What we found, overall, was that the world has changed in ways that make it far harder to contain disease—and some of the mistakes that fuel its spread have already happened in the current real-world outbreak. There is still time, though, to think more carefully about how to respond both to this outbreak and likely future ones.
We chose a new strain of coronavirus for our scenario because scientists agreed that this was a likely pathogen for a future epidemic; recent outbreaks such as SARS and MERS were also caused by the coronavirus family. The future we described was based on the research of deep subject matter experts who have studied recent epidemics, including our colleagues in the Center for Strategic and International Studies Global Health Security program and researchers with the Johns Hopkins Center for Health Security.
The parallels between our exercise and today’s real outbreak aren’t exact. We assumed a research laboratory-created virus first released in Europe (by accident or intentionally—we left it deliberately unclear); the real-world SARS-CoV-2 virus likely originated in wild animals sold at a meat market and was first detected in Wuhan, China. But other aspects are extremely similar: In our scenario, the virus was highly transmissible and had a 3.125 percent lethality rate. So far, the true rate of the new virus is unknown, but according to the World Health Organization about 3.4 percent of reported COVID-19 cases have died.
So what happened, as our exercise unfolded—and what do Americans need to know about what might happen next?
The coronavirus in our scenario spread much as today’s virus does, jumping between countries via international air travel, causing problems not only for their health systems, but for economies and political leaders.
The fictional outbreak rapidly spread from its primary case at Berlin Tegel Airport to a range of connecting international destinations. An infected individual first transmitted the virus as he transited the airport, then proceeded to John F. Kennedy International Airport in New York, traveling to several additional destinations in the New York area, where he continued to transmit the virus. In the three months since its first human-to-human transmission at Tegel Airport, our virus spread rapidly across Europe, North America, Northeast Asia and the Middle East.
Our scenario assumed governments would first turn to short-term measures to try to slow the spread, such as travel bans and border closures. These bans, we found, did little to slow the spread of the virus: By the time those decisions got made, it had already started to spread through international air corridors and further human-to-human transmission. Like the real-world COVID-19 we are battling now, our hypothetical disease was transmissible before carriers show serious symptoms, so authorities—as now—found themselves playing catch-up.
Our experts also projected that travel bans could have the unintended effect of worsening international cooperation and disrupting trade. They noted that travel bans are easy to enact, but difficult to repeal, creating lasting friction in the movement of people that is central to the U.S. services-led economy. In our scenario, we assumed that economic activity had slowed substantially, due to the direct effects on worker health and government efforts to prevent further spread of the virus. If anything, the real-world disruption has sometimes exceeded our expectations, especially in the case of the extraordinary quarantine measures imposed in China. In the U.S., we assumed that life as normal would be on pause, as individuals focused on their personal health and that of their families.
We also assumed that nations would begin turning to fiscal and monetary stimulus to calm markets and prop up growth—a response we’re already seeing in the real world, such as the extraordinary decision on March 3 by the Federal Reserve Bank to cut its benchmark interest rate by a half percentage point.
Our workshop presented experts with a world coming to terms with a pandemic three months after the initial outbreak. During that time, governments, bio-research communities and drug manufacturers had raced to develop treatments and a vaccine for this novel coronavirus, much as they are today. But, given the long lead time for research and then human subject testing, it would still take more than a year to come forward—exactly the amount of time U.S. health officials are now forecasting a vaccine for SARS-CoV-2 is likely to take.
We ended up with a handful of clear insights that we should heed in our current crisis, and to get ahead of the next one.
• One of our exercise’s most important insights is that early and preventative actions are critical. Establishing trust and cooperation domestically and internationally among governments, companies, workers and citizens is important before crisis strikes. There has been some progress on this in recent years: After the last crisis of the 2014-16 Ebola response, a range of investments were made and initiatives undertaken in the United States, within the World Health Organization, and elsewhere. In an era in which Congress seems unable to agree on anything, global health security has been a bright spot for bipartisanship—including $50 million allocated to the CDC Infectious Diseases Rapid Response Reserve Fund, the passage of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act, and the continuation of the Global Health Security Agenda. It’s not enough according to public health experts, but it is a start.
