We should have done better. The Global Health Security Index in October 2019 rated the United States as the most prepared nation in the world for a pandemic — a wealthy country with advanced health capacity and capabilities. But, as the new edition points out, those advantages were bungled when the pandemic occurred. This should be a warning to prepare better for next time.
Published for the first time in 2019, the index was created by the Nuclear Threat Initiative and the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, with help from the Economist Impact. In that edition, the United States was rated in the top ranks on such criteria as preventing the emergence or release of pathogens, early detection and reporting of epidemics, rapid response and mitigation, a robust system to treat the sick and protect health-care workers, and financing of public health.
But the United States has so far suffered more than 800,000 deaths in the worst public health disaster in a century after a pandemic response that was a chaotic mess. There was one bright spot, the emergency development and manufacturing of effective vaccines, but much went wrong in the United States during the first year — why?
The latest health index report, released Dec. 8, offers some insights. At the start of the pandemic, it found, the United States scored poorly on public confidence in government, which undermined adherence to mitigation measures, such as wearing masks, complying with stay-at-home orders and vaccination mandates. This distrust is a long-running problem. “Over nearly two years,” the report says, “U.S. politicians have questioned the motives and messages of health officials and debated the seriousness of the virus and the effectiveness and safety of vaccines.” Without mentioning former president Donald Trump and his stream of deceptions in 2020, the report concludes that political leaders “expressed overconfidence” about the United States’ ability to respond, with “devastating consequences” when it turned out assets on paper were lacking in reality. For example, officials who knew the U.S. stockpile of personal protective equipment was short were ignored when they called for funds to replenish it, the report says. We’d add this was not only a Trump issue; such problems in U.S. public health programs and funding are long-standing.
The U.S. experience underscores an important lesson for the world: pandemic preparedness involves stockpiles, resources, emergency plans (including for communications), and robust surveillance and health-care systems, but it also comes down to people. Both leaders and the public must summon the willpower to respond. It is absolutely essential to build and sustain trust and confidence.
The new report examined the preparedness of 195 nations in the thick of the pandemic, between August 2020 and June 2021, based on 37 indicators. Not everyone will agree with the rankings. Some nations suffered fewer deaths per capita than the top-ranked United States. But looking ahead, the report found “all countries remain dangerously unprepared” for the next catastrophe. This is a warning not to fall back on the cycles of panic and neglect that left the world so vulnerable last time.
