A hypothetical pop-up case set in 2025: The world has emerged from COVID-19 and is trying to learn the lessons of the pandemic and prepare for the next one. However, a recent report found many countries are still underprepared. What can and should the United States do to secure global health preparedness before the next pandemic arrives?
Long before the arrival of coronavirus disease 2019 (COVID-19) and the global devastation left in its wake, experts had warned of the dire need for countries to be better prepared to deal with infectious diseases. This warning, amplified during previous epidemics such as Ebola, resulted in only moderate and inconsistent improvements, including funding for health initiatives and international agreements such as the 2005 International Health Regulations (IHR), aimed at coordinating and regulating health policy. Those improvements were obviously insufficient. A 2019 survey found that all 195 signatories of the IHR were underprepared for a health crisis, a finding that was borne out by the ensuing chaos as countries across the world struggled to meet the extreme health and economic challenges precipitated by COVID-19. Moreover, the World Health Organization (WHO), which coordinates health policy at an international level, lacked the resources and enforcement capabilities to effectively lead an international pandemic response. As the COVID-19 pandemic overwhelmed health-care systems and halted economies in their tracks, the deadly costs of global health unpreparedness came into sharp relief.
COVID-19 highlighted faults in global health security on two fronts. First, current international norms and regulations proved insufficient: noncompliance with IHR travel restriction guidelines and a lack of government transparency and information sharing hindered containment efforts and accelerated economic damage. Second, national health-care systems were unprepared and uncoordinated in their responses. Many countries, including the United States, failed to implement sufficient testing practices to contain the spread of COVID-19 and strained to handle the resulting surge of patients. Although several countries, including Singapore and South Korea, mounted robust responses that successfully slowed the spread of the virus, the global nature of the pandemic highlighted the need for coordinated action at an international level to detect and prevent future outbreaks and to ensure health-care systems were able to manage a pandemic if containment failed. The measures required to improve preparedness were and continue to be difficult: investing in health care is expensive—sometimes prohibitively so for poor countries—and strengthening international norms can meet with resistance. Moreover, with no way of predicting the next pandemic, gauging the effectiveness of improvements is difficult. It appears that some countries view policies deemed prudent for the future as financially unattainable or inessential in the present. Considering the lessons of COVID-19, policymakers will need to decide what financial and political tradeoffs are acceptable to safeguard against future pandemics.
Emerging from the COVID-19 pandemic, countries around the world made efforts to learn the lessons of COVID-19 and prepare for the inevitability of another pandemic. As part of this effort, in September 2022 the National Security Council (NSC) undertook a survey of global preparedness. The report revealed that 75 of the 195 IHR signatories were still underprepared for a pandemic. The president has convened the NSC to consider what strategies would best shore up pandemic preparedness at home and abroad. Given that this preparedness depends on eliminating, to the extent possible, weaknesses in the global system, NSC members will need to discuss what costs they are willing to accept to secure global health.
NSC members should consider any combination of the following policy options:
- Lead a global funding initiative to bolster countries’ health-care capacities and pandemic preparedness. This option could facilitate vital improvements to national health-care systems, especially in developing countries. However, it requires significant U.S. investment as well as international participation and does nothing to improve transparency and coordination practices.
Work to strengthen the IHR and bolster WHO enforcement capabilities. This option could improve coordination of health practices, but reaching a consensus would be difficult: improving standards could be too expensive for poorer states, and some states could see stricter enforcement as sacrificing national autonomy.
Work bilaterally to implement better global health practices, using trade policies and aid as incentives while calling out or even sanctioning countries that fall short. This option could lead countries to improve their preparedness and place the United States in a leadership position, but it does not ensure a coordinated global response to a future pandemic.
Prioritize U.S. preparedness by investing in domestic health-care infrastructure, infectious disease research, and public health initiatives. This option does not improve international preparedness or coordination, though perhaps a better- prepared United States could better assist in international epidemic responses.