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We are approaching the third year of the 2019 coronavirus pandemic that caused both tremendous tragedy–in lives lost, economic hardship, and social disruption–and unprecedented triumph in the rapid development of effective vaccines. In Congress, several committees have held hearings on the COVID-19 pandemic and multiple bills have been introduced that aim to improve the U.S. response to future pandemics. It is not too early to reflect on the missteps that have been made and lessons that can be learned so that the United States and nations worldwide can be better prepared for the future.
A new RAND publication contains a collection of essays that explores topics of critical importance toward that end and identifies actions to take to not only improve pandemic preparedness but also help prevent the occurrence of future pandemics. The essays center on U.S. challenges and experiences, but the solutions, in many cases, require collaborative efforts that reach across national boundaries.
The essays investigate:
Warning about threats without actors: Warning about threats to national security that do not have an obvious perpetrator–state or terrorist–poses an inherently difficult challenge for analysts to alert policymakers in a way that persuades them to take proactive measures. Analyzing threats without actors and effectively communicating the danger to busy policymakers places a burden on analysts to come up with new ways to assess threats and alert policymakers and responders to the implications of prospective dangers.
Lessons from China’s early decisions: The next essay explains the challenges Chinese officials faced in discerning the severity of the outbreak and then communicating to international authorities and other nations what they discovered and what the implications might be. Their response to the outbreak that led to COVID-19 was adversely influenced by internal Chinese bureaucratic government practices, regional political concerns, and, ultimately, national political concerns about the country’s reputation in the international community.
Reforming the World Health Organization: The WHO’s role and responsibilities are largely defined by its member states. When an outbreak occurs and appears to start in one country, tensions between national sovereignty, economic stability, security, and international responsibilities ultimately emerge. The essay on WHO reform describes how these challenges influence the operations of the WHO and presents various options that have been put forward to “reform” and “empower” the WHO in the wake of the current pandemic.
Conducting complex scientific research with dangerous biological materials: This type of research may be well intentioned to assess spillover potential, figure out the characteristics of future viruses, or aid in the development of vaccines and therapeutics to address them. But attempting to get ahead of nature runs the risk of creating something nature has not, and if it somehow escapes from the lab, the dangers greatly outweigh the benefits. Easy solutions involving greater regulatory measures may reduce potential benefits and achieve limited practical restraint. Even if new regulations are designed to reduce risks, policymakers and public health officials should advocate training and education on lab leadership, mentorship, and research ethics.
Prioritizing biosafety and biosecurity: Concern about laboratory safety practices as a possible cause of the COVID-19 outbreak in China and the proliferation of high containment laboratories raise questions about future research with dangerous pathogens. Not all countries have the skills, experience, or regulatory structure to ensure safe and secure operations of laboratories to handle dangerous pathogens. More labs may result in more lab accidents. The biotechnology revolution offers great promise but also has inherent risks that need to be managed effectively.
Ensuring access to medical supplies: The COVID-19 pandemic exposed flaws in the stockpiling of medical supplies essential for responding to a pandemic, as well as national supply chain vulnerabilities affecting these materials. With a host of vulnerabilities exposed, the challenge U.S. policymakers confront is how to hedge against uncertain health risks at a reasonable cost and how to manage the supply chain risks for those supplies that are not cost effectively made in America.
American public support for vaccine globalism: A RAND survey of American public opinion about the U.S. sharing of vaccines with other countries revealed that the American public supported vaccine sharing, in part because it was persuaded that the pandemic would endure longer in the U.S. homeland if it were not contained abroad as well. These findings suggest that policymakers and public health officials may have more opportunity for alignment in public health attitudes and practice than previously perceived.
In the final chapter, the researchers highlight key findings from the preceding chapters and briefly outline three additional areas that warrant examination.
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