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Illustration: Aïda Amer/Axios

Early global and national lessons of COVID-19 are already being used to plot a path to preventing the next pandemic.

Why it matters: As hard as it might be to accept, we're no less at risk for another infectious disease pandemic now than we were at the start of COVID-19. Unless we revamp how the international community monitors infectious disease and bolster our national defenses, the next one could be even worse.

What's happening: On Thursday the Council on Foreign Relations (CFR) released the first broad, bipartisan investigation into how the world failed on COVID-19, and how it can shore up its defenses against the inevitable next global disease.

  • The failures began with China, which dissembled early about the extent of the new disease, and with the WHO, which didn't press Beijing for transparency and initially underplayed the threat of what would become COVID-19.
  • But while those failures "explain how a local outbreak became a global pandemic," as CFR President Richard Haass writes in the report, the fact remains that the U.S. government bears major responsibility for how much worse COVID-19 has been here than in many other comparable countries.

Context: CFR's recommendations fall into two main areas: global and national.

  • We need what Thomas Bollyky, director of CFR's global health program, terms a "sentinel network" in health care facilities around the world that can rapidly share data about any new diseases, as well as enhanced UN coordination to help ensure countries don't cover up outbreaks.
  • That will require funding of international health at a scale that currently doesn't exist — the WHO's entire $2.4 billion budget is less than some major U.S. hospitals, and less than 1% of total foreign aid for health goes to pandemic preparedness.

On the national side, CFR distinguishes between failures of preparation and failures of response — both of which hobbled the U.S.

  • The U.S. has underfunded pandemic preparation for years, and in the 2020 fiscal year budget the government allocated just $547 million to global health security threats, compared to $750 billion for the U.S. military overall.
  • Funding for the CDC's Public Health Emergency Preparedness cooperative agreement has decreased by more than 25% since 2002, while over the past decade local public health departments — the foot soldiers of disease response — have cut more than 50,000 staff because of budget cutbacks.

What they're saying: While the U.S. was far from ready when the pandemic came, "I'm still surprised we didn't do better at containment," says Bollyky.

  • A pandemic, unlike nearly every other natural disaster, is a truly national catastrophe, yet Washington left it to "states to largely figure it out for themselves," writes Haass, to the point where governors were competing for scarce protective equipment.
  • Far from providing a unified message, the national government has too often been a font of misinformation, with a recent study identifying President Trump himself as as the single largest driver of the "infodemic."
  • Without a national system for testing and tracing, "we had to shut down everywhere," says Bollyky, creating enormous economic pain that more nimble nations like Singapore and South Korea were able to avoid.

What's next: From the top, the White House needs to designate a senior official who can act as a focal point for global health.

  • A national surveillance program for testing and tracing needs to be put in place and kept in place for the next disease, as well as building up a Strategic National Stockpile of medicine and equipment.
  • Internationally, the U.S. should work to reform the WHO — rather than leave it, as the Trump administration has promised — and reassert international leadership on global health surveillance.

The big picture: The rate at which new pathogens like the novel coronavirus are emerging from nature is increasing, while advances in biotechnology enhance the threat of man-made diseases.

"The next pandemic could easily emerge imminently, even while the current pandemic is still raging. It could easily be worse than the one we have today. So the time to move forward is now. "
— Thomas Bollyky

What to watch: The rapid progress on COVID-19 vaccines is the one real bright spot in this pandemic, but will the international community figure out a way to rapidly and equitably distribute them?

Go deeper

Rep. Lou Correa tests positive for COVID-19

Lou Correa. Photo: Tom Williams/CQ-Roll Call, Inc via Getty Images

Rep. Lou Correa (D-Calif.) announced on Saturday that he has tested positive for the coronavirus.

Why it matters: Correa is the latest Democratic lawmaker to share his positive test results after last week's deadly Capitol riot. Correa did not shelter in the designated safe zone with his congressional colleagues during the siege, per a spokesperson, instead staying outside to help Capitol Police.

Updated Jan 15, 2021 - Axios Events

Watch: Affordability and the next administration

On Friday, January 15, Axios' Caitlin Owens hosted a conversation on the future of health care affordability with a new Biden administration, featuring former CMS administrator Dr. Mark McClellan and former Rep. Greg Walden (R-Ore.)

Dr. Mark McClellan discussed the priorities of the incoming Biden administration and challenges in health care access and affordability exacerbated by the pandemic.

  • On President-elect Biden dealing with the pandemic: "[He] was elected above all else for an effective response to the crisis. And that means the first round of legislation has to focus on more effective vaccination, more effective testing, reopening the economy, and giving people the economic support they need."
  • On people not getting the care they need during the pandemic: "We've seen a lot of health care complications because people did not get help. We don't have a strong public health system in this country...Most people did not get help. If they were at risk for infections, they had to go find a way to get tested on their own."

Rep. Greg Walden unpacked the value of telemedicine and creating an affordable, patient-centered health care system.

  • How technology can bridge existing health gaps: "We've learned the importance and practicality of getting health care closer to the patient. I'm speaking specifically about telemedicine. I think it can be both cost-effective and so much more convenient for the patient...You shouldn't have to rush into a hospital for everything you need."

Axios Vice President Yolanda Taylor Brignoni hosted a View from the Top segment with the CEO of OptumHealth, UnitedHealth Group, Dr. Wyatt W. Decker, who discussed the pandemic as a moment for the industry to think differently about how they provide accessible care.

  • On the potential for telemedicine: "Let's put the decision-making, good information, and support in the hands of a person and help provide them with digital tools that can give them easy access to health care with excellent outcomes. We [can] do this in a whole variety of ways by providing telehealth solutions."

Thank you UnitedHealth Group for sponsoring this event.

Caitlin Owens, author of Vitals
43 mins ago - Health

Who benefits from Biden's move to reopen ACA enrollment

Photo: Chip Somodevilla/Getty Images

Nearly 15 million Americans who are currently uninsured are eligible for coverage on the Affordable Care Act marketplaces, and more than half of them would qualify for subsidies, according to a new Kaiser Family Foundation brief.

Why it matters: President Biden is expected to announce today that he'll be reopening the marketplaces for a special enrollment period from Feb. 15 to May 15, but getting a significant number of people to sign up for coverage will likely require targeted outreach.