, in global health governance.
Dr. Fauci’s Legacy and the Pardon
Dr. Anthony Fauci, one of the most controversial figures during the COVID-19 crisis, is a perfect example of the good and bad of leadership at difficult times. His pardon by President Biden is not only a recognition of his past contributions but also a stamp of a tainted legacy.
Fauci has spent over five decades in the public medical profession, starting as a bench scientist at the National Institutes of Health in 1968 and then serving as the director of the National Institute of Allergy and Infectious Diseases from 1984 to 2022. By his leadership, he helped in the formulation of global policies for dealing with infectious diseases such as HIV/AIDS, Ebola, Zika, and COVID-19. He was not only a trusted voice to seven U.S. presidents but also one of the most cited researchers in the world, who made significant contributions in immunology and his discoveries changed the manner of treatment and saved millions of lives.
Fauci’s career, however, was not without its share of controversies. At the beginning of the HIV/AIDS crisis, he was criticized for the government’s slow response and the early portrayal of the disease as a behavioral issue as he later advocated for the progress in treatment by working with advocates. There has been controversy about AIDS vaccine trials in Africa. His recommendations on the use of masks and the lockdowns during the COVID-19 pandemic were a source of much irritation to the public, because it eroded the trust of the opponents.
Most importantly, he came under immense scrutiny for having funded research that was associated with gain-of-function studies on coronaviruses. Dr. Fauci’s Senate testimony in which he claimed that NIAID had not funded gain-of-function research related to the pandemic was the subject of heated debate. His testimony was based on a very legalistic definition of gain of function research adopted by the NIAID, after the fact, which excluded studies like those that may have taken place in Wuhan. This research entailed modifying bat coronaviruses to make them more infectious and I believe led to a global tragedy that claimed the lives of more than 20 million people.
The pardon itself has consequences which go beyond the legal pardon. By accepting it, Dr. Fauci has indirectly admitted the truthfulness of the issues that made the pardon necessary. When history looks back at his legacy, the pardon will be part of his contributions to science, a permanent asterisk on his career. Fauci’s story also reminds us that in public health leadership, things like accountability, ethics and transparency matter, first and foremost. Fauci’s experience offers several implications for future generations of leaders. He shows that in times of a crisis there is an even greater need for the highest level of transparency, strong oversight, and the trust of the public.
A Call to Action
COVID-19 is a story of what can happen, but it is also a story of what must happen. The failures of the WHO and other organizations are the lesson. It is not just a suggestion of the need for change but a requirement for change immediately in terms of openness, de-centralization and readiness.
Let me imagine a future in which global health systems are strong, adaptable and credible. A world in which the outbreak of a lethal pathogen can be stopped before it becomes a pandemic. This is not a pipe dream; this is possible if we act now.
About the author Steven Quay, MD, PhD
Dr. Steven Quay has over 390 published contributions to medicine and has been cited over 11,700 times, placing him in the top 1% of scientists worldwide. He holds 236 US patents and patent applications. He has invented seven FDA-approved pharmaceuticals which have helped over 80 million people. He is the author of the best-selling book on surviving the pandemic, Stay Safe: A Physician’s Guide to Survive Coronavirus.
He received his M.D. and Ph.D. from The University of Michigan, was a postdoctoral fellow in the Chemistry Department at MIT with Nobel Laureate H. Gobind Khorana, a resident at the Harvard-MGH Hospital, and spent almost a decade on the faculty of Stanford University School of Medicine. A TEDx talk he delivered on breast cancer prevention has been viewed over 229,000 times. He has testified in the US Congress on matters of national security and dangerous synthetic biology research. For more information, visit www.DrQuay.com or follow him on X at @Quay_Dr.