It’s a familiar litany by now: As Covid-19 spread, ravaged lives, and upended the global economy over the last two months, President Donald Trump first downplayed the virus—assuring Americans that it was going to go away—then chalked it all up as a complete surprise. On January 22, at the World Economic Forum in Davos, it was all business as usual. He promised CNBC’s Joe Kernan there were no worries about a pandemic: “We have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.”
A month later, Trump’s message was the same. “It’s going to disappear,” Trump said of the coronavirus on February 27. “One day—it’s like a miracle—it will disappear.” Then, as it became clear the virus wasn’t going away, Trump has instead tried to avoid blame, arguing that the novel coronavirus pandemic is a Black Swan, an unimaginable, surprise, out-of-left-field event. “This was unexpected,” he said on March 10. “It hit the world.” On March 16, Trump said, “This came up—it came up so suddenly. Look, he was surprised; we were all surprised.” And on March 24, he told a Fox News town hall, “Nobody ever expected a thing like this.”
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Except it was expected. Over the last quarter century, warnings have been clear and consistent from both US government leaders, scientists, and global health officials: A pandemic was coming—and whenever it arrived, it would be catastrophic to the global economy. In recent years red alerts have come almost monthly—sometimes weekly—and all three of Trump’s predecessors have dedicated significant personal time and public attention to the pandemic threat.
The most recent warning, a bipartisan report by the Center for Strategic and International Studies, co-chaired by former New Hampshire Senator Kelly Ayotte, a Republican, and Julie Gerberding, George W. Bush’s one-time director for the Centers for Disease Control and Prevention, was published on November 18, 2019—one day after we now know the first case of the novel coronavirus that would be later named SARS-CoV-2 appeared in China’s Hubei Province. That report’s No. 1 recommendation was to undo the Trump administration’s cuts to pandemic planning: “Restore health security leadership at the White House National Security Council.”
A careful review of past reports, books, planning documents, Congressional hearings, op-eds, speeches, and public testimonies make clear that all the problems of the current Covid-19 crisis were foreseen over the last 15 years, as officials and leaders like Bill Gates warned in increasingly dire terms about the government’s lack of sufficient preparation.
As early as 2005, President Bush said, “Our country has been given fair warning of this danger to our homeland.” Eight years ago, a report by the US Department of Health and Human Services cited the need to develop “social distancing” models to inform how we combat the spread of a pandemic; it also pointed to potentially dangerous shortfalls in ventilator stockpiles and noted that there were local shortages of masks during the H1N1 pandemic, though these were filled by the national stockpile equipment. Repeated public warnings came even from those on the frontline of today’s response, including Health and Human Services Secretary Alex Azar and Anthony Fauci, the longtime head of the National Institute of Allergy and Infectious Diseases.
Despite substantial progress during the Obama administration—which grappled with the H1N1 scare and the 2014 Ebola outbreak and which was so concerned about the threat of a pandemic that it even highlighted the threat in a tabletop exercise with incoming officials during the transition—the Trump administration let pandemic planning efforts lapse.
That trend, too, was clear early. As early as seven weeks into the Trump administration, a group of Democratic lawmakers, including Massachusets Senator Elizabeth Warren, were raising concerns that the Trump administration was undermining pandemic preparedness efforts. As she and four other members of Congress wrote to then-Health and Human Services Secretary Tom Price, “Actions taken by President Trump could also impair our readiness in the face of a public health crisis, such as a flu pandemic.”
The truth is, it isn’t just the Trump administration that failed to sufficiently heed the tsunami of warnings. Leaders in state and local government, industry, and multinational institutions—all of whom share the responsibility to be prepared—were equally on notice that a pandemic was coming. But in the United States, we look to the federal government to lead the efforts on problems too big and too complex for any one jurisdiction or company.
The following oral history of public pandemic warnings has been compiled from government and other official reports, medical journals, videos, books, op-eds, Congressional hearings, news articles, statements, and other public records. None of the following quotations are backward-looking “I told you so’s”; all are contemporaneous, forward-looking warnings and predictions. None was classified; all but one was publicly released and available for all to read. The one document not released to the public: A National Security Council pandemic playbook reportedly written by the Obama administration in 2016 and passed off to the Trump administration in 2017.
Editor’s Note: If you’d like to read previous installments of our Covid Spring series, Chapter 1 dealt with patients and those on the front lines of the response across the country. Chapter 2 featured the voices of eight Americans who have watched what would normally be some of the biggest and most quintessentially human moments in their lives—births, weddings, loved ones’ deaths—remade and altered forever by the virus’s shadow. Chapter 3 featured the voices of New Yorkers at the center of America’s Covid-19 epidemic. Last week’s Chapter 4 featured Jewish and Christian faith leaders about Passover and Easter in a time of anxiety and quarantine. Also, for ease of reading, certain acronyms in the quotations below have been written out.
I. The Clinton Era
Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance, October 1, 1994: Many aspects of history are unanticipated and unforeseen, predictable only in retrospect: the fall of the Berlin Wall is a single recent example. Yet in one vital area, the emergence and spread of new infectious diseases, we can already predict the future—and it is threatening and dangerous to us all.
White House Press Release, June 12, 1996: Calling emerging infectious diseases a growing global health threat, Vice President Gore today announced President Clinton’s new policy to establish a worldwide infectious disease surveillance and response system and expand certain federal agency mandates to better protect American citizens. “Emerging infectious diseases present one of the most significant health and security challenges facing the global community,” Vice President Gore said during remarks to the annual meeting of the National Council for International Health in Crystal City, Virginia. “Through President Clinton’s leadership, we now have the first national policy to deal with this serious international problem.”
