At the opening of the Fourth Pandemic Policy Summit in the Fall of 2018, “Texas Commissioner of Public Health Dr. John Hellerstedt, recalled the response from across the United States to the needs of Texas and specifically the Houston area, in the wake of Hurricane Harvey. He showed pictures of National Guard helicopters, American Red Cross relief packages, and volunteers pouring into the state. The cavalry rode to the rescue. He rightly pointed out, though, that in pandemics on the scale of the 1918 Spanish Flu or the 1957 Hong Kong Flu, capitals like Washington, DC, Beijing, or Brussels will have limited capacity to aid distant provinces, able only to deal with their own sick and dying. The cavalry won’t ride to the rescue because the cavalry will be in the hospital. Instead, communities need to prepare to respond alone.”1 These words, written before COVID19 was even on the radar screen, turned out to be hauntingly accurate.

For years, the scientists and academics at the Pandemic & Biosecurity Policy Program at Texas A&M have quietly labored away, preparing for the next pandemic. In the Fall of 2019 they held their latest Pandemic Policy Summit and had begun compiling insights gathered over the past five summits into a book, edited by Scowcroft’s Dr. Christine Crudo Blackburn, PhD. Little did Dr. Blackburn and her co-authors know that in just a few weeks, their work would become suddenly more vital and urgent. To help share their insights, CollaborateUp CEO, Richard Crespin, moderated a virtual roundtable with experts from the Scowcroft Institute of International Affairs of Texas A&M University on their recently published Preparing for Pandemics in the Modern World.

Panelists included:

  • Christine Crudo Blackburn, Ph.D. — Deputy Director, Pandemic & Biosecurity Policy Program, Scowcroft Institute of International Affairs, Texas A&M University.
  • Gerald Parker, Ph.D. — Associate Dean, College of Veterinary Medicine & Biomedical Sciences and Director of the Pandemic & Biosecurity Policy Program, Texas A&M University.
  • Leslie E. Ruyle, Ph.D. — Assistant Director of the Scowcroft Institute of International Affairs, Texas A&M University.
  • Richard Crespin — CEO of CollaborateUp and CSIS Senior Associate.

Watch the webinar here:

Read the e-book here!

The roundtable called for a fundamental paradigm shift surrounding the importance of pandemic preparedness as an existential issue. Co-author and Associate Dean of the College of Veterinary Medicine & Biomedical Sciences at Texas A&M University Dr. Gerald Parker said that “emerging infectious diseases with pandemic potential constitute and ought to be treated like other national security threats.”

“I’m hopeful that we will get beyond this boom-and-bust cycle that we’ve had over the last 15 years and have pandemic preparedness recognized as a national security issue.”

The conversation delved into the lessons learned from past outbreaks, leadership strategies for COVID-19 and future pandemics, and much more. Panelists built a roadmap to change the game around pandemic preparedness and learn from what we know, instead of just reacting to the crisis we see.

Dr. Blackburn explained that the team hoped to fill essential pandemic preparedness gaps, with lessons learned from the 1918 pandemic, analysis of the One Health approach — which argues that community health relies on the health of the environment and its inhabitants — and the need for collaboration across governments, response organizations, and the private sector. 

Picking up on One Health, Dr. Leslie E. Ruyle explained the zoonotic origins of COVID-19 through the lens of environmental science and international spread, bringing the panel to its first key takeaway:

Takeaway #1: prepare to act in the face of uncertain data by moving upstream of the problem. 

Dr. Ruyle noted that the true scientific consensus on the origins of COVID-19 remains a mystery; we have a global issue that started from a very small and still mysterious beginning. While initial reports claimed that the virus originated in a Wuhan seafood market, 13 of the 41 initial patients had no relationship to that market at all.

But the widespread impact of COVID-19 draws on recent scientific understanding of the growing influence of zoonotic infectious disease in the modern world. Dr. Ruyle stated that about 60% of infectious disease has a basis in animals and 72% come from wildlife, with that trend increasing as humans and animals come into close contact through deforestation/climate change and globalization/international travel increases the potential for global infectious disease spread.

