After COVID’s devastating toll, the US needs a ‘Pentagon’ for diseases

We lost about three times as many Americans to COVID-19 as we did in World War II. 

Certified COVID deaths totaled roughly 1.1 million in the US, while fewer than 420,000 Americans died in the war.

That’s more deaths per capita than any other developed nation.

Only Peru, Bulgaria, and a few Eastern European countries did worse. 

By my calculations, the US saw 540,000 more Americans perish during the pandemic than we would have if we’d performed as well as peers like Germany and Canada. 

If this was a war, we lost. 

To do better, as I explore in “The Wisdom of Plagues: Lessons From 25 Years of Covering Pandemics,” we must create a Pentagon for disease.

The book, which was released last week, relies on lessons and observations learned from covering catastrophic illness as a science reporter for The New York Times. 

I’ve reported on pandemics and plagues for nearly three decades in over 60 nations and one thing has become unquestionably clear: Our greatest flaw in the battle against disease is that, below the president, no one is in charge. 

We have no Ulysses S. Grant, no Eisenhower, no Westmoreland.

Presidents have plenty of advisors, from Tony Fauci to Jared Kushner, but the chain of command during health crises is a mess.

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The FDA approves drugs, the NIH makes grants, and the CDC offers advice. (It’s really an investigative agency, an FBI without guns or arrest warrants.)

When we needed a vaccine, a whole new bureaucracy with a goofy name – Operation Warp Speed – had to be dreamed up.

Many of the ideas that arise in “The Wisdom of Plagues” will infuriate both the left and the right.

In it, I advocate policies I would never have been permitted to defend in the Times.

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I favor vaccine mandates in crises like COVID-19 and oppose religious vaccine exemptions.

I highlight places like Taiwan, where masks clearly worked during the SARS outbreak in 2003, and defend Fidel Castro’s imprisonment of Cuba’s early AIDS victims (most of whom were soldiers, not gay men).

I generally back ironfisted responses to epidemics for a simple reason: We must choose the path that saves the most lives. 

The dead lose everything — including their civil liberties that the lucky living howls about.

From Ebola to HIV, the greatest danger is never the virus itself, but the collective psychology of the response.

All too often, it becomes mired in denialism, fatalism, bigotry, rumor-mongering, profiteering and partisan politics.

Sure enough, all of these maladies befell America during the COVID crisis.

The roots of this failure?

We became a nation in an age before germs were understood. Our Founding Fathers knew war and considered it an affair of government.

George Washington’s cabinet included a Secretary of War.

But epidemics back then traveled at the speed of a horse-drawn wagon and whether one lived or died was considered a matter of luck and prayer. 

In an age of jet travel and miracle cures, that’s dangerously anachronistic.

The Constitution is silent on health, so fighting illness has been left to localities and eventually to private industry.

We’ve seen the results across decades: Hospitals in cities with no cases hoarded ventilators when New York was desperate, during COVID.

States fought each other over masks and monoclonal antibodies.

During Zika in 2016, mosquito control was left up to counties. (We got lucky with Zika, but it could easily have become a national disaster, as it did in Brazil — and as malaria and yellow fever once were here.) 

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My chapter about the 2022 monkeypox outbreak describes even more ludicrous weaknesses: The virus named someone in charge.

We were again lucky, in that a vaccine created decades before because of false rumors that Saddam Hussein had weaponized smallpox also happened to work against monkeypox.

But even the CDC didn’t know how many doses existed.

Nearly all, it turned out, were frozen in bulk in Denmark. Deploying them took months.

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Imagine fighting a war like that.

Any student of history can name great generals and their successes, from crossing the Delaware to D-Day.

They can name officers who died or were cashiered for their blunders, from Little Bighorn to Pearl Harbor.

We know that victory requires peacetime preparation.

Instead, what we have resembles what Lincoln faced when the Civil War broke out in 1861.

The standing army was so small—a mere 17,000 — that he had to ask cities and rich citizens to raise regiments. 

The result was chaos and defeat in the first battle of Bull Run/Manassas.

Congress then organized a truly national army and authorized its new commander to replace the inept officer corps; by 1862 the North had 700,000 men under arms.

We must have the same effective responses that other countries can muster.

China, using harsh methods, contained COVID for three years.

Vietnam, by compelling citizens to take their pills, drove down its sky-high rates of drug-resistant tuberculosis over three decades.

We eradicated polio in the US in 1979 and measles in 2000, although both could return if vaccination rates fall.

We need laws that kick in during crises.

We must incentivize private industry but temper its inclination to prioritize profits over lives. (Warp Speed was a Trump administration triumph, even if many of his followers reject its results.)  

We must control travel. In early 2020, residents fleeing New York and Seattle spread COVID nationwide. 

We must reorganize hospitals so some treat epidemic victims while others handle births and surgery.

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We must be able to move resources to the front; as we’ve known ever since the Black Death, no disease strikes every city at once.

I believe we must even be empowered to draft doctors, as we did during the Korean War.

Our scattered health bureaucracies must cooperate as our military services do under the Joint Chiefs of Staff.

The CDC director should not be a political appointee.

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We cannot again have White House operatives rewriting agency studies or craven silence when a president falsely claims a pandemic will “just fade away” as Trump did during COVID.

We may even want to introduce ranks and uniforms like those worn by the Surgeon General to add a dose of gravitas to their mission.

Congress respects them, and the prospect of medals for success and epaulets stripped for failure focuses leaders on achieving success.

And we must have ways to stop and even imprison doctors who prescribe false cures.

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We do not tolerate spies who sell our military secrets to our enemies.

We should not tolerate quacks who lethally betray their fellow citizens for money.

We also need imagination and solutions that defy convention.

As I’ve witnessed during my career and in detail in my book, controversial measures have long had their place in disease mitigation and prevention — protecting porn actors in Los Angeles, sex workers in South Africa, and drug addicts in Canada against AIDS.

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Out-of-the-box thinking has also involved enlisting traditional healers to detect Ebola outbreaks or recruiting Imams to fight anti-vaccine rumors during polio immunization drives. 

Given the polarization of our country, I despair of our ability to adopt new thinking.

But thousands of American lives were needlessly thrown away. We must do better. 

Donald G. McNeil Jr., who led The New York Times’ coverage of COVID and global health, is the author of “The Wisdom of Plagues: Lessons From 25 Years of Covering Pandemics,” from which this excerpt has been adapted.

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