We Were Warned

When the inevitable inquiry into the government's response to COVID-19 happens, it will conclude that signs of a coming crisis were everywhere.

We were warned in 2012, when the Rand Corporation surveyed the international threats arrayed against the United States and concluded that only pandemics posed an existential danger, in that they were “capable of destroying America’s way of life.”

We were warned in 2015, when Ezra Klein of Vox, after speaking with Bill Gates about his algorithmic model for how a new strain of flu could spread rapidly in today’s globalized world, wrote that “a pandemic disease is the most predictable catastrophe in the history of the human race, if only because it has happened to the human race so many, many times before.” If there was anything humanity could be certain that it needed to prepare for to prevent the deaths of a lot of people in little time, it was this.

We were warned in 2017, a week before inauguration day, when Lisa Monaco, Barack Obama’s outgoing homeland-security adviser, gathered with Donald Trump’s incoming national-security officials and conducted an exercise modeled on the administration’s experiences with outbreaks of swine flu, Ebola, and Zika. The simulation explored how the U.S. government should respond to a flu pandemic that halts international travel, upends global supply chains, tanks the stock market, and burdens health-care systems—all with a vaccine many months from materializing. “The nightmare scenario for us, and frankly to any public-health expert that you would talk to, has always been a new strain of flu or a respiratory illness because of how much easier it is to spread” relative to other pandemic diseases that aren’t airborne, Monaco told me.

We were warned in 2018, on the 100th anniversary of the flu pandemic of 1918, which killed 50 to 100 million people around the world. My colleague Ed Yong served notice that the “next plague” was coming, with influenza the most dangerous possibility, even as the United States succumbed to “forgetfulness and shortsightedness.” Luciana Borio, then the director for medical and biodefense preparedness at the National Security Council, told a symposium that “the threat of pandemic flu is our number-one health security concern.” Serving under a president who’d come to office on the pledge to wall off the United States, she noted that such a threat could not “be stopped at the border.” The very next day, news broke that National Security Adviser John Bolton had shuttered the NSC’s unit for preparing and responding to pandemics, of which Borio was a part. The White House official in charge of spearheading such a response to infectious threats departed as well and was not replaced.

We were warned in 2018 and 2019, when the Johns Hopkins Center for Health Security gathered public-health experts, business leaders, and U.S. government officials for simulations of the devastating humanitarian, political, social, and economic consequences of fictional novel coronaviruses that left tens of millions dead around the world. Participants exited the events thinking, “‘Oh my god, we really need to get working on this,’” Eric Toner, who helped run the exercises, told me. Two months after the second simulation, a novel coronavirus (albeit with what appears to be a substantially lower lethality rate than the fictional viruses in the scenarios at Johns Hopkins) emerged in China.

We were warned in 2019 of the grave hazards of a new influenza pandemic by the U.S. intelligence community in its annual “worldwide threat assessment.” They had also cautioned us in 2018. And in 2017. And in 2016. And in 2015. And in 2014. And in 2013, when intelligence officials pleaded, “This is not a hypothetical threat. History is replete with examples of pathogens sweeping populations that lack immunity, causing political and economic upheaval.” (The 2020 worldwide threat assessment, which reportedly yet again flagged America’s vulnerability to a flu pandemic, has been postponed without explanation.)

When the National Commission on the COVID-19 response materializes, it will differ from the 9/11 Commission in that it will conclude that “the system was blinking red” not just in the inner sanctum of the U.S. intelligence community but out in the open, as well. For years. Within government and outside government. And that, despite all that, the U.S. government was not sufficiently prepared when the boogeyman, in this case the virus SARS-CoV-2, finally came calling. President Trump has referred to the coronavirus outbreak as “an unforeseen problem,” as “something that nobody expected,” and as a crisis that “came out of nowhere.” It is demonstrably none of the above.

The systemic failure stems in part from the fact that in recent decades successive administrations have not treated pandemic preparedness with the degree of seriousness they reserved for addressing other top security threats—from, say, terrorists or adversarial nations. The pattern repeats itself: Presidents rush to prioritize health security and lavish money on it after crisis strikes, then scale back resources and succumb to complacency once it subsides.

Pandemics don’t occur with the frequency of other national-security incidents such as terrorist attacks and therefore often seem “like a remote possibility,” Toner said, especially for elected officials thinking in the time horizon of their term in office.