II.The Bush Era
Gardiner Harris, “From Washington, a Story About a Killer Flu,” The New York Times, October 16, 2005: This week, the Bush administration is expected to release its pandemic flu plan, which could generate its own movie epic. The New York Times obtained a draft of the plan, dated September 30. No one would confuse the 381-page document with a screenplay, but pages 45 through 47, the section titled “Pandemic Scenario—Origin and Initial Spread,” are gripping. They describe a flu epidemic moving from a village in Asia to the United States, where it causes panic and as many as 1.9 million deaths.
Excerpt, “Pandemic Scenario—Origin and Initial Spread,” White House planning scenario: During the peak of disease activity in the community, police, fire and transportation services are limited by personnel shortages, and absenteeism at utility companies leads to spot power outages. Supplies of food, fuel, and medical supplies are disrupted as truck drivers become ill or stay home from work. In some areas, grocery store shelves are empty and social unrest occurs. Long lines form where food and gasoline are available. Elderly patients with chronic, unstable medical conditions hesitate to leave their homes for fear of becoming seriously ill with influenza. Riots occur at some vaccination clinics as people are turned away or supplies run out. Several trucks transporting vaccine are hijacked, and a gray market develops for vaccine and antiviral drugs—many of which are counterfeit…Family members are distraught and outraged when loved ones die within a matter of a few days. Public anxiety heightens mistrust of government, diminishing compliance with public health advisories. “Worried well” seek medical care despite their absence of influenza illness, further burdening the health care system. Mortuaries and funeral homes are overwhelmed.
President George W. Bush, National Strategy for Pandemic Influenza, November 1, 2005: Once again, nature has presented us with a daunting challenge: the possibility of an influenza pandemic. Most of us are accustomed to seasonal influenza, or “the flu,” a viral infection that continues to be a significant public health challenge. From time to time, changes in the influenza virus result in a new strain to which people have never been exposed….Although the timing cannot be predicted, history and science suggest that we will face one or more pandemics in this century.
The next pandemic is likely to come in waves, each lasting months, and pass through communities of all size across the nation and world. While a pandemic will not damage power lines, banks or computer networks, it will ultimately threaten all critical infrastructure by removing essential personnel from the workplace for weeks or months.
Michael O. Leavitt, Secretary of Health and Human Services, “HHS Pandemic Influenza Plan,” November 2005: One of the most important public health issues our Nation and the world faces is the threat of a global disease outbreak called a pandemic. No one in the world today is fully prepared for a pandemic—but we are better prepared today than we were yesterday—and we will be better prepared tomorrow than we are today…. History teaches us that everything we do today to prepare for that eventuality will have many lasting benefits for the future. We will realize important advances in health care, and we will be better prepared for other types of emergencies. I am humbled by the enormity of the challenge that the global community confronts should there be a pandemic. Public cooperation and global partnerships will be essential tools in fighting back and creating a constant state of readiness. If together we take the steps necessary, we will be able to save the lives of millions of people in our country and all around the world.
Excerpt, Congressional Budget Office, “A Potential Influenza Pandemic: Possible Macroeconomic Effects and Policy Issues,” December 8, 2005, revised July 27, 2006: During a severe pandemic, hospitals, clinics, and doctors’ offices would probably be overwhelmed, and surveillance (keeping track of where the disease was and where it was going) would be difficult. Health care workers would be exposed to the disease, resulting in further strains on the health care system’s capacity, as some workers became sick and others stayed home to care for family members or to avoid becoming ill. Care for non-acute health problems would be sharply curtailed.
As the pandemic progressed, international travel would dramatically decline, as people avoided avian flu “hotspots” and governments restricted travel. It seems unlikely that domestic and international air travel would cease completely, but as a point of reference, at the peak of the SARS outbreak in April 2003, airline passenger arrivals in Hong Kong had declined by nearly two-thirds relative to their levels in March. In all likelihood, people would quarantine themselves and their families by staying at home more. Nonessential activities that required social contact would be sharply cut, which would lead to significant declines in retail trade. People would avoid public places, such as shopping malls, community centers, places of worship, and public transit. Attendance at theaters, sporting events, museums, and restaurants would decline. It seems likely that many schools would close, and even if they did not, attendance would fall dramatically as parents kept their children at home. In either event, large-scale school closings would lead to a spike in workplace absences because parents would stay home to care for their children even if they were not sick.
Homeland Security Council, National Strategy for Pandemic Influenza Implementation Plan, May 2006: History suggests … another novel influenza virus will emerge at some point in the future and threaten an unprotected human population. The economic and societal disruption of an influenza pandemic could be significant. Absenteeism across multiple sectors related to personal illness, illness in family members, fear of contagion, or public health measures to limit contact with others could threaten the functioning of critical infrastructure, the movement of goods and services, and operation of institutions such as schools and universities. A pandemic would thus have significant implications for the economy, national security, and the basic functioning of society.
Unlike geographically and temporally bounded disasters, a pandemic will spread across the globe over the course of months or over a year, possibly in waves, and will affect communities of all sizes and compositions. In terms of its scope, the impact of a severe pandemic may be more comparable to that of war or a widespread economic crisis than a hurricane, earthquake, or act of terrorism. … Preparedness for a pandemic requires the establishment of infrastructure and capacity, a process that can take years.
