Preparing for the next pandemic

The tide may be slowly going out on COVID-19 but its lasting legacy may well be defined by whether our society can recognize the lessons learned in how to respond to a worldwide health care crisis before the next pandemic.

Regrettably, America has historically demonstrated that it has no institutional memory. Consider: Before World War II, the Navy war-gamed an attack on Pearl Harbor, yet was unable to defend the base during the actual attack. Repeated hurricanes over generations have devastated Long Island, but superstorm Sandy was a shock to many. Disease pathogens like SARS and H1N1 have emerged at an alarming pace, but we were stunned into disbelief that our nation would face a 21st-century pandemic.

And yet the warnings have always been there.

In the 1990s, consensus emerged among the global health community that the threat of deadly infectious diseases was increasing. Accelerated globalization increases the interaction between humans and animals, which facilitates the rapid spread of these zoonotic diseases. The outbreak of the SARS virus in 2003 exposed the difficulty of identifying and responding to an emerging and novel disease. In an attempt to create better global surveillance and response, in 2005, the World Health Organization created a program designed to "prevent, protect against, control and provide a public health response to the international spread of disease."

Identifying a disease is not enough, especially if the disease was previously unknown, like COVID. Quickly understanding how a disease spreads, what the successful treatment protocols are, and the assets needed to mitigate worldwide impacts is incredibly difficult even for wealthy and technologically sophisticated countries. The challenge with the pre-positioning of assets is that the responding nation does not know what disease or treatment protocols will be required.

Following the 2001 anthrax attacks, the U.S. created Project Bioshield, which authorized $5 billion for the purchase of medical countermeasures to be used in the event of a weapon of mass destruction attack. In addition, there exists a Strategic National Stockpile, which is designed to resupply states with essential medical material in the event of a health emergency. New York State has a Medical Emergency Response Cache, which provides support for local governments as well.

Although this system is focused on responding to a terrorist event and not a pandemic, there is obvious utility here for a pandemic. These programs were designed for the short term and presumed a far stronger supply chain. They failed to imagine the possibility of a multiyear event that would engulf the world.

So where do we go from here? Let’s build on what we already have, but do it for the long term. Following the Sept. 11 attacks, states created homeland security programs designed to integrate security, emergency preparedness and response, and public health. Billions of dollars were spent to train, equip and plan for an "all hazards event." Many of those assets and plans exist today, but they lack sufficient personnel. After 21 years, most of the leadership and institutional memory has retired. We need to refocus and recreate these programs.

We should also recognize that we can do great things when we need to. Consider that within months of the pandemic hitting New York, we created testing sites and programs for millions of New Yorkers. We also distributed millions of vaccines that were developed in a timeline that would have never been imagined 12 months ago. Lastly, we developed a surge capacity for hospitals that relies on mutual aid and surveillance.

We also need to think of the unthinkable because in this post-COVID paradigm, we learned that what we never thought would happen, can and will. Nor can we allow ourselves to believe that the next pandemic will either be the same type of disease or that it will be far off in the future. Under a nightmare scenario, instead of an airborne virus, it could involve the compromise and degradation of our food supplies. The Department of Defense, the Centers for Disease Control and Prevention and the White House have already considered this and many other disturbing scenarios. The challenge is to get preparation buy-in from the nation as a whole at a time when we can’t agree on masks and vaccines.

One of the reasons we have not prepared for future emergencies the way we should is because of the cost. But consider this: The World Economic Forum estimates that $11 trillion has been spent worldwide on COVID response.

And then there is the issue of our collective mental health. Millions of Americans may take months or years to feel safe going outside again. In nursing homes and assisted living facilities across the country, the use of psychotropic drugs has skyrocketed as more and more residents have succumbed to depression and paranoia.

For all of us around the world, COVID-19 has been an intensely personal and life-altering event. That searing experience should serve as a warning, and motivate us to develop the strategies, resources and fortitude to prepare for the next pandemic. Otherwise, we will pay perhaps an even more terrible cost the next time the world experiences such a crisis.

Michael Balboni is a former New York State senator and deputy secretary for public safety.