While the science may not be entirely clear on the virus’s precise origin, a significant preponderance of the evidence shows us that it likely emerged from human-wildlife interaction. Therefore we need to move “upstream” of the problem. Rather than only reacting to the presence of wildlife in Asian “wet markets” and other food markets, governments should take steps now to reduce the likelihood of transmission in the first place by discouraging the use and consumption of endangered wildlife, increasing public health standards in legal food markets, and shutting down illegal wildlife trade. 

The conversation then turned to Dr. Gerald Parker, focusing on what leaders and communities can do to prepare for the recent uptick in COVID-19 cases and future unforeseen pandemics.

Takeaway #2: lead by example and through a comprehensive, overarching strategy

Dr. Parker emphasized that leading by example is essential. Leaders at the international, national, and community level must display that they are wearing face coverings and following social distancing, and must assume that they’re not doing a good enough job in communicating these essential practices. Mandates lose power and can stir resentment if central communication and leading by example are not present. Consistent, repetitive messaging from public officials is vital.

He then turned to the especially troubling nature of pandemics for local leaders, who, as mentioned earlier, often feel abandoned by overwhelmed central governments. This suggests the crucial nature of a comprehensive, national preparedness strategy that enables effective leadership, coordination, collaboration, communication, and innovation at all levels of government and the private sector.  Everyone needs to know their roles and responsibilities to mitigate all levels of governments and responders from becoming overwhelmed in the first place. Dr. Parker touched on the George W. Bush administration’s comprehensive H5N1 pandemic preparedness program, which entailed coordination between local governments, NGOs, and the private sector to develop community mitigation guidelines and other plans in the case of sudden spread. Disturbingly, the current and past administration chose to not keep the focus on, and the importance of pandemic preparedness a national priority, and this administration has not valued the importance of global health security compared to past investments.

Dr. Parker argued that we lack that coordination at the moment, which has contributed to the present policy confusion over COVID-19. Still, Dr. Parker recognized the challenges any federal government would face in the case of a widespread pandemic — a situation similar to 25 hurricanes hitting different regions of the United States all at once. Preparedness therefore must involve local and state capacity building to build up resilient response across communities and moving beyond a just-in-time supply chain system to stockpile resources at the local level. If we had a national pandemic response strategy, we would be able to overcome many challenges we are confronting now. 

Dr. Blackburn then built off of Dr. Parker’s analysis on the importance of overarching preparedness strategy:

Takeaway #3: use the past to look to the present, and don’t forget hard lessons learned.

Dr. Blackburn brought up the nightmarish loop that policy makers and leaders often find themselves in during pandemics: wishing that they were more prepared when the outbreak happens combined with an inability to take forward tough lessons learned after the crisis wanes so that future preparedness systems can be put in place.

“One of the things that we keep running into over and over as we analyze pandemics like Zika or Ebola is that we really wish we were prepared before it happened. But we’re saying that every single time that a pandemic comes along.”

— Christine Crudo Blackburn, Ph.D.

These tough lessons include the need to put funding and resources in place outside of crisis so that they can be deployed quickly to contain infection instead of simply mitigate it. Timing is crucial in pandemic response and if the system is not ready to launch and supply chains ready to adapt at a moment’s notice, the situation can quickly spiral out of control. As Dr. Blackburn put it, we must learn going forward, not just observe.

Dr. Parker added that challenges observed in COVID-19 can be seen in many past outbreaks like Ebola, H1N1, Zika, SARS, etc, including issues with vaccines, therapeutics, information sharing, diagnostic and hospital surge, and many more. This again draws on the fundamental need for an overarching structure that allows political commitment and will to re-organize at all levels of government and create a flexible and agile response system. Dr. Parker argued that emerging infectious diseases should be treated as national security threats, bolstered by public advocacy from citizens, to encourage resource commitments toward a sustained preparedness and prevention effort.

Dr. Parker listed some tangible steps that can be taken to achieve this outcome, such as:

  • Investment in international development and global health security: while it might seem counter-intuitive to invest abroad when resources are needed at home to fight a pandemic, the best offense in this case is a good defense — by prepositioning resources abroad we create early warning systems to alert us before the pandemic reaches our shores and the opportunity to fight it in countries of origin before it explodes across the globe.
  • Public and animal health capacity:  especially in low and middle-income countries where zoonotic spillovers often occur. By investing in their capacity, we shore up the early warning system and again, hopefully stop the disease well before it becomes a pandemic.
  • Going beyond simply “flattening the curve”: local leaders need to proactively make decisions through: research on transmission and immunology; protecting those most at risk; increasing hospital capacity; and building the public health nexus to balance testing, tracing, and triage.