Michael O. Leavitt, Secretary of Health and Human Services, Pandemic Planning Update II, November 13, 2006: A year ago, few Americans had heard of avian flu. Today, awareness is high. There has been a deluge of news reports, and we’ve had not one, but two made-for-TV bird flu movies. This past year, a nearly forgotten word, pandemic, re-entered our vocabulary. And then the media moved on. There is a danger that as avian flu slips from the headlines, people will believe the threat is no longer real.
Michael O. Leavitt, Pandemic Planning Update VI, January 8, 2009: The history of pandemics is not so much the history of health as it is the history of humanity. When pandemics strike, they cause massive sickness and terrible loss of life. They even reshape nations… Today, many people mistakenly think influenza pandemics are a thing of the past, but influenza has struck hard in the era of modern medicine—much harder than most people realize. And it will strike again. Pandemics are hard things to talk about. When one discusses them in advance, it sounds alarmist. After a pandemic starts, no matter how much preparation has been done, it will be inadequate.…. I believe we can prepare successfully for a pandemic. But it will require determination. It will require change.
III. The Obama Era
Dennis C. Blair, director of national intelligence, Annual Threat Assessment of the Intelligence Community, February 12, 2009: The most pressing transnational health challenge for the United States is still the potential for emergence of a severe pandemic, with the primary candidate being a highly lethal influenza virus. The World Bank estimates that if the next pandemic virus is similar to the one that caused the 1918 pandemic, it could kill 71 million people worldwide and cause a major global recession with global costs exceeding $3 trillion.
Dennis C. Blair, director of national intelligence, Annual Threat Assessment of the US Intelligence Community, February 2, 2010: The current influenza pandemic is the most visible reminder that health issues can suddenly emerge from anywhere in the globe and threaten American lives and US strategic objectives. It also highlights many of the United States’ critical dependencies and vulnerabilities in the health arena. But like an iceberg, the visible portion is just a small fraction of the myriad of health issues that will likely challenge the United States in the coming years. Significant gaps remain in disease surveillance and reporting that undermine our ability to confront disease outbreaks overseas or identify contaminated products before they threaten Americans.
Kathleen Sebelius, Secretary of Health and Human Services, 2009 H1N1 Influenza Improvement Plan, May 29, 2012: In the approximately three years since the start of the 2009 H1N1 influenza pandemic, the U.S. Department of Health and Human Services has continued our efforts to improve the nation’s readiness for a future influenza pandemic. It is essential that these efforts continue since influenza viruses with pandemic potential continue to spread widely in animals and sporadically infect humans, and the place and time of the next pandemic cannot be anticipated. Prior pandemic preparedness efforts and investments provided the groundwork for the 2009 H1N1 response; now those preparedness strategies and plans need to be adjusted to incorporate real world experiences and recent technological advances.
Executive Summary, 2009 H1N1 Influenza Improvement Plan, HHS, 2012: The 2009 H1N1 pandemic arose against a backdrop of five years of pandemic planning efforts—including efforts on the part of the United States and the international community as a whole—to develop, refine, and regularly exercise pandemic plans at national, state, and local levels, and to engage the private sector and nonprofit partners….A severe influenza pandemic can affect society well beyond just the health and medical sectors. Potentially high rates of illness (25 – 30 percent of the US population) and death could affect critical infrastructure, private-sector activities, educational institutions, and the movement of goods and services across the nation and the globe—resulting in significant economic and security consequences. Workplace absences due to high rates of illness and death among not only those who are sick, but also among caretakers of the ill, could have a significant impact on employers and the economy. The Congressional Budget Office has estimated that the immediate disruptions from a severe pandemic could cause a 4.25 percent reduction in the nation’s Gross Domestic Product.
Summary of Key Priorities, 2009 H1N1 Influenza Improvement Plan, HHS, 2012: Enhance understanding of the benefits and societal costs of social distancing measures…. Promote the development of healthcare coalitions and other collaborative regional planning entities at the sub-state/regional levels, and integrated medical care surge plans … Reassess the quantity and composition of ventilators that should be stockpiled by various levels of government and other partners for pandemic influenza and other threats … Reassess strategies for distributing ventilators in the Strategic National Stockpile to the states, to help ensure federal assets will be used equitably across the US.
Excerpt, 2009 H1N1 Influenza Improvement Plan: Mechanical ventilators serve an essential role in managing respiratory failure from severe respiratory illnesses, including influenza…. Respiratory failure requiring mechanical ventilation is also characteristic of many other diseases and conditions that could manifest in a mass casualty event. As such, the HHS maintains ventilators in the strategic national stockpile for a future pandemic or other public health emergency to augment state and local needs….. Results of a survey conducted in the summer of 2009 showed great geographic variation in the nation’s population-adjusted ventilator supply and revealed that the nation’s supply is higher per capita than any other developed country, albeit significantly lower than the current estimated need during a severe pandemic… If a large proportion of the US population were to become severely ill during a pandemic and required mechanical ventilation, the health care system would quickly become overwhelmed.
James R. Clapper, director of national intelligence, Worldwide Threat Assessment of the US Intelligence Community, March 12, 2013: An easily transmissible, novel respiratory pathogen that kills or incapacitates more than 1 percent of its victims is among the most disruptive events possible. Such an outbreak would result in a global pandemic that causes suffering and death in every corner of the world, probably in fewer than six months. This is not a hypothetical threat.
