US Lags in Pandemic Preparedness Post-Covid, Experts Warn

The hantavirus outbreak, while unlikely to trigger the next major pandemic, has drawn attention to the deterioration of U.S. public health capabilities, including testing for rare diseases, outbreak prevention expertise, response capacity, and the ability to combat misinformation and rebuild trust.

“Assuming everything goes well in containing this outbreak, which I hope it does, the takeaway from that should not be ‘we’re fine,’” said Stephanie Psaki, former White House global health security coordinator. “We’re not ready for this type of threat.”

Many of the health agency personnel and systems that support rapid outbreak response have been eliminated, Psaki noted. Yet “this is just one of many, many pathogens. These types of things will continue happening.” She added that scientific models indicate a 50/50 chance of another pandemic at least as severe as Covid-19 within the next 25 years.

Examining the mistakes and progress made during the Covid-19 pandemic can help prepare for future crises, Psaki and other former top U.S. officials said at a recent event in Washington D.C.

Misinformation represents one of the greatest challenges to public health. Conspiracy theories and rumors are not new—even the Milan plague around 1630 had them.

But “the only difference between hundreds of years ago is social media,” said Anthony Fauci, former chief medical adviser to the president and former director of the National Institute of Allergy and Infectious Diseases. “We’re just being overwhelmed” with online misinformation, he said, calling it “a real problem which I don’t see any easy solution to.”

People rarely relate to rigorous scientific studies with methods sections, statistical analyses, and 17 supplementary figures in the New England Journal of Medicine, but they frequently relate to social media influencers promoting fake cures, Fauci said.

“It’s stunning. It’s painful, but it’s true that somebody on social media who’s a trusted influencer will outflank any scientist who’s trying to show you data, so you can’t fight misinformation with data,” Fauci said. “You have to fight misinformation with figuring out a better way to communicate to people on a level that they understand.”

That approach requires releasing accurate information quickly and pre-bunking myths before they spread, Fauci said. “Otherwise you’re always playing catch-up. And when you’re playing catch-up, you’re losing.”

Officials also need to improve their communication of uncertainty, said Nina Schwalbe, a senior scholar at Georgetown University’s Center for Global Health Policy and Politics and former director of Covid-19 Vaccine Access and Delivery Initiative at the U.S. Agency for International Development (USAID).

“We say things too simply, and then people lose their trust.” But people can handle uncertainty “because the world is an uncertain place,” she said.

The very technological advances stemming from the pandemic—such as mRNA vaccines, widely regarded as one of the greatest innovations of this generation—are now at risk due to funding cuts and growing misinformation.

The science conducted during the pandemic was “extraordinary,” but it often “gets lost in the somewhat muddled public health response,” said Fauci. Vaccine development began six days after publication of the SARS-CoV-2 genome, and a vaccine that was approximately 95% effective was administered 11 months later.

“That didn’t happen by accident—that happened because of the years of investment in basic and clinical research,” Fauci said. That work built on responses to prior epidemics, such as HIV. The Covid-19 vaccine is “one of the best vaccines that was ever developed,” Fauci said, particularly because it can be modified rapidly as the virus evolves and can be produced in large quantities.

“It saved us,” he said. “Could you imagine how many more people would have died?”

Yet now that work is being pulled back.

The United States also failed to slow the pandemic through flawed efforts to vaccinate the world, Fauci said, adding: “We got in our own way. We didn’t make equity our driving force.” When the U.S. later offered vaccines to other countries, a lack of planning—including basic supplies like sufficient syringes—hindered the effort.

“Tens of millions of doses of vaccine is meaningless if there’s no way of distributing them in the country that needs it,” Fauci said.

This delay in global access to Covid-19 vaccines caused “deep” and “long-lasting” damage to alliances between the United States and other countries, Psaki said. “It’s being reinforced by the positions of this administration, but the damage was deep, and it’s very, very difficult to rebuild trust after that kind of betrayal.” The 2024 mpox outbreak response was better, in part because vaccines were already available, but “we were still not able to get those vaccines in arms,” Psaki said.

It is also crucial to develop and distribute tests quickly, Fauci said. “The South Koreans were putting out 20,000 tests per day, and we were playing around with five tests that didn’t work.” The “catastrophe” extended beyond faulty tests to a “refusal to believe that there are other ways of doing it,” he said.

Pandemic preparedness is not solely a domestic issue, Fauci said; it requires close collaboration with international partners, “and that’s something that, unfortunately, we seem to be steering away from right now, which is very troublesome to me.”

Donald Trump has moved to withdraw from the World Health Organization (WHO), which Psaki described as “an absolutely essential institution.” The U.S. contribution to WHO is $130 million—roughly equivalent to the Pentagon’s recent spending on lobster and steak, she noted.

In the absence of federal guidance, states are taking the lead by forming health alliances and working directly with the WHO.

“From where I sit, the federal government is not going to play the role that is needed in the next pandemic, and so we are watching states step up,” said Matthew Kavanaugh, director of the Georgetown global health policy center.

The fundamentals of outbreak response and pandemic preparation remain unchanged, Psaki said: “Stop a threat from emerging, identify the threat quickly, contain the threat, have a way to respond to the threat and keep people alive and keep hospitals from getting overwhelmed.”

Experts worry that the public, divided by politics and overwhelmed by misinformation, will lack appetite for public health measures. But it’s important to maintain “a little more space for hope and trust,” Psaki said. “Most families want to keep their family members safe”—a motivation distinct from that of political leaders and others who may benefit from misinformation, she noted.

Schwalbe’s father was among the first Covid-19 victims in New York. He became ill in March 2020 as the entire health system collapsed, Schwalbe said. “It was just me and my dad in his apartment on Lexington Avenue as he died.”

They had no oxygen or palliative care, but they had refrigerator trucks for bodies and constant sirens in the street. Schwalbe knew six people who died of Covid-19. The experience strengthened her resolve to improve public health before the next crisis.

“We can’t just leave public health as the unseen thing that people complain about when it’s not working,” Schwalbe said. “We have to invest in it.”