“Confused,” “frustrating,” “fragmented,” “acute,” and “a reckoning” were just some of the ways three health care experts described the United States’ response to the coronavirus pandemic during a recent virtual discussion. And the absence of a national strategy, they agreed, is only helping fuel the crisis.
“We don’t have a national set of targets that are being communicated across states. We don’t have a national plan,” argued guest Beth Cameron, the former senior director for global health security and biodefense at the White House National Security Council, the office established in 2016 under former President Barack Obama but merged into two others by the Trump administration.
“So, I would say it’s chaotic, and viruses thrive in chaotic environments,” added Cameron, now the vice president for global biological policy and programs at the Nuclear Threat Initiative. “And so, we’re feeding the virus right now with our chaotic response. We’re making it worse.”
Her comments came at a live show called “COVID State of Play” hosted by Harvard University’s Berkman Klein Center for Internet & Society on Tuesday, led by Harvard Law School Professor Jonathan Zittrain ’95 and Dr. Margaret Bourdeaux, research director for the Security and Global Health Project at Harvard Kennedy School’s Belfer Center. Guests included Cameron and KJ Seung, chief of strategy and policy for Partners in Health’s MA COVID-19 Response. The show was part of the Berkman Klein Center’s new Digital Pandemic Response program, co-led by Zittrain, Bourdeaux, and Urs Gasser LL.M. ’03, executive director of the Berkman Klein Center and a professor of practice at HLS.
The guests noted that the lack of a national response strategy in the United States, including a plan for testing, has caused many medical professionals and public health officials in this country to look to nations that have more successfully contained the virus with admiration.
“I do see a lot of South Korea envy,” said Seung. “Like ‘Wow, we could have been like that!’” But he cautioned that the comparison isn’t “really fair,” because it and other Asian countries had gained important experience battling SARS and MERS. “So, in some sense,” he argued, “they’ve been preparing for COVID for over ten years.”
Cameron, who praised the success of South Korea, Germany, and New Zealand in reducing the rate of spread, disagreed, noting that the United States had recently dealt with Ebola successfully and that the American military had troops stationed on the Korean peninsula during the MERS crisis. “We should have learned the lesson from that too,” she said. “And I think we did learn a few lessons from that we just didn’t act on.”
Looking forward, Bourdeaux described what she called the “three-legged stool” of preventing and responding to the spread of COVID-19. The first leg involves “population-based interventions, where you ask people to do things like wear masks and wash their hands and stay socially distant,” she said. Environmental modifications—such as better ventilation for buildings and reorganizing workplaces to keep people socially distanced—can make the virus “less likely to transmit.” Finally, contact tracing is necessary to identify those who may have been exposed and keep them from exposing others.
“If we do those things,” Bourdeaux argued, “we will get control of this” without the need for more lockdowns. However, without those three legs in place, “lockdowns become inevitable.” Seung agreed that once control of the spread of the virus is lost, “you just need to shut it down, shut everything down, and then let’s reset, and then you can start over.”
Cameron responded that there needs to be uniform approach to how decisions about lockdowns are made. “I think there needs to be a national agreement on when that reset happens …” because, she said, if New York responds one way, but Florida responds another way, “we end up in a situation where we just continually are perpetuating spread.” It also requires “fact-based communication with the American people about what that means, for how long it might be, and what the American government’s going to do in the meantime to get back in control. And we lost our chance to do that in March, April, and May, but we still need to do it.”
The guests also agreed that the federal government needs to develop a national testing plan to ensure, among other things, that the limited number of available tests are distributed appropriately and equitably. While exactly who should get tested first and what types of tests to use for which populations can be debated, Bourdeaux said that the lack of a strategy, however flawed, was inhibiting the ability to control the virus’ spread. “Sometimes any plan is better than no plan,” she said. “And we need any plan.”
Several guests argued that the lack of a national testing strategy also creates winners and losers. “How does it get decided [who to test], when there’s only so many tests that can be turned around in three or four days?” Zittrain asked. “Whether it goes to [a university to test their students] or whether it goes to a fish processing plant and their employees or whether it goes to a community at large? How does that get figured out?”
“Well, it gets figured out in our typical American fashion,” Seung responded, “which is that … the person [who] pays for it gets it.” As a result, he added, “I don’t think that there is a rational distribution of a scarce resource.”
Cameron believes that the lack of national leadership has contributed to the fact that COVID has impacted communities of color at disproportionate rates. “We are a federated society. But the tone gets set from the top. And what the tone is right now is that … everybody decides for themselves, and we’re not going to set out specific priorities. And when that happens, the people at the top, the wealthiest people in our country are the ones who are going to win.”
As a final question, Zittrain asked the guests to “fast-forward two years” to July 2022 and describe what they envision as the likely lingering impacts of the coronavirus pandemic on American society.
Cameron predicted that Americans would still be living with its effects. “I think the history of vaccination programs around the world for other diseases tells us how hard it is to eradicate something. So, I think COVID-19 is here to stay for the foreseeable future,” she said. “I hope that it’s a vaccination program that is not more rigorous than annually, but we just don’t know. We don’t know what the vaccine is going to look like. … I think it’s on the table that movie theaters and shopping malls won’t survive this crisis because of the economic downturn that we’re all living in.” Cameron also suggested that the U.S. can plan for a different outcome, “but right now we’re not behaving like we [want that] as a country.”
Seung said he believes that the development of vaccines and treatments for COVID-19 “will make things a lot easier” by 2022. But he worries about what we do in the meantime. “I think the harder issue is in the next six to 12 months … where we don’t have access or enough of these tools,” he said. “Can we get to that point, like other countries have, that we have much better control? Can we have much stronger suppression?”
“I think we can,” he added. “We’re obviously failing right now. But … the playbook is there, the public health tools. They’re centuries old, they’re effective. And I think that once things get a little worse, I think there’s going to be more appetite to do things the right way.”
Bourdeaux struck an even more hopeful tone about controlling and eventually defeating the virus. “I don’t want to give up on eradication,” she said. “I don’t want to give up on elimination. And I think that if we can crack the governance nut right now, we can come together and have some leadership and a national plan and we execute on it with all of our resources … I think we can do a really good job. And then I think we’ll get a vaccine in here and we’ll mop it up.”