Harvey V. Fineberg, “Pandemic Preparedness and Response—Lessons from the H1N1 Influenza of 2009,” New England Journal of Medicine, April 3, 2014, updated December 22, 2014: Influenza outbreaks and pandemics will continue to challenge policymakers and public health leaders to make decisions under conditions of stress and uncertainty….Perhaps because only three or four influenza pandemics tend to occur each century, at least in recent centuries, the annals of influenza are filled with overly confident predictions based on insufficient evidence.
Lawrence Summers, “The world can’t hide from pandemics,” The Washington Post, November 9, 2014: The lack of investment in public health is a global emergency. The WHO’s slow response to Ebola was not surprising, given its recent staff cuts. For that, we all share the blame. Since 1994, the WHO’s regular budget has declined steadily in real terms. Even before the Ebola crisis, it struggled to fund basic functions. Its entire budget for influenza was just $7.7 million in 2013—less than a third of what New York City alone devotes to preparing for public health emergencies. It takes just one infected airline passenger to introduce an infection into a country. We need the WHO more than ever. It alone has the mandate and legitimacy to serve as a health protection agency for all countries, rich and poor. Starving it of funds is reckless.
President Barack Obama, Remarks to the National Institutes of Health,” December 2, 2014: We can’t say we’re lucky with Ebola because obviously it’s having a devastating effect in West Africa but it is not airborne in its transmission. There may and likely will come a time in which we have both an airborne disease that is deadly. And in order for us to deal with that effectively, we have to put in place an infrastructure—not just here at home, but globally—that allows us to see it quickly, isolate it quickly, respond to it quickly.
James R. Clapper, Worldwide Threat Assessment of the US Intelligence Community, February 26, 2015: Infectious diseases are among the foremost health security threats. A more crowded and interconnected world is increasing the opportunities for human and animal diseases to emerge and spread globally.… The world’s population remains vulnerable to infectious diseases because anticipating which pathogen might spread from animals to humans or if a human virus will take a more virulent form is nearly impossible. For example, if a highly pathogenic avian influenza virus like H7N9 were to become easily transmissible among humans, the outcome could be far more disruptive than the great influenza pandemic of 1918. It could lead to global economic losses, the unseating of governments, and disturbance of geopolitical alliances.
Bill Gates, Gates Foundation co-founder, “We’re not ready for the next epidemic,” blog post, March 18, 2015: The Ebola outbreak in West Africa is a tragedy—as I write this, more than 10,000 people have died. I’ve been getting regular updates on the case counts through the same system we use to track new cases of polio. Also, last month I was lucky enough to have an in-depth discussion with Tom Frieden and his team at the Centers for Disease Control and Prevention in Atlanta. What I’ve learned is very sobering. As awful as this epidemic has been, the next one could be much worse. The world is simply not prepared to deal with a disease—an especially virulent flu, for example—that infects large numbers of people very quickly.
Bill Gates, “The Next Outbreak? We’re not ready,” TED, March 2015: We need to get going, because time is not on our side. In fact, if there’s one positive thing that can come out of the Ebola epidemic, it’s that it can serve as an early warning, a wake-up call, to get ready. If we start now, we can be ready for the next epidemic.
Bill Gates, “How to Fight the Next Epidemic,” New York Times, March 18, 2015: I have not seen a rigorous projection for what a [adequate prevention] system like this would cost. But we know the cost of failing to act. According to the World Bank, a worldwide flu epidemic would reduce global wealth by $3 trillion, not to mention the immeasurable misery caused by millions of deaths. Preventing such a catastrophe is well worth the world’s time and attention.
Ronald Klain, Obama administration Ebola response coordinator, “Stopping the next pandemic today,” Washington Post, June 5, 2015: Our No. 1 lesson from the Ebola crisis: the need for substantial measures to keep us safe from the pandemic on the horizon, a catastrophic event that is inevitable if we don’t move quickly to prevent it….As scary as Ebola was, the world’s success in taming it may have given us a false sense of security. Ebola was, in many ways, a deceptively simple test of the world’s epidemic response system. Ebola is hard to transmit and easy to detect. The epidemic broke out in three relatively small countries that contained no mega-city and sent only a limited number of travelers out of the region. The next time, the world might face a far more dangerous threat. A pandemic flu could be spread easily and quickly, carried by individuals with no obvious symptoms. It could explode like a wildfire in a massive city and be carried overnight by thousands of travelers to the world’s major commerce centers.
James R. Clapper, Worldwide Threat Assessment of the US Intelligence Community, February 9, 2016: Infectious diseases and vulnerabilities in the global supply chain for medical countermeasures will continue to pose a danger to US national security in 2016. Land-use changes will increase animal-to-human interactions and globalization will raise the potential for rapid cross-regional spread of disease, while the international community remains ill-prepared to collectively coordinate and respond to disease threats. Influenza viruses, coronaviruses such as the one causing Middle Eastern Respiratory Syndrome, and hemorrhagic fever viruses such as Ebola are examples of infectious disease agents that are passed from animals to humans and can quickly pose regional or global threats.
Excerpt, Joint External Evaluation of International Health Regulations Core Capacities of the United States of America, World Health Organization, June 2016: While the USA is generally recognized as effective in delivering international support to global health security, maintaining a level of effectiveness over time to keep up with increasing emerging threats requires continuing political commitment and support. In addition, upholding its international roles and participating in relevant international networks that would contribute to the global public good will reduce public health threats globally and to the USA itself.
