The U.S. Government Was Not Adequately Prepared for Coronavirus at Home or Abroad.

AuthorKolker, Jimmy

While the Coronavirus outbreak and pandemic found nearly all countries unprepared, U.S. lapses in addressing major documented flaws in our preparedness contributed to breakdowns of international collaboration and solidarity as well as institutional conflicts and stress on our health system at home.

The Ebola Legacy

Much of the current U.S. Government structure to deal with global outbreaks and epidemics was reviewed and developed based on the strengths and weaknesses of how we dealt with Ebola 2014-15. Thus, it is worth starting with the lessons of that experience.

The initial response of the global community, especially the World Health Organization, to the West Africa Ebola epidemic was late, ineffective and uncoordinated. U.S. leadership in bringing attention to the scope of the problem and mobilizing international response to Liberia, Guinea and Sierra Leone was indispensable. Field trials of U.S.-developed and other candidate vaccines and therapies were begun, but after the epidemic passed its peak and were not coordinated.

Likewise, the United States scaled up domestic preparedness, but hospital and health system readiness was never tested, as only three individuals whose infections were not first identified abroad presented for treatment in the U.S. Internal debate about Ebola policies never became highly partisan, nor was there a shortage of protective gear, diagnostics or hospital supplies.

In West Africa, the U.S. Agency for International Development foreign disaster assistance structure, along with surge capacity from the U.S. Centers for Disease Control and Prevention and the U.S. Public Health Service, ultimately rose to meet Liberia's needs for Ebola treatment centers. The U.S. military provided timely but limited logistical support.

Although Blue Ribbon commissions set up to review the Ebola response and suggest measures for improvement found serious gaps, they unanimously concluded that there was no multilateral alternative to the World Health Organization in outbreak-led emergencies. (https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002042) Existing instruments already in place, such as the International Health Regulations (https://www.who.int/ihr/publications/9789241580496/en/) and the U.S.-initiated Global Health Security Agenda (https://ghsagenda.org/), should remain the foundation for an improved global response capacity.

With domestic systems not tested or found wanting, while the WHO implemented many of the recommended reforms and U.S. international engagement was judged largely positive, the Ebola experience did not engender major review or reinforcement of U.S. structures or level of effort. Emergency funds appropriated for the Ebola emergency ran out without being re-appropriated. We were left with a complacency that capacity would be sufficient to deal with an outbreak or epidemic.

Relations with China

The Severe Acute Respiratory Syndrome (SARS) outbreak that originated in the People's Republic of China in 2003 revealed numerous lapses in both the Chinese ability to respond to and share information about the novel disease and the norms for international collaboration in the event of such an epidemic.

The Chinese government tried to address these shortcomings, notably by establishing a Chinese Center for Disease Control and Prevention (http://www.chinacdc.cn/en/), consciously modeled on the U.S. CDC. American CDC personnel assigned to China had their office within the Chinese CDC; in 2013, when Chinese epidemiologists identified a potentially severe outbreak of H7N9 avian influenza, CDC surged 40 additional staff to China to bolster Chinese surveillance and detection activities. U.S. and Chinese disease response teams worked together in Liberia during the 2014-15 Ebola outbreak. And the two nations collaborated with the African Union, as the leading foreign partners for the African CDC, (https://africacdc.org/about-us/) which was established in 2016.

The Trump Administration, however, called into question Chinese intentions and the value to the U.S. of health collaboration. The U.S. Department of Health and Human Services, which has personnel from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) as well as CDC based in China, was told to reduce...

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