From the Atlantic
The Next Plague Is Coming. Is America Ready?
The epidemics of the early 21st century revealed a world unprepared, even as the risks continue to multiply. Much worse is coming.
ED YONG JULY/AUGUST 2018 ISSUE
This article appears in the July/August 2018 print edition with the headline “When the Next Plague Hits.”
Yet even the U.S. is disturbingly vulnerable—and in some respects is becoming quickly more so. It depends on a just-in-time medical economy, in which stockpiles are limited and even key items are made to order. Most of the intravenous bags used in the country are manufactured in Puerto Rico, so when Hurricane Maria devastated the island last September, the bags fell in short supply. Some hospitals were forced to inject saline with syringes—and so syringe supplies started running low too. The most common lifesaving drugs all depend on long supply chains that include India and China—chains that would likely break in a severe pandemic. “Each year, the system gets leaner and leaner,” says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It doesn’t take much of a hiccup anymore to challenge it.”
Perhaps most important, the U.S. is prone to the same forgetfulness and shortsightedness that befall all nations, rich and poor—and the myopia has worsened considerably in recent years. Public-health programs are low on money; hospitals are stretched perilously thin; crucial funding is being slashed. And while we tend to think of science when we think of pandemic response, the worse the situation, the more the defense depends on political leadership.
When Ebola flared in 2014, the science-minded President Barack Obama calmly and quickly took the reins. The White House is now home to a president who is neither calm nor science-minded. We should not underestimate what that may mean if risk becomes reality.
Bill Gates, whose foundation has studied pandemic risks closely, is not a man given to alarmism. But when I spoke with him upon my return from Kikwit, he described simulations showing that a severe flu pandemic, for instance, could kill more than 33 million people worldwide in just 250 days. That possibility, and the world’s continued inability to adequately prepare for it, is one of the few things that shake Gates’s trademark optimism and challenge his narrative of global progress. “This is a rare case of me being the bearer of bad news,” he told me. “Boy, do we not have our act together.”
Preparing for a pandemic ultimately boils down to real people and tangible things: A busy doctor who raises an eyebrow when a patient presents with an unfamiliar fever. A nurse who takes a travel history. A hospital wing in which patients can be isolated. A warehouse where protective masks are stockpiled. A factory that churns out vaccines. A line on a budget. A vote in Congress. “It’s like a chain—one weak link and the whole thing falls apart,” says Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. “You need no weak links.”
Rear Admiral Tim Ziemer, a veteran malaria fighter, was appointed to the National Security Council, in part to oversee the development of the White House’s forthcoming biosecurity strategy. When I met Ziemer at the White House in February, he hadn’t spoken with the president, but said pandemic preparedness was a priority for the administration. He left in May.