Ronald Klain, “Confronting the Pandemic Threat,” Democracy Journal, Spring 2016: The next president must act from day one to prepare for that threat: If she or he waits until grim-faced aides file into the oval office to explain that a pandemic is unfolding, it will be far too late to save countless people around the world, protect our interests abroad, and preserve lives here at home.
Excerpt, “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents,” White House National Security Council, 2016: A newly emerging infectious disease pathogen may represent a high-consequence threat to human health, which at first may be unknown. For instance, influenza poses a constant threat for emergence into an epidemic or pandemic.
IV. The Trump Era
Anthony Fauci, director, National Institute of Allergy and Infectious Diseases,“Pandemic Preparedness in the Next Administration,” Center for Global Health Science and Security at Georgetown University Medical Center, January 10, 2017: If there’s one message that I want to leave with you today, based on my experience, and you’ll see that in a moment, is that there is no question that there will be a challenge to the coming administration in the arena of infectious diseases—both chronic infectious diseases, in the sense of already-ongoing disease, and we have certainly a large burden of that, but also there will be a surprise outbreak….History, and the history of the last 32 years that I’ve been the director of NIAID, will tell the next administration that there’s no doubt in anyone’s mind that they will be faced with the challenges that their predecessors were faced with.
Tom Frieden, “Outgoing CDC chief talks about agency’s successes—and his greatest fear,” Washington Post, January 16, 2017: The biggest concern is always for an influenza pandemic.… Even in an average year, really causes a huge problem. And a pandemic really is the worst-case scenario. If you have something that spreads to a third of the population and can kill a significant proportion of those it affects, you have the makings of a major disaster.
Bill Gates, Munich Security Conference, February 17, 2017: The fact that a deadly global pandemic has not occurred in recent history shouldn’t be mistaken for evidence that a deadly pandemic will not occur in the future… Pandemics are everyone’s problem—and as leaders, we cannot ignore it. Imagine if I told you that somewhere in this world, there’s a weapon that exists—or that could emerge—capable of killing tens of thousands, or millions, of people, bringing economies to a standstill and throwing nations into chaos. You would say that we need to do everything possible to gather intelligence and develop effective countermeasures to reduce the threat.
Erna Solberg, prime minister, Norway, Munich Security Conference, February 18, 2017: We have forgotten how catastrophic those epidemics have been.
Jonathan Tirone, “Superbugs, Climate Chaos Have Bill Gates and the UN Worried,” Bloomberg, February 18, 2017: Microsoft co-founder Bill Gates joined the United Nations to warn world leaders about a new series of threats shaping up as megatrends, led by global warming, superbugs, and artificial intelligence. US Vice President Michael Pence and trans-Atlantic military officials were on the receiving end of the warnings issued by Gates, UN Secretary-General Antonio Guterres, and German Chancellor Angela Merkel. They all said that the world isn’t prepared to deal with the emerging risks.
Office of Elizabeth Warren, Press Release, March 13, 2017: Senators Elizabeth Warren (D-Mass.) and Patty Murray (D-Wash.), along with Representatives Frank Pallone, Jr. (D-N.J.), Gene Green (D-Texas), and Diana DeGette (D-Colo.), today wrote to Tom Price, Secretary of Health and Human Services, and the Acting Director of the Centers for Disease Control and Prevention to ask how several actions taken by the Trump administration could harm the CDC’s preparedness for a pandemic flu outbreak. ”The Department of Health and Human Services and the Centers for Disease Control and Prevention would lead the federal government response to a pandemic flu,” wrote the Members of Congress. “But alarmingly, President Trump has issued at least seven threats to ‘proven programs’ that the agency would rely on as part of an effective response to such a threat.”
Lena H. Sun, “The Trump administration is ill-prepared for a global pandemic,” Washington Post, April 8, 2017: The Trump administration has failed to fill crucial public health positions across the government, leaving the nation ill-prepared to face one of its greatest potential threats: a pandemic outbreak of a deadly infectious disease, according to experts in health and national security. No one knows where or when the next outbreak will occur, but health security experts say it is inevitable. Every president since Ronald Reagan has faced threats from infectious diseases, and the number of outbreaks is on the rise.
Excerpt, “Pandemic Influenza Risk Management Guidance,” World Health Organization, May 2017: Influenza pandemics are unpredictable but recurring events that can have consequences on human health and economic well-being worldwide. Advance planning and preparedness are critical to help mitigate the impact of a pandemic.
Ronald Klain, Aspen Ideas Festival, June, 29, 2017: Thus far in the 21st century, the world has avoided a catastrophic pandemic that could quickly take hundreds of thousands of lives. But is the world ready for such an event? Is the US? Sadly, the answer to both questions is “no.” … Next year, in 2018, we mark the 100th anniversary of the horrifically deadly Spanish Flu epidemic—a disease that claimed more American lives than World War I and World War II and Vietnam combined. This anniversary is a reminder that a threatening test of global health systems and international response capabilities is on the horizon, with potentially devastating consequences. The United States, and the world, needs to be ready.
Excerpt, Pandemic Influenza Plan, Centers for Disease Control and Prevention, 2017: Pandemic influenza is different from other outbreaks we have faced because the characteristics of influenza viruses–their propensity to change, the ability to spread easily among people, and the routes of transmission–make the disease challenging to contain.…We issue this 2017 Update to the HHS Pandemic Influenza Plan with the aim of highlighting and building upon the successes of the last decade, and making clear the additional efforts that are needed to improve pandemic preparedness.