Turning to the recent headlines of the US announcing its withdrawal from the World Health Organization, Dr. Blackburn brought an international perspective on pandemic preparedness:

Takeaway #4: disease doesn’t respect borders; we must engage the global system to prevent pandemics at home.

Building off of Dr. Parker’s insights, Dr. Blackburn argued that a country as influential as the US withdrawing from the WHO presents a twofold issue; it puts the pandemic response capacity of both the United States and the international system at a disadvantage because of lack of global crisis collaboration. Countries must work together to manage and prevent pandemics given the rapid, global spread of infectious disease like COVID-19.

Dr. Ruyle built on Dr. Blackburn’s comment by breaking down the borderless conception of the One Health approach — to holistically address pandemics caused by zoonotic spillover, it’s important to remember that the health of humans, animals, and the environment are all linked and must be addressed together. This concept can save resources in the long run, as investing in conservation in low and middle-income countries can, for pennies on the dollar, prevent the massive allocation of resources that states have had to undertake during the COVID-19 pandemic.

“When we look at the cost of doing conservation, of supporting investments in lower and middle-income countries, that will be a lot cheaper if we invest at that very basic level than what we’re dealing with now.”

— Leslie E. Ruyle, Ph.D.

Dr. Parker added that while leaders should have the right to evaluate the international institutions and their effectiveness, withdrawing from the WHO in the middle of a pandemic is not the effective path forward. Wait for the crisis to pass and then segue to an after-action state of mind. Reforming these existing institutions will be much cheaper than starting over.

Panelists then analyzed the upcoming decision many schools will soon have to make regarding in-person vs. online instruction as the Trump administration announces it will press states to re-open schools in the fall, forming our fifth takeaway:

Takeaway #5: think about unintended consequences and respect the innovation of other leaders.

Dr. Parker stated that decisions surrounding resuming in-person classes at educational institutions should pay attention to local dynamics. Different communities are hit with differing severity, so governors and local community officials should be given the space to make decisions and think creatively. In addition, the potential for innovation in the private sector, such as grocery stores’ new safety practices, to adapt to changing circumstances should be encouraged and brought to scale so that many crucial parts of the economy can remain operational.

During these re-opening decisions, leaders should also consider the unintended consequences of lockdown protocol, such as economic impact, mental health, learning loss, and unequal access to broadband for low-income students. COVID-19 will be a risk that we have to live with for a while, and we’ll need to figure out a way to both mitigate its risk and keep community needs met.

“We’ve learned that there’s been many unintended consequences in the health and medical lane that go bar beyond the consequence of COVID-19, whether that be mental health, whether that be people not seeking care for other conditions, or other deaths that have occurred because they were afraid to go to the hospital.”

— Gerald Parker, Ph.D.

Dr. Blackburn elaborated on the importance of turning to scientific data when addressing questions like these; evidence suggests that children are less susceptible to COVID-19 and may also be less infectious, meaning that kids could be put back in school if effective systems are put in place.

The panel concluded with moderator Richard Crespin asking each panelist their one tip for people as they respond to COVID-19 and future pandemics:

Takeaway #6: be kind and don’t place blame.

In the words  of Dr. Ruyle, “we are all in this together.” Pandemics are a human issue and we need to be creative and support each other if we’re going to get through them. Be kind and patient, and think about those who are vulnerable.

Takeaway #7: prepare, prepare, prepare, and prepare more.

Dr. Parker echoed the importance of kindness and closed with the idea that pandemic preparedness should become an existential policy question. We have some rough days ahead of us, so fall back on respect and dignity as we navigate the coming days, months, and years.

Takeaway #8: don’t forget COVID-19 when it’s over

Dr. Blackburn closed with the importance of remembering the lessons of 2020 and COVID-19. Though 1918 is often discussed now, it was quickly forgotten during its immediate aftermath and is referred to as “the forgotten pandemic” by historians. Move forward remembering the challenges we faced and learn from those challenges. 

Footnote:

1 Richard Crespin, Preparing for Pandemics in the Modern World, ed. Christine Crudo Blackburn (College Station: Texas A&M University Press, 2020), 223.


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