9 things for the next pandemic

1. Move fast

This is one of the biggest, sharpest dividing lines between the countries that handled the coronavirus well and the ones that handled it poorly. If you don’t kick into gear until it’s a crisis, you’re only going to ensure a much bigger and longer-lasting crisis.

2. Diversify the preparation

The global public health community had been preparing for a pandemic, but may have been too narrowly focused on an influenza pandemic, says Claire Standley, an expert on international public health systems at Georgetown University.

• There were plenty of good reasons to think flu would be the most likely source of a pandemic, and it’s probably still the most likely to cause the next one, but the fact that we got a coronavirus instead should be a wake-up call against disease-specific planning.
• That means stockpiling a wider range of antiviral drugs, as well as generalized supplies like protective gear and testing components.

3. Have a backup plan for diagnostics

The World Health Organization’s initial coronavirus test had a high error rate, so the U.S. decided to develop its own, but then that test didn’t work. Mistakes happen, and it’s not realistic to just plan not to have any problems next time.

• The lesson is to be nimble — even a flawed test is better than no testing.
• The Trump administration ultimately cleared away a lot of red tape to get commercial and academic labs into the mix, and some of those policy changes should probably happen even faster next time.

4. Build up contact tracing

The basic playbook is testing, contact tracing and isolation, in that order. If testing is better in a future pandemic, we’ll want to be able to do the second step, too.

• Other countries can do it. Massachusetts has a contact tracing infrastructure that, while not perfect, is probably the best in the U.S. and a model to build on. Baltimore found a clever solution by reassigning school nurses to do contact tracing.
• Silicon Valley’s on-the-fly coronavirus tracing tools have had relatively limited pickup, but there’s an obvious role for tech in a more structured, preemptive framework.

5. Accept risk on vaccines

Governments, drug companies and philanthropies are accepting an unprecedented financial risk in the race for a coronavirus vaccine, and it seems very likely to pay off.

• Trials are still ongoing, so there’s no promise that any one vaccine will work.
• But the way this process is progressing — plowing ahead on multiple fronts, getting a jump on manufacturing and throwing away the products that don’t work — is a new model. And it seems likely to deliver a vaccine faster than anyone thought possible.

6. Walk the public through the things you’re asking of them

Especially with a new virus, our scientific understanding will inevitably change, and public-health guidance will have to change along with it. Being transparent about what the public is being asked to do, and why, will go a long way.

• Masks are a great example. Early on, officials dissuaded the public from buying masks because there weren't enough masks, and health care workers needed them. But that rationale wasn’t made explicit.
• As scientists later learned that masks were even more effective than they thought, and as the supply of masks skyrocketed, a very reasonable evolution toward pro-mask guidance felt instead like confusion and whiplash, undermining the message.

7. International cooperation is key

In the earliest days of COVID-19, China quickly and openly shared the virus’ genetic sequence, and the WHO helped disseminate that information. Experts call it one of the most consequential successes of the pandemic, imperative to getting started on potential tests, therapies and vaccines.

• Since then, however, the WHO has faced plenty of well-founded criticism, the U.S. has retreated from that body, and some of China's data has become much less trustworthy.
• Some institutions may need to be reformed, Standley said, and others — perhaps the United Nations — may need to take on a bigger role in some parts of future response efforts.
• But in a global pandemic, information-sharing and cooperation is essential to understanding the threat, figuring out who’s most at risk, and allocating the resources everyone needs to get through it.

8. Build a more equitable health care system

The coronavirus has reflected and amplified the inequality within the U.S. health care system. As long as those inequities persist, future pandemics will exploit them, too.

• We knew well before this pandemic that Black Americans had worse health outcomes, on average, than white Americans. We knew that inadequate housing, poverty and food insecurity were all tied to health, and that those factors also break along racial lines.
• We can’t know now what will cause the next pandemic, but we know that the status quo of the U.S. health care system will put poor people and people of color at a disadvantage from the very beginning.

9. The economic response and the health response go together

In a pandemic like this one, where isolation is part of the solution, economic stability and public health reinforce each other.

• Some European economies have rebounded more quickly than the U.S., largely because they have done a far better job containing the virus.
• They were better able to control the virus in part because they had more successful lockdowns, and they had more successful lockdowns in part because they constructed stimulus plans that allowed people to lock down without sacrificing their livelihoods.

The bottom line: The constant here is preparation and upfront investments — in big-picture systems, long-term planning and swift, early action once a crisis hits.

• “All of that is money well spent if you can avert the kind of catastrophe we’ve seen with COVID-19,” Standley said.