Peter Sands, chair, International Working Group on Financing Preparedness, “From Panic and Neglect to Investing in Health Security: Financing Pandemic Preparedness at a National Level,” The World Bank, December 2017: Multiple pandemics, numerous outbreaks, thousands of lives lost and billions of dollars of national income wiped out—all since the turn of this century, in barely 17 years—and yet the world’s investments in pandemic preparedness and response remain woefully inadequate. We know by now that the world will see another pandemic in the not-too-distant future; that random mutations occur often enough in microbes that help them survive and adapt; that new pathogens will inevitably find a way to break through our defenses; and that there is the increased potential for intentional or accidental release of a synthesized agent. Every expert commentary and every analysis in recent years tells us that the costs of inaction are immense. And yet, as the havoc caused by the last outbreak turns into a fading memory, we become complacent and relegate the case for investing in preparedness on a back burner, only to bring it to the forefront when the next outbreak occurs. The result is that the world remains scarily vulnerable.
Excerpt, “From Panic and Neglect“: In countries where there is a reasonably comprehensive and well-functioning underlying health system, which would include a number of low-income and many middle-income countries, financing improved preparedness might cost less than $1 per person per year, not a huge sum compared to the scale of the risks to human lives and livelihoods.
Dan Coats, director of national intelligence, Worldwide Threat Assessment, February 13, 2018: The increase in frequency and diversity of reported disease outbreaks—such as dengue and Zika—probably will continue through 2018, including the potential for a severe global health emergency that could lead to major economic and societal disruptions, strain governmental and international resources, and increase calls on the United States for support. A novel strain of a virulent microbe that is easily transmissible between humans continues to be a major threat.…The frequency and diversity of disease outbreaks have increased at a steady rate since 1980, probably fueled by population growth, travel and trade patterns, and rapid urbanization.
Lena H. Sun, “Bill Gates calls on U.S. to lead fight against a pandemic that could kill 33 million,” Washington Post, April 27, 2018: Bill Gates says the US government is falling short in preparing the nation and the world for the “significant probability of a large and lethal modern-day pandemic occurring in our lifetimes.” In an interview this week, the billionaire philanthropist said he has raised the issue of pandemic preparedness with President Trump since the 2016 presidential election. In his most recent meeting [with Trump] last month, Gates said he laid out the increasing risk of a bioterrorism attack and stressed the importance of US funding for advanced research on new therapeutics, including a universal flu vaccine, which would protect against all or most strains of influenza.
Bill Gates, Massachusetts Medical Society Shattuck Lecture, Boston, Mass., April 27, 2018: Usually, I’m the super-optimist, pointing out that life keeps getting better for most people in the world. There is one area, though, where the world isn’t making much progress, and that’s pandemic preparedness. This should concern us all, because if history has taught us anything, it’s that there will be another deadly global pandemic. We can’t predict when. But given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and how connected our world is through air travel, there is a significant probability of a large and lethal, modern-day pandemic occurring in our lifetimes.
Lena H. Sun, “Top White House official in charge of pandemic response exits abruptly,” Washington Post, May 10, 2018: The top White House official responsible for leading the US response in the event of a deadly pandemic has left the administration, and the global health security team he oversaw has been disbanded under a reorganization by national security adviser John Bolton. The abrupt departure of Rear Admiral Timothy Ziemer from the National Security Council means no senior administration official is now focused solely on global health security.
Julie Gerberding, former director of the CDC, “The Terrifying Lessons of a Pandemic Simulation,” New Yorker, June 1, 2018: In a way, it’s sad that we’re still having these conversations….We have a Department of Defense, we fund it pretty well, and it’s pretty stellar. We still don’t have that for this kind of [pandemic] defense.
Excerpt, “The State of US Public Health Biopreparedness: Responding to Biological Attacks, Pandemics, and Emerging Infectious Disease Outbreaks,” Hearing, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, June 15, 2018:
Rep. Gregg Harper (R-Miss.): Dr. Schuchat, is there one biological threat that is at the top of your list? I know they’re all important, but is there one that gives you the greatest concern?
Anne Schuchat, principal deputy director, Centers for Disease Control and Prevention: I think influenza needs to be at the top of my list. It can affect everyone rapidly and is constantly changing. And with pandemics, all of the population of the world can be susceptible. So the threat of a pandemic has to be at the top of the list because it can all happen fast.
Rep. Harper: Dr. Fauci?
Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases: My number one and maybe number two and number three is influenza also. I agree, for the reasons that Dr. Schuchat has mentioned.
Ed Yong, “The Next Plague Is Coming. Is America Ready?,” The Atlantic, July 2018: On average, in one corner of the world or another, a new infectious disease has emerged every year for the past 30 years: MERS, Nipah, Hendra, and many more. … With the centennial of the 1918 flu looming, I started looking into whether America is prepared for the next pandemic. I fully expected that the answer would be no. What I found, after talking with dozens of experts, was more complicated—reassuring in some ways, but even more worrying than I’d imagined in others….
The US is prone to the same forgetfulness and shortsightedness that befall all nations, rich and poor—and the myopia has worsened considerably in recent years. Public-health programs are low on money; hospitals are stretched perilously thin; crucial funding is being slashed. And while we tend to think of science when we think of pandemic response, the worse the situation, the more the defense depends on political leadership.