“Most people find thinking about a severe pandemic just too hard,” he added. “I’ve fought this battle my whole career: They say … ‘I can’t deal with a small-scale epidemic. How can you expect me to deal with something on the scale of 1918?’

“Responding to a catastrophic pandemic, as I think we will all learn in the coming weeks, requires really changing the way that we do a lot of things. It’s probably more analogous to what we did during World War II than anything else,” he continued. “It requires an all-of-society response, and I think until the crisis happens policy makers don’t know how to do that.”

Funding for pandemic preparedness has long lagged behind other homeland-security priorities. The U.S. government, for example, spends at least $100 billion a year on counterterrorism efforts versus $1 billion on pandemic and emerging-infectious-disease programs, according to one calculation in 2016. This despite the fact that the new coronavirus threatens to kill vastly more Americans than terrorism ever has.

And the Trump administration has gone further—not only underfunding these efforts but also proposing steep spending cuts year after year to institutions, such as the Centers for Disease Control and Prevention, that are tasked with handling outbreaks. Congress has resisted these efforts in the bills Trump has ultimately signed, but the president’s requests have nevertheless spoken to his priorities. His budget proposal for fiscal year 2021, released in February when the coronavirus outbreak had already reached the United States, called for the CDC’s overall funding to be slashed by hundreds of millions of dollars. The administration did suggest more resources for certain subsets of the CDC’s work relevant to the current crisis. Each of those increases, however, is less than the Trump administration devoted in its 2021 budget proposal to counter Chinese and Russian propaganda and disinformation, and a small fraction of the additional $459 million the administration wished to pour into offensive hypersonic weapons. (But what’s $459 million when you’re spending billions on them already?)

The Trump administration has also downplayed global health threats through structural changes within the White House’s national-security architecture. It downgraded the role of homeland security adviser so that it didn’t report directly to the president after Monaco’s successor, Tom Bossert, was dismissed in 2018. (Bossert was an advocate of developing a biodefense strategy for addressing biological attacks and pandemic diseases like influenza.) That same year, it closed a pandemic-response unit that the Obama administration had created after the Ebola outbreak, folding some of the remnants into other NSC directorates. Tim Morrison, who led the resulting counterproliferation and biodefense office before leaving the administration in 2019, has argued that the shake-up was an effort to reduce “bloat” at the NSC. But the consequences were serious: When the novel coronavirus first broke out, there were no senior administration officials focused solely on combatting such threats and coordinating global health security policy across agencies.

Monaco said that the Trump administration and its predecessors did not do enough to fund America’s public-health infrastructure, which in the coming weeks is at risk of being “overwhelmed by the onslaught” of cases of COVID-19, the disease caused by the coronavirus.

“I’m not saying that having that structure in place means that the coronavirus wouldn’t have happened or wouldn’t have arrived here,” Monaco clarified. But “back in December, when we first saw [the coronavirus emerge], who was asking, ‘Do we have sufficient tests?’ Who was asking, ‘Do we have sufficient personal protective equipment if this gets here and gets here at scale?’ Who was asking, ‘What is our public-health capacity, and let’s model this out. If this really spreads, how many ICU beds are we going to need?’ Who’s developing that list of questions and getting them answered? That’s got to happen at the White House to really bring all of the government to bear.”

When I spoke with Toner last Thursday (what admittedly seems like an eternity ago at the pace of this crisis), he said that “it’s clear that the administration through its actions did not prioritize public-health preparedness until last week or so,” and that this is not the kind of crisis that can be prepared for in a week—not even the couple months that Trump administration officials claim they lost because China wasn’t initially forthcoming about the virus. Pandemics move at lightning speed, but pandemic preparedness is measured in years.

When the virus was first detected in China, Toner told me, a more prepared U.S. government would have immediately begun bracing for the “inevitable arrival of the disease” by bolstering hospitals and helping state and local governments implement the social-distancing and other mitigation measures they are now scrambling to put in place. “It would have been much easier to do those things with more time than we have now,” he explained.

The irony is that this is all occurring in a country, the United States, that for decades “has been a leader in pandemic preparedness,” Toner said. “We were better prepared than others,” he acknowledged, “but no one, no country, is prepared for what we’re seeing now.”

Just as the spread of the coronavirus is a function of human nature, so too is humanity’s capacity to be caught unprepared for it—despite warning after warning after warning that we would live to regret it.