As President Trump prepares to sign legislation passed in response to COVID-19, there is an opportunity to address the current crisis and to prepare for the next pandemic.
Although there is a tendency to view health policy as separate and distinct from foreign policy and national security, COVID-19 and previous pandemics have demonstrated that they are inextricably linked.
Well before COVID-19, public health professionals and national security officials warned of the potential impact of pandemics to the United States. However, those warnings were ignored by successive presidential administrations and the U.S. Congress. Instead, the continued emphasis on military expenditures and interventions has come at the expense of investing in and securing America’s health care and public health infrastructure.
In the weeks after the 9/11 attacks, the media reported on potential threats to the U.S.’s infrastructure. Underlying the ominous scenarios was the threat of bioterrorism after a series of anthrax attacks. The George W. Bush administration launched the Global War on Terror, and since then at least $2 trillion has been spent on the Global War on Terror to date. Funding related to health and health security, however, has lagged far behind.
COVID-19 has demonstrated the difference in Washington’s priorities. Last week, the U.S. military announced the successful testing of new hypersonic missiles, the launch of two new aircraft carriers and recognized the seventeenth anniversary of the invasion of Iraq.
Meanwhile, California and New York warned of dire shortages in medical equipment and supplies. Hospitals also cautioned that they lacked a sufficient number of critical care beds and trained staff as well as their precarious financial position.
In addition, the dearth of available testing for COVID-19 around the U.S. exposed yet another failure in pandemic preparation.
This desperate situation is the result of decades of misplaced priorities that further demonstrate the intersection of America’s domestic and foreign policies.
Previous estimates of the global economic impact of a pandemic were roughly $6 trillion. As demonstrated by the $2.2 trillion COVID-19 stimulus package, these claims now appear optimistic. Yet the stimulus may only prevent catastrophe, but not a deep recession.
The combination of climate change, global trade and travel and forced migration ensure that pandemics will become more frequent. Therefore, it is imperative the budgets of the U.S. Centers for Diseases Control (CDC) and the World Health Organization (WHO) are steadily increased over the next five to ten years.
The Trump administration deserves criticism for steadily cutting CDC’s budget, including eliminating the pandemic response team. But Congress also shares some blame as the CDC has been underfunded for years. At $6.59 Billion, the CDC’s Fiscal Year 2020 budget is less than 10 percent of the Pentagon’s approved budget.
Even if CDC’s budget was doubled, it pales in comparison to the human and financial impact of COVID-19 to date or the cost of the next pandemic. Although the CDC is U.S.-based, it is often the lead agency in a global health crisis as it coordinates with WHO and governments around the world.
COVID-19 has reaffirmed the need for global cooperation in response to pandemics. Yet at roughly $4.4 billion per year, WHO’s budget is hardly sufficient for this task. In addition, the organization has little discretionary funding available. The United States is the leading contributor to WHO and this is an opportunity for Washington and leading American philanthropic foundations to dramatically increase their contributions over the next decade.
Washington must also take the lead in coordinating with other countries to increase their support. This includes China, Russia and India, whose contributions to the organization lag far behind other leading economic powers.
The increased funding should be focused on improving the monitoring, reporting and interventions related to pandemics. In addition, strengthening the responses in regional pandemic hotspots must be prioritized.
Finally, COVID-19 has demonstrated the shortage in medical equipment and supplies. A global stockpile of ventilators and personal protective equipment that is maintained and managed by WHO or another organization in coordination with national governments is needed.
This is also an opportunity for a bipartisan initiative to establish a long-term investment in the future of medical research and public health. As it did during the Cold War, when faced with a national emergency, Washington should increase funding for education and research in the basic sciences. This includes greater support for K-12 education in the sciences and mathematics. It is also vital that the government incentivize careers in medical research and public health and health policy.
Such a program could be modeled after or expanded upon the National Defense Education Act of 1958 (and later the Higher Education Act of 1965), the National Security Education Program and the U.S. military’s Health Professions Scholarship Program. The program would provide scholarships and fellowships for undergraduate, graduate and postdoctoral education for recipients who commit to working for state or federal government agencies or an international organization like WHO.
In addition, the National Institute of Health and the National Science Foundation require more robust and secure funding, rather than the threat of cuts. These efforts would help attract promising students to public service in a range of careers.
Yet these measures will only be partially successful unless the United States finally acknowledges the grave risk of its current approach to health care. The large number of uninsured or underinsured Americans as well as the linking of health insurance coverage to employment creates gaps in the health care system that allow a pandemic to thrive. This is further exacerbated by the large percentage of the workforce in the service sector as well as the “gig economy.” With 3.3 million Americans filing unemployment claims, even greater pressure will be placed on an overburdened health care system.
In a pandemic, domestic policy is foreign policy and the threat will not end with COVID-19. Indeed, the next pandemic may be far deadlier and arrive with less warning.
Osamah F. Khalil is an Associate Professor of History at Syracuse University’s Maxwell School of Citizenship and Public Affairs.