• We also concluded that communication is vital—but a decline in trust makes it harder. Dramatic shifts in the world also raised new alarm bells for health security in our exercise. The first of these is the need for consistent messaging and trusted sources of information. A critical ingredient for addressing pandemics is public order and obedience to protocols, rationing, and other measures that might be needed. Today, public trust in institutions and leaders is fragile, with routine evidence of intentional disinformation by foreign actors and elected officials alike.
Misstatements about science are particularly damaging to the credibility of scientists and health officials seeking to guide policy. One need look no further than the anti-vaccination movement to see how disinformation can effectively impair public health goals. And the broad-scale use by state and nonstate actors alike of online disinformation to diminish public confidence in governments and institutions is especially dangerous in an already fragile crisis environment. Amid the hyperpartisanship of the current U.S. political environment in a presidential election year, coronavirus is a dangerously political issue.
• International cooperation is also key. A virus knows no borders, as we have already seen with the real-world outbreak, and here a concerning change is heightened mistrust among countries. In the midst of trade tensions, increased meddling by one country in the internal politics of another and growing military tensions in hot spots around the globe, organizations such as the World Health Organization are increasingly caught in the middle, unable to play their intended neutral function. States compete with one another rather than cooperate, ignoring the inherently transnational nature of the threat as they try to minimize the downsides to their own populations, economies and ruling party. In our scenario, these international tensions inhibited information sharing, much as we initially saw from China with COVID-19. (Our scenario had an additional complication: Because it wasn’t clear who exactly was behind the disease outbreak, and whether it was accidental or intentional, the global environment was even more charged.)
• Our exercise also underscored that the private sector will be vital to managing the outbreak. There’s a good reason the president gathered pharmaceutical executives on Monday. The U.S. federal government is rightly at the center of the response to this likely pandemic, but it is the private sector that holds the bulk of the technological innovation to producing treatments and cures. One bit of good news on this front: There is already in place a highly effective public-private partnership structure in the Coalition for Epidemic Preparedness Innovations, which is making important contributions in the current race for a vaccine.
The principal conclusion of our scenario was that leaders simply don’t take health seriously enough as a U.S. national security issue. Congress holds few hearings on the topic, especially in the defense committees, and the White House last year eliminated a top National Security Council position focused on the issue.
There’s also weakness at the global level: Though there are bodies dedicated to global coordination, especially the WHO, countries prioritize domestic considerations in times of crisis, and international coordination and collaboration become an afterthought. Even within the European Union, countries make their own independent decisions in responding to an epidemic. We already see rising frictions from border closures and travel bans to export restrictions related to medicine.
Ours was not the first pandemic scenario to raise serious questions about the strength of the global health system. The Johns Hopkins Center for Health Security has developed a particularly outstanding pandemic exercise, Clade X, a full video of which is available online.
These warnings have not been taken seriously enough. Overall, the U.S. government’s approach continues to suffer from a “cycle of crisis and complacency,” as the CSIS Commission on Strengthening America’s Health Security recently reported—meaning that leaders scramble to react to a headline epidemic, and then their attention drifts, hurting their ability to prevent the next one. Managing from crisis to crisis carries a staggering cost in lives and dollars.
In the real crisis unfolding now, tens if not hundreds of billions of dollars will be spent—but little of that money will address underlying issues that will set in when the complacency strikes again. Overall economic costs to the global economy will range in the trillions. It’s in America’s interest to spend money on greater pandemic preparedness, not just in the U.S., but globally.
The fact that the real-world outbreak happened in China may actually have been lucky: China is the world’s second-largest economy, with a relatively advanced scientific base and uniquely top-down system of governance that gives it unusual ability to control and monitor its enormous population. Despite significant missteps at the outset, China has come to deal aggressively with this outbreak. The next pandemic is far likelier to emerge from a country or region that is poor, weakly governed and with weak public health infrastructure.
The coronavirus scenario we crafted was one of three designed to investigate the vital but rapidly changing role for government at the intersection of security and emerging technology. The other two focused on Chinese military employment of artificial intelligence and a major state cyberattack and large-scale disinformation campaign aimed at the United States. Across all the threat streams we examined, early detection, public and international trust and information sharing, and harnessing innovation in the private sector were vital to effective risk reduction. Policy, health and our very survival are within our control. Scenarios and foresight work can be powerful tools to imagine a possible future. But we must do better. We must make policy that prevents and, where needed, prepares for those futures we do not want.
Source: politico.com
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