COVID-19: Now is the time to create the future we want

It is now crystal clear that the health of the world determines our health here at home. As countries around the world hunker down to control COVID-19, it is not too early to plan for the next phase of the pandemic. America should lead the world in creating the systems and organizations required to overcome COVID-19, prepare to respond to future threats, and make the world safer and more prosperous. 

Like SARS and MERS, other recent coronavirus epidemics, COVID-19 could disappear and not come back. But those epidemics never broke out of isolated areas. The worldwide spread of COVID-19 raises concern it will follow a course similar to the 1918 Flu. 

That pandemic tracked troop movements during World War I. The first wave in spring infected three-quarters of all French and half of British troops but did not kill at a high rate. However, it did not disappear. It moved South to North Africa and India, reaching China in June. From August to December, a second deadly wave occurred, likely a mutated version of the first, and then a third the following January eventually killing up to 50 million people.

We do not yet know if COVID-19 is seasonal and will disappear in the U.S. and Europe. Even if it does, it has already gone South with cases in 46 African nations, the sentinel cases being mostly imported, and many other countries as they head into winter. 

Like the 1918 Flu, COVID-19 could simmer in countries with less robust health systems throughout warmer months in the Northern Hemisphere, mutating enough to come back with vengeance in America. Massive troop movements are not required to replicate 1918. Seventy-five million troops were mobilized during the three years of WWI. In 2018, 234 million international travelers flew to/from the U.S. alone

After every previous threat, serious but insufficient efforts were made — and then faded away. This time the pandemic has reached our borders and caused global panic. Right now, most people must focus on meeting the current threat. 

But it is not too early to start planning for a professional, sustained structure if COVID-19 reappears and/or to respond to future threats. And for the future we want.

We can stop all movement and commerce between every country, causing massive economic chaos and suffering. Or we can use the crisis to embrace a global human family and come out of this safer, stronger, more prosperous.

Ninety-five percent of consumers live outside of the U.S. In the past decade, America’s agricultural exports to low- and middle-income countries (LMIC) increased 63 percent. 

With remarkably strong bipartisanship, the U.S. has been the global leader in the development of LMIC, in particular in global health. The President’s Emergency Plan for AIDS Relief (PEPFAR) has saved 17 million lives. 

The U.S. is the largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria that has saved 32 million lives.

Together with the Millennium Challenge Corporation, the President’s Malaria Initiative and many other approaches the U.S. has led the transformation in development to focus on results, accountability and engagement of the private and faith sectors. 

Investments in LMIC pay big dividends. Eleven of 15 of the U.S. largest trading partners once received our development support. Countries in Africa that have participated in large programs significantly increased their positive view of America. The continent of Africa is projected to double in population and has the second-highest and most sustained economic growth in the world making it a strong trading partner for the future.

In the past several years the U.S. has ceded its leadership. China and Russia have jumped into the void. American exports to Africa dropped to a 10-year low in 2016, while China’s trade increased to 3 times more than the U.S.

First, we need to get our own house in order. The experts, health officials and providers are doing heroic work. They could do much more and do it faster if systems had been in place from the outset. The recommendations of the CSIS Commission on Health Security are a great starting point. Now is the time to put meat on the bones. 

The White House pandemic response directorate should be re-established, empowered and expanded with security forces represented and an advisory council from the private sector, the councils of governors and mayors and civil society. Regular simulations of a rapid response to pandemics should be practiced — starting with a resurgence of COVID-19. 

That approach should be replicated in each state, major county and city getting down to the community, which is essential for any rapid and effective response. A network between each level should be established to ensure real-time sharing of what is and is not working. 

Based on the simulations and expert input, laboratories, health and community surge response systems should be funded and put in place. It is not enough only to continue with the current approach. We need professional, sustained structures that outlast COVID-19 and any administration. That is what South Korea did after the MERS epidemic leading to a rapid and effective response to COVID-19. 

Then we can lead by example to help get the global house in order. PEPFAR, the Global Fund, the Global Vaccine Alliance and other organizations the U.S. supports should use the health and community systems they have helped create to respond to the COVID-19 threat and to ensure that other life-saving services continue and even expand. 

This was done with great effect during the Ebola crisis. In the short term, the U.S. should build a coalition to support lasting global, regional, national and sub-national pandemic response teams and the health and community systems surge capacity that mirrors what we create at home.

When the pandemic abates, America should lead a transformation of global systems to help prevent another massive health threat and to respond rapidly if one does occur. The government should continue to support what works — PEPFAR, the Global Fund and the Global Vaccine Alliance — while we reshape our own global efforts. 

We should shift from disconnected programs, impactful as they may be, to develop plans for countries spanning economic growth and increased trade to health, education, agriculture, renewable energy, gender equality among others. Such an approach would put countries on a journey to self-reliance capable of managing a pandemic. As we accompany countries on that journey, the U.S. would once again be the trading and security partner of choice. This would not be easy. It would require significant changes in the executive branch and how Congress allocates money. 

Finally, the US should host a Bretton Woods II to reshape global development and health to meet today’s needs including pandemic responses. The global organizations we have today grew out of a conference after World War II in Bretton Woods. Over time new, often overlapping and competing institutions have been established. Good work is done, but the system and its institutions are not fit for purpose in the 21st century. Each health crisis of the past has proven this at a high human and financial cost. America can again lead the world in creating the system and organizations to meet the challenges we face today.

COVID-19 has exposed the massive fault lines in domestic and global systems that run deep and risks a repeat of 1918. There is no easy fix and no country can do it alone. Will we look inward, backward with fear or look forward, outward with hope? The former course threatens far more than our health. It brings economic ruin and insecurity. And it is fundamentally un-American. Leading by example, the U.S. can create a hopeful, secure and prosperous future. We can help create a more perfect world. 

Mark Dybul is co-director at the Center for Global Health Practice and Impact, Georgetown University Medical Center. He was the head of the U.S. President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, TB and Malaria

Deus Bazira is the co-director, the Center for Global Health Practice and Impact, Georgetown University Medical Center.