New Zealand closed its borders yesterday. The Land of the Long White Cloud called its sons and daughters home, latching its door shut behind them like a parent ushering their children across the threshold as the day darkens. In a world of porous borders, it’s strange to be reminded that each of us belongs in a place.
There’s some comfort in it, some security in laying down roots and staking a claim to a piece of land. It gives you a kind of assurance—or is it insurance? As if, when everything goes to hell, you can sink yourself in your own sweet mud, a frog seeing out the winter. But there is a flipside to the bargain. A country quite literally is its people; it cannot live unless its people survive. That connection is what makes public health a matter of national security.
And so, the nations of the world debate what can be done and what should be done to curtail the spread of COVID-19. The world has broken apart into its constituent pieces, each one coming to its own conclusion. As of now, it’s unclear which countries have been bold enough to walk the tightrope successfully and which have made missteps. What is beyond doubt is that when you put all those puzzle pieces together, we as a global community are not prepared for pandemics. And if past performance is the best predictor of future behaviour, I’m afraid that there is no reason to expect that to change.
In his seminal work, The Plague, Albert Camus wrote:
The people of the town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate? They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine .
Camus lays out the problem clearly: part of living is ignoring the fact that we will die. That’s natural, even essential. It does not merit blame, only acknowledgement. But a side effect of this defence strategy, which protects us so well from distress, is that we lower our guard and leave ourselves vulnerable to attacks from other quarters.
The result, as it relates to pandemics, is a cycle of increased funding followed by relative neglect . A disease emerges and spreads and we are afraid, and where our fear is, so goes funding. Then time passes and we forget, because forgetting lets us go on with our lives. Less fear, less funding.
This is not new. Following the Ebola epidemic of 2013-2016 (remember that?), there were calls for increased, sustained funding for pandemic preparedness , as professionals felt that the crisis highlighted gaps in our defences. But it is hard to stay focused on what seems like a possible threat when there are so many real and present dangers and only so many dollars to go around.
It’s true that over the short-term (1-4 years or so, the length of an elected official’s term in office), the threat of disease is merely possible. But over longer periods, say, a decade, an outbreak becomes a near certainty. I was born in 1987. In my lifetime, there have been at least 3 pandemics (AIDS (ongoing); H1N1influenza (2009-2010); and COVID-19), as well as several serious epidemics, including SARS and Zika virus. And yet, even with all this warning, the world wasn’t ready. All around us, governments, schools and businesses are developing plans on the fly. Lessons have not been learned because the fear doesn’t last. As recently as 2018 (just two years after an Ebola epidemic), President Trump dissolved the White House National Security Council Directorate for Global Health Security and Biodefense, one of the bodies in charge of pandemic preparedness at the federal level .
Rahm Emanuel famously said that we should “never let a serious crisis go to waste” , urging action when fear is the freshest in our minds. Abiding by that advice means taking definitive, long-term steps now to stave off the next pandemic. But how can we break the cycle and ensure that a boost in funding now doesn’t fall prey to later cuts? The only way is to place humans one step removed from the equation. Nations need to set aside a generous fund for pandemic preparedness in perpetuity with the appropriate checks and balances, eliminating annual budget debates. Spending should be scrutinized, but the allocation should be accepted as a given. That is the only way to insulate pandemic preparedness from the whims of lawmakers in less troubled times.
We need to establish a system that will shoulder the burden of remembering our fear. And we need to do it when we are most afraid. Because, lest we forget, we always forget.
1. Camus, Albert. The Plague. Penguin Modern Classics, London, England, p.30-31.
2. Yong E. The deadly panic-neglect cycle in pandemic funding. The Atlantic 24 October 2017. Accessed on 15 March 2020. Available at: https://www.theatlantic.com/science/archive/2017/10/panic-neglect-pandemic-funding/543696/
3. Burkle FM. Global health security demands a strong international health regulations treaty and leadership from a highly resourced World Health Organization. Disaster Medicine and Public Health Preparedness 9(5):568-580.
4. Cameron B. I ran the White House pandemic office. Trump closed it. The Washington Post 14 March 2020. Accessed 15 March 2020. Available at: https://www.washingtonpost.com/outlook/nsc-pandemic-office-trump-closed/2020/03/13/a70de09c-6491-11ea-acca-80c22bbee96f_story.html?fbclid=IwAR0TFwUNNFGx6U9zyQiK0MHwGKmj8abG-BusDcQbH-Wp5IHYuW82yA7U5ZU
5. Wikiquote. Rahm Emanuel. Wikipedia. Accessed on 15 March 2020. Available at: https://en.wikiquote.org/wiki/Rahm_Emanuel