I Helped Write the U.S. National Preparedness Influenza Plan. This is Why It Failed.
My career at the U.S. State Department started in a rush. As a political science major fresh out of undergrad in 2007 with a burning desire to travel the world and promote peace abroad, I was practically floating when I received my first diplomatic passport. I was granted Top Secret clearance, the title of U.S. Special Projects Officer, and initially stationed within the State Department's now defunct Avian Influenza Action Group. There, I was granted the authority to craft foreign policy alongside scientists and researchers from every corner of U.S. government from the Centers for Disease Control and Prevention to the Department of Defense. Our mandate was to make policy recommendations to White House and senior level officials to help prepare for and combat viruses of pandemic potential while protecting U.S. citizens abroad.
As my impostor syndrome began to set in, my bosses assured me my specialty would be diplomacy, not pharmacology. I was trained by the U.S. Foreign Service Institute and eventually transferred to the Office of International Health and Biodefense where I facilitated dialogue among U.S. government officials and experts within health, agriculture, and foreign ministries operating in regions of the world most vulnerable to pandemic threats. My colleagues and I worked across language and cultural barriers to get international public health agreements signed and, ideally, implemented.
Once I was promoted to U.S. Foreign Affairs Officer, my role involved encouraging policymakers from all over the world to care about science. My colleagues and I knew a potentially catastrophic pandemic was coming, not COVID-19 specifically, but that a viral outbreak loomed somewhere in the future. Our classified and unclassified sources told us this, but we were by no means operating in a vacuum. Bleak historical lessons from the Spanish Flu of 1918 and the Bubonic Plague in the mid-1300s, which killed a third of Europe’s population, highlighted the need for disaster planning in every sector from the airline industry to cargo shipping.
From where we sat in Washington, we knew the U.S. government writ large wasn’t nearly prepared enough for the next highly contagious virus. Our proof lied in a sweeping assessment done by the Government Accountability Office (GAO) in 2009 which concluded that, “While a number of actions have been taken to plan for a pandemic, including developing a national strategy and implementation plan, many gaps in pandemic planning and preparedness still remain.” Even still, the reality we’ve found ourselves in today is beyond comprehension for me and virtually all of my former colleagues.
The National Strategy for Pandemic Influenza was my office’s ultimate manifesto. It was first drafted in 2006, but the National Security Council at times asked for weekly updates, which I coauthored along with my colleagues. The Plan accurately forecasted how the next global pandemic—unnervingly similar to the one we’re experiencing right now—would require unprecedented federal government intervention to assist citizens on everything from border closures to the delivery of essential services such as shelter, power, water, sanitation, food, security, and the flow of communication. It recommended coordinated efforts across vaccine manufacturers, and for the federal government to prioritize how to distribute countermeasures (vaccines, antivirals, and nonpharmaceutical interventions) certain to be in limited supply during a pandemic. It also cited that the $2.3 trillion international trade market was vulnerable to a pandemic outbreak. Earlier this month, in a stunning coincidence, the Federal Reserve rolled out a plan to stabilize the U.S. economy with loans totaling $2.3 trillion to bolster the ability of state and local governments to deliver critical services during COVID-19.
While pedantic and tedious, the 227-page National Strategy for Pandemic Influenza was impressive but not perfect. It failed to provide state and local emergency planners with sufficient specific guidance on how to implement the Strategy’s many recommendations at the community level, according to the GAO. Also, and perhaps most fundamentally, the National Strategy for Pandemic Influenza did not provide information on the financial resources needed to implement its recommendations. Funding for pandemic influenza preparedness experienced significant budget cuts in the years following the plan’s release. Without appropriate funding, state and local authorities were put in the difficult position of deciding whether to spend tax dollars on potential threats or more immediate issues already facing constituents.
During my time in Washington, to say I was hopeful would be an understatement. I thought that if I wrote an impassioned speech or a policy memo in just the right tone, more money would appear in more capable hands and more stockpiles of ventilators would form. At minimum, I hoped the members of the White House and State Department’s senior staff would agree to more classified meetings with my colleagues and I, or that Congress would mobilize resources to increase vaccine manufacturing capacity in the U.S. It's now clear far too many of the fatalistic predictions made in 2006 have come true. The question on most everyone’s mind is, why are we as a nation so underprepared? How is the richest country on earth struggling desperately to manage and contain this public health crisis?
Of course, the answers to these questions are far from simple. In large part, we could blame the litany of more pressing, urgent, and politically prioritized concerns that control the energy and pocketbooks of the people in Washington at any given time. I remember a cacophony of noise clamoring for policymakers’ attention that made almost any action on the issues I cared about seem improbable. Pandemic preparedness has always been yet another item on our government’s never-ending to-do list.
I don’t blame everyday voters for having turned a blind eye to this looming threat; if I didn’t receive orders to directly obsess over pandemic preparedness for roughly half a dozen years, I probably wouldn’t have grasped the whole picture of just how horrific and unpredictable viruses can be. Many of our elected officials, though, frequently receive detailed and highly sensitive briefings on public health threats facing our nation. As we now know, they were either in denial or at least hopeful a pandemic wouldn’t happen during their tenure.
The line edits I inserted into State of the Union addresses, White House press briefings, and speeches made by U.S. Secretaries of Agriculture, Health and Human Services, and State were often shortened if not altogether cut. The pandemic preparedness media notes I, along with so many of my colleagues, penned for WhiteHouse.gov and State.gov received a dismal number of clicks. The talking points we pitched to media outlets were similarly ignored. I suppose I felt then how many climate change experts feel now. Waving my hands wildly in the air as almost everyone else seemed to stroll by. Now, as we mourn so many lives lost, we can solemnly acknowledge we were collectively inconceivably unprepared.
Above all, I can’t help but fixate on how this pandemic has highlighted an uncomfortable truth: How unless a hardship appears at one’s doorstep, it goes unaddressed. Earlier today, when I stepped outside to collect my mail, the silence in my apartment building’s hallway reminded me how most of my neighbors are either quarantined or fighting for their lives. But the fight didn’t have to be as hard or fatal as it’s been. Which is why we must hold our elected officials accountable today, tomorrow, and every day going forward. The fate of humanity depends on how well governments prepare for disasters. Even when no one is paying attention.
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