When Ebola flared in 2014, the science-minded President Barack Obama calmly and quickly took the reins. The White House is now home to a president who is neither calm nor science-minded. We should not underestimate what that may mean if risk becomes reality.
Opening Paragraph, “National Biodefense Strategy,” White House, August 9, 2018: It is a vital interest of the United States to manage the risk of biological incidents. In today’s interconnected world, biological incidents have the potential to cost thousands of American lives, cause significant anxiety, and greatly impact travel and trade. Biological threats—whether naturally occurring, accidental, or deliberate in origin—are among the most serious threats facing the United States and the international community. aldOutbreaks of disease can cause catastrophic harm to the United States. They can cause death, sicken, and disable on a massive scale, and they can also inflict psychological trauma and economic and social disruption.
Tom Inglesby and Eric Toner, “Our lack of pandemic preparedness could prove deadly,” The Washington Post, September 19, 2018: There are still no licensed vaccines for most of the deadly viral pathogens that have occurred naturally in the past 40 years. That includes HIV, West Nile, severe acute respiratory syndrome, and Middle East respiratory syndrome. A pathogen that combined the lethality of any of these diseases with the ability to spread like influenza could cause extraordinary illness and mortality. We and our colleagues at the Johns Hopkins Center for Health Security brought this threat to life in May with a tabletop exercise simulating the spread of a severe new pandemic involving a virus we called Clade X…. The exercise made clear that the only way to stave off a catastrophic outcome would have been a global public-health system capable of rapidly detecting a nascent outbreak and responding vigorously before it could become a pandemic. Such preparedness doesn’t exist today.
Eric Toner, quoted in Business Insider, about the Clade X exercise: We learned that even very knowledgeable, experienced, devoted senior public officials who have lived through many crises still have trouble dealing with something like this. And it’s not because they are not good or smart or dedicated, it’s because we don’t have the systems we need to enable the kind of response we’d want to see.
Lisa Monaco and Vin Gupta, “The Next Pandemic Will Be Arriving Shortly,” Foreign Policy, September 28, 2018: In January 2017, while [Lisa] was serving as a homeland security adviser to outgoing President Barack Obama, a deadly pandemic was among the scenarios that the outgoing and incoming US cabinet officials discussed in a daylong exercise that focused on honing interagency coordination and rapid federal response to potential crises. The exercise is an important element of the preparations during transitions between administrations, and it seemed things were off to a good start with a commitment to continuity and a focus on biodefense, preparedness, and the Global Health Security Agenda—an initiative begun by the Obama administration to help build health security capacity in the most critically at-risk countries around the world and to prevent the spread of infectious disease. But that commitment was short-lived.…The prevailing laissez-faire attitude toward funding pandemic preparedness within President Donald Trump’s White House is creating new vulnerabilities in the health infrastructure of the United States and leaving the world with critical gaps to contend with when the next global outbreak of infectious disease hits.
Bruce Sterling, WIRED, October 15, 2018: Massive planetary epidemics—the way we carry on nowadays, we’re kinda begging for one of these.
Ronald Klain, “A pandemic killing tens of millions of people is a real possibility—and we are not prepared for it,” Vox, October 15, 2018: In an era with so much progress in science and medicine, how can the United States remain so vulnerable to such a pandemic? With so much money and energy being devoted to combatting large-scale terrorist attacks, nuclear proliferation, and other dangers, why has so much less attention been devoted to a threat that is arguably more likely and potentially deadlier? …. The past two decades have seen a roll call of near-miss catastrophes.
New political and social trends further increase our risk level….The ability of social media to rapidly spread false information—painfully illustrated in the 2016 campaign—is another source of danger: Would the directives of public health officials be followed in a crisis? Would they be undermined by misinformation spread by misguided provocateurs or a hostile foreign power? And then there is the risk factor of isolationism and xenophobia. While responsible officials in the Trump administration have responded to two Ebola outbreaks in the Democratic Republic of Congo this year…in a more visible crisis, Trump’s isolationist instincts might assert themselves.…No city in America has existing capacity (i.e., treatment units within a hospital supported by trained staff and equipment) to treat more than a handful of dangerous infectious diseases patients at one time….An outbreak of even just a few dozen cases of a deadly, highly infectious disease—let alone a few hundred—would overwhelm any city in our country. In such a scenario, death would beget death, as patients carrying the virus would stream into hospitals and infect others who did not yet have the disease.…We need to step up our investment in facilities, training, and equipment for our domestic epidemic response—and do so now, not when a crisis comes.
Bill Gates, “What I learned at work this year,” December 29, 2018: I had hoped that hitting the 100th anniversary of this epidemic would spark a lot of discussion about whether we’re ready for the next global epidemic. Unfortunately, it didn’t, and we still are not ready….If anything is going to kill tens of millions of people in a short time, it will probably be a global epidemic. And the disease would most likely be a form of the flu, because the flu virus spreads easily through the air.…To be prepared, we need a plan for national governments to work together. We need to think through how to handle quarantines, make sure supply chains will reach affected areas, decide how to involve the military, and so on. There was not much progress on these questions in 2018.
Alex Azar, Health and Human Services Secretary, National Biodefense Summit, April 17, 2019: The thing that people often ask is: “What keeps you most up at night in the biodefense world?” Pandemic flu, of course.
