We could dodge this bullet, but we need to be prepared for the next one.
I’m worried about the new coronavirus that has broken out in China and spread, albeit as of now in isolated cases, to other countries. Fortunately, the CDC has assessed that the risk of a major outbreak in the United States is low.
I hope the risk is indeed low, because the stakes are very high, particularly now that human-to-human transmission has been confirmed.
I was heavily involved in this issue from 2007 to 2012. During that time, I co-chaired, with former senator Bob Graham of Florida, two congressional commissions on the danger of bio-weapons and the best means of combating or responding to them. The commissions produced reports, recommendations, and a report card on the government’s preparedness for a bio-attack.
Senator Graham and I also co-founded the WMD Terrorism Research Center, a not-for-profit organization. The purpose was to conduct a comprehensive, end-to-end assessment of America’s ability to detect, diagnose, and respond to a large-scale biological event, either man-made or naturally occurring. We wanted to know how resilient the American health-care system would be if the balloon went up on a pandemic.
It was a groundbreaking effort. To that point, no one had ever defined the different links in the chain of resilience, much less conducted a national assessment of their strength. Of course Senator Graham and I did not have the technical expertise to manage such an undertaking, so the assessment was led by our CEO, Randy Larsen, our president, Lynne Kidder, and dozens of public-health experts who developed the methodology, identified the categories of response, defined metrics for performance, and conducted the actual assessment. Larsen and Kidder describe what the process entailed here.
We released our assessment in October of 2011. The report is over eight years old now, but to my knowledge, it is still the only effort of its kind, and its framework for assessment is still the leader in the field.
It’s been apparent for years that a global biological pandemic is the biggest single threat, other than a strategic nuclear war, to the health and economy of the United States. The pandemic could occur naturally, or it could be the product of a terrorist attack or even a laboratory accident. One of the worst-case scenarios involves a virus that is contagious through the air, which has a potentially deadly effect, and for which no vaccine or therapeutic can quickly be developed.
Such viruses can be difficult to diagnose, and people can carry the disease and infect others for days before becoming symptomatic. Once such a virus spreads into a number of countries, it has the potential to kill millions, especially in densely populated areas in the Third World.
The potential economic impact of such a pandemic, even in countries that largely escape the disease, is enormous. We live in a very interconnected world. There is a cascading and highly negative effect on economies when for long periods of time people are unable to travel or gather in large groups for fear of becoming infected, or because of government health restrictions.
The Center for Health Security at Johns Hopkins periodically conducts tabletop exercises to educate policymakers and the public about the dangers of a pandemic. The latest exercise last October dealt with a virus that, in the space of 18 months, killed 65 million people, reduced global GDP by 11 percent, and caused stock markets around the world to lose 20 to 40 percent of their value.
As it happens, the hypothetical pathogen in the scenario was a coronavirus.
The CDC and its allied agencies in other countries have a lot of experience in dealing with potential pandemics. They were able to control both SARS and Ebola, and I have confidence in their assessment of the current threat. I’m not canceling any of my travel plans. But going forward, if our government wants to increase the health and economic security of its citizens, it will focus like a laser on improving our ability to develop and manufacture new vaccines and therapeutics in response to new pathogens.
At some point the public-health authorities are going to lose control of a disease. When that happens, we need to be able to “go from bug to drug” as quickly as possible; a public-health system without medical countermeasures is like an army without bullets. The next most important priorities are swift diagnostic techniques — we have to know who has been infected as quickly as possible — and much greater surge capability within the health-care system to care for the sick.
When a new contagion appears, events move swiftly, and the situation is always fluid. I consider it a good sign that the Chinese are imposing quarantines in a number of cities and public places. They are trying to get ahead of the disease, and at this point international public-health authorities think they will succeed even without an effective vaccine. I hope they are right; but if we dodge this bullet, every effort should be made to be better prepared for the next one.