Pandemic Preparedness: Where America Fell Short

This article was originally published in our Spring 2021 print issue.

The 2020 coronavirus outbreak is not the first outbreak in America. Over a century ago, the 1918 H1N1 influenza sent the world into lockdown. After a grim 675,000 deaths, the pandemic finally slowed, but strains of the influenza frequently returned . Nothing  was  as devastating to America as the original “Spanish” influenza. These returning strains of influenza, particularly the 2009 H1N1 outbreak, caused the government to create pandemic preparedness plans. This detailed plan is updated every few years, with updates in 2006, 2009, and most recently 2017. With such an in-depth plan (including objectives related to surveillance, community mitigation measures, vaccines, health care system preparedness, public outreach, scientific infrastructure, and more), why was the government so unprepared to deal with the coronavirus outbreak?

The coronavirus and the “Spanish” influenza are not comparable as diseases; with coronavirus having a higher mortality rate, the government could not react in an identical way to their previous influenza response. Influenza outbreaks never called for a shutdown of the economy, and recent influenza outbreaks have had an efficient vaccine distribution process due to previous research on influenza vaccines. 

As for the previously established general plans for pandemic preparedness, underfunding on behalf of the government led to the debilitation of any organized response to the outbreak. Government public health agencies were severely underfunded, thanks to both Democratic and Republican parties. “There was essentially no robust public health system in the United States,” comments John Swartzberg, MD of the UC Berkeley School of Public Health. In actuality, there was a plan. After the SARS-CoV-1 outbreak in 2002, there was work on a pandemic preparedness plan under the Bush administration, which was continued and developed under the Obama administration. The main issue came when the plan was significantly dismantled during the Trump administration. “The plan had been undercut and underfunded. We had a continuation of the underfunding of public health. Our hands were tied in this game,” says Dr. Swartzberg. What stopped America’s pandemic preparedness plan from being developed into a safety net from the coronavirus outbreak?

In November 2019, the Trump administration received an information briefing regarding coronavirus. Immediately afterward, the vital information was essentially disregarded. With continuous budget cuts to public health in the past years, dismantling of the previously established plan, and neglect of the briefing, all the pieces were in place for coronavirus to cause disaster in America. The US was extremely behind in preparation, especially compared to Asian countries. Taiwan, South Korea, and Japan, were all hit hard by Sars-CoV-1, but they continued to revise a robust plan. So, when this pandemic began in South Asia, most countries were prepared with a better public health system. According to Swartzberg, “This particular pandemic had the perfect storm for the decades of under-preparedness, due to a pandemic plan that had essentially been put on the shelf… this virus could not have picked a better time to emerge in the US.” 

Other main culprits in the lackluster CDC response? Politicization and hubris. According to Swartzberg, the politicization of the CDC and FDA lead to a slow, ineffective response to the coronavirus outbreak. One CDC scientist even predicted an upcoming pandemic, but was “muzzled” by the Trump administration. Not long after the Trump presidency came to an end, the CDC halted its politically-based statements and began releasing more science-based announcements. However, a lack of preparedness cannot be blamed only on the Trump administration: the CDC’s internal issues share the stage. The CDC, when presented with the opportunity to use a diagnostic test for coronavirus created by the Germans, turned it down. Instead, the agency was adamant about creating their diagnostic test, which fell flat. Through revisions upon revisions of the test, time was wasted in obtaining an effective test.

A third, less obvious party also played a role in politicization of the pandemic. According to Dr. Swartzberg, media outlets have strayed from science-based reporting and choose instead to purvey a political perspective. “because they [the media] are not scientists, physicians, or public health officials, they have difficulty translating what is important. They can magnify things that aren’t important, or move on from things too quickly. The media has its own time course; the pandemic has been going on for  a year, but a media cycle is one week. That doesn’t work well together.”

With a lacking public health system and a collection of misinformation, America continues to fall short in its pandemic preparedness.