William Brangham and Judy Woodruff, “Why another flu pandemic is likely just a matter of when,” PBS Newshour, June 18, 2019: Judy Woodruff: Public health officials fear the emergence of a new, previously unknown flu virus that could be far more lethal and become a pandemic by spreading across the world.…William Brangham: [Dr. Anthony] Fauci is the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. He says while many take the so-called seasonal flu for granted, it still kills tens of thousands in the US every year. But the seasonal flu isn’t really what Fauci loses sleep over. It’s the concern that a new flu strain emerges, a virus we have never seen before and have no protections against, like what happened in 1918.
Susan Brooks, US Representative, Republican, Indiana’s fifth district, PBS Newshour, June 18, 2019: We have not given [a pandemic] all of the attention that it deserves. Every time you do an exercise, you realize where the gaps are. If large numbers of people begin to get sick, actually, your economy is impacted, our national security can be impacted. There are so many things that people just don’t realize. These are the types of things that most citizens don’t think about. We don’t want to think about them. Yet we expect the systems to be in place to take care of them. We expect the medical community, pharmaceutical community, diagnostic community, everyone to be ready. And that’s not how it works.
Ronald Klain, Third Annual Pandemic and Biosecurity Forum, Texas A&M University, May 14, 2019: We need leadership at the White House. I do not think it should be the vice president. The vice president has a full-time job. Getting ready for and responding to pandemic threats is also a full-time job. And the idea the vice president would do it in his spare time, doesn’t seem like a good idea to me. President Obama after he brought me in to do the Ebola response—when I left, we were getting close to zero cases—appointed a senior member of the National Security Council staff to be in charge of pandemic response, and President Trump continued that for the first year of his presidency. That position has been terminated. I hope that President Trump changes his mind.
Excerpt, “A World At Risk: Annual Report,” Global Preparedness Monitoring Board, The World Bank and World Health Organization, September 2019: For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: We ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act…. What we need is leadership and the willingness to act forcefully and effectively…. The world is not prepared for a fast-moving, virulent respiratory pathogen pandemic…. In addition to tragic levels of mortality, such a pandemic could cause panic, destabilize national security and seriously impact the global economy and trade. Trust in institutions is eroding. Governments, scientists, the media, public health, health systems and health workers in many countries are facing a breakdown in public trust that is threatening their ability to function effectively. The situation is exacerbated by misinformation that can hinder disease control communicated quickly and widely via social media.
Excerpt, “Preparedness for a High-Impact Respiratory Pathogen Pandemic,” Johns Hopkins Center for Health Security, September 2019: The potential for an epidemic or pandemic caused by a high-impact respiratory pathogen is increasing. Data show that the frequency of outbreaks of newly emerging diseases is rising. Novel pathogens continue to emerge, often first in animals, then with subsequent spillover into human populations living in close contact with animals, due to changing patterns of animal management and land use. Global conditions enable pathogens to spread widely and quickly in people.
Laurie Garrett, “The World Knows an Apocalyptic Pandemic Is Coming. But nobody is interested in doing anything about it,” Foreign Policy, September 20, 2019: This core message has been shouted from the rafters many times before, with little discernable impact on tone-deaf political leaders, financial enterprises, or multinational institutions. There’s no reason to think this time will be any different. It’s hard to know what, shy of a genuinely devastating pandemic of killer influenza or some currently unknown microbe, will motivate global leaders to take microscopic threats seriously.
Ronald Klain, “The Ebola Epidemic is in Full Swing—Where is the Trump Administration?“, Washington Post, October 1, 2019: Warning lights are flashing in our global health security system.…There is no substitute for leadership at the White House. When John Bolton took over as national security adviser in 2018, he disbanded the National Security Council unit that worked on pandemic prevention and response. The White House has tried to cut investments in global health security, the president only discusses the threat of epidemics when he is stirring fears to bash immigrants…. As epidemics rage and the risk of a pandemic mounts, the lack of leadership at the White House in confronting this threat feels larger every day.
Julie Gerberding and Kelly Ayotte, co-chairs, CSIS Commission on Strengthening America’s Health Security, “Ending the Cycle of Crisis and Complacency in U.S. Global Health Security: A Report,” November 2019: Over the course of our careers, we have witnessed, often up close, a mounting number of severe health security incidents, including the 2001 anthrax attacks, SARS in 2003, and the recurrent, dangerous outbreaks of influenza and Ebola, to name but the most conspicuous. Not only did these moments demonstrate the staggering public health, economic, and political costs borne of infectious disease outbreaks and biological attacks, they have convinced us that the United States needs a far better line of defense.
Excerpt, “Ending the Cycle of Crisis and Complacency in US Global Health Security”: The business case to invest early in preparedness is crystal clear—and powerful. The United States must either pay now and gain protection and security or wait for the next epidemic and pay a much greater price in human and economic costs. The long-term costs of strategic protection and prevention programs are but a tiny fraction of the astronomic costs of episodic, often chaotic responses to sudden, emergent crises. Investing strategically now is smart and cost-effective, brings proven results, and would draw support from across the political spectrum.
Julie Gerberding, Biological Threats to US National Security, video, November 22, 2019: We are living in an age of epidemics.
Josephine Ma, South China Morning Post, March 13, 2020: The first case of someone in China suffering from Covid-19, the disease caused by the novel coronavirus, can be traced back to November 17.
Donald Trump, Press Briefing, March 13, 2020: No. I don’t take responsibility at all.
Nora McGreevy contributed research and reporting to this article.
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