43of that work happened in 2020, as the Trump administration
insisted on having state governments handle testing, acquire
and distribute personal protective equipment, and imple-
ment vaccine distribution protocols.
This has arguably been, in retrospect, the most unfortu-
nate and most easily avoided failure. “A national and inter-
national crisis needs the full intervention of the federal
government,” says Peter Hotez, a vaccine researcher and dean
of the National School of Tropical Medicine at Baylor College of
Medicine in Houston. “It’s one of the major reasons we’ve lost
400,000 American lives, because of this bizarre insistence.”
Biden’s plan to have the federal government set up mobile
clinics and community vaccination centers in gymnasiums
and stadiums could spur things along. (It probably should
have been the plan from the beginning.) But once we’re
through the immediate crisis, the U.S. needs to take stock
of its supply chains for basic drugs, equipment, and testing
supplies—and then to provide incentives for companies to
create more capacity where it’s needed. “Our federal govern-
ment has no idea what supply chains are vulnerable,” says
Julie Swann, a health-systems expert at North Carolina State
University. When Hurricane Maria slammed into Puerto Rico
in 2017, it shut down power to one of the biggest U.S. mak-
ers of saline IV bags, exacerbating an existing shortage of
an essential medical item. This year, to name one of many
examples, a shortage of plastic pipette tips needed for auto-
mated laboratory machines slowed down Covid testing, forc-
ing labs into a constant scramble for supplies.
Not only do we have no effective way to count basic
medical staples, but we’re also unable to keep proper track
of public-health data on patients and testing capacity; it’s
all logged in a hodgepodge of outdated and often incompat-
ible federal, state, and local computer systems. Not know-
ing where outbreaks are worst makes it difficult to identify
where to send supplies. “We’re flying blind,” Swann says.
State databases need “more integration so we know in real
time where our inventory is.”
During the current crisis, all of this has been harder than
it needed to be. That’s because pandemic response requires
foresight, something that was in short supply the past few
years. “Nobody ever expected a thing like this,” Trump said
on March 24, in one of his many false statements about the
virus. Many experts had, in fact, been predicting a pan-
demic for years, but they couldn’t persuade anyone to do
enough about it.
Slaoui, the former Operation Warp Speed adviser, says
policy makers seem to care about fighting epidemics only
shortly after they’ve happened. “When the outbreak is there,
every government is all over you as an industry,” he says.
“And then when the outbreak dissolves, everybody looks
the other way.”
That’s what happened in too much of the world after
SARS, MERS, and Ebola. With 2 million dead worldwide
and a year’s worth of economic devastation, it should be
harder to look the other way now. —With James Paton
and Riley Griffinloomberg usinessweek ebruary8, 2021