J. Stephen Morrison, U.S. Congresswoman Susan Brooks, and Julie Louise Gerberding, M.D., MPH. "2022 Is the Year of Decision." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, January 10, 2022. Accessed November 30, 2022. https://healthsecurity.csis.org/articles/2022-is-the-year-of-decision/
The year 2022 is the year of decision. Confronted at the year’s opening with the Omicron surge, we have no choice but to rethink U.S. approaches, at home and abroad, in both managing the ongoing pandemic and in creating better preparedness for the future. Although we have achieved significant progress with vaccines, boosters, and new therapeutics, we must come to terms with several hard realities, setbacks, and uncertainties. We must better unify and balance our domestic and international strategies, dissolving the tension between the two and making clear to Americans that each is essential to the truly global response necessary to resolve this crisis. We need to preserve and strengthen the fragile bipartisanship that has been and remains foundational to success in advancing America’s health security.
Science and technology do provide us with vital tools to manage the SARS-CoV-2 virus, even as Omicron dramatically raises the urgency and stakes in developing and deploying better, more durable, and possibly pan-variant vaccines and in bringing new therapies rapidly to scale. Operation Warp Speed taught us what is possible in terms of speed, scale, and production of vaccines when there is political will, resources, oversight, and concentrated decision authority, including use of the Defense Production Act, that blends civilian and military capacities. Thinking on our future technology needs and preparedness infrastructure is advancing; the draft American Pandemic Preparedness Plan, released in September 2021, calls for $65 billion over 7 to 10 years to develop vaccines, therapies, and diagnostics and strengthen monitoring and surveillance, domestically and globally. Whether we are successful in taking full advantage of our scientific capabilities is a matter of choice. It is a question of political will, execution, and sustained high-level diplomacy, matched by long-term funding, global coordination, and dynamic partnerships. It is also a matter of resilience and strategic foresight in adapting rapidly and effectively to variants and other changes that influence the course of the pandemic.
The pandemic calls for a longer time horizon than anticipated. That means acknowledging the uncertainty about the time it will take to gain control over SARS-CoV-2 and focusing beyond just the current phase to investing adequately against future threats. The Omicron shock may open the door to such a change in thinking. However, it will not be easy. Omicron’s apparent reduced severity may induce complacency that could in turn fuel further mass infection. Across the world today, there is widespread exhaustion. Health systems are frayed and at risk of breaking. Essential workforces are demoralized and depleted. Too many people are simply unwilling to accept vaccines, reinforced in their convictions by deep distrust, misinformation, and conspiracy theories.
The global response over the past two years has been conspicuously ineffectual and fragmented, a disarray dominated by nationalism and market forces and reflective of weakened alliances and multilateral institutions. Deep and enduring global inequities persist, manifest through disparities in access to vaccines, tests, and therapies, as well as in delivery capacity and financing. As the wealthiest and most powerful countries advance boosters and the vaccination of children, low- and middle-income countries face a 3 billion dose vaccine gap in 2022, according to the World Health Organization (WHO). Any strategy for 2022 and beyond must directly address whether—and how—to avoid the historic mistakes that thus far have created such profound disparities.
Inequities create vulnerabilities for all, including Americans who are fully vaccinated and boosted and young children who are not yet eligible to be vaccinated. They pose a threat to both U.S. national security and the American economy, since dangerous variants will continue to emerge in areas of uncontrolled transmission, particularly among the unvaccinated, and threaten to unravel gains in control of the virus everywhere. Trade, travel, and supply chains will fail to return to pre-pandemic levels. Inflation will not be arrested. The safety and health of us all will remain at risk.
In 2021, the United States increased its diplomatic engagement and invested over $19 billion appropriated by Congress toward the international response. It committed to provide COVAX, the international vaccine facility, 1 billion Pfizer-BioNTech vaccines and another 150 million vaccines to partner countries. President Biden hosted a summit in September 2021 and pledged to host a second summit in the first quarter of 2022. As 2022 opens, U.S. global leadership, while welcome and promising, is nonetheless insufficient and too often ad hoc. To meet the scale of this historic crisis requires bold U.S. action, behind a coherent and clear strategy, and a fit-for-purpose interagency structure. Robust diplomatic leadership requires financial commitments at an estimated annual level of $18–20 billion over the next five years to cover both the acute response and investment in future pandemic preparedness. Recent opinion surveys demonstrate that Americans will stand behind such a strategy when it is explained.
An emergency supplemental appropriation is an urgent, essential step, however difficult that may be to achieve. If the administration provides Congress with an accounting of the monies already appropriated under past coronavirus spending bills, that will bolster support and confidence in Congress in new appropriations. Capacities used to great effect domestically, most importantly at the Department of Defense (DOD), have not yet been systematically integrated into the U.S. international effort. Though there is a promising U.S. government consensus supporting a new global leaders’ group and a pandemic preparedness financing mechanism, the Biden administration has struggled to enlist longstanding allies and global leaders to make ambitious commitments. More patient and intensified U.S. diplomatic investments are needed. Meanwhile, stark differences with China impede even routine global cooperation on critical health security challenges.
What scale and type of U.S. leadership and enhanced diplomacy are essential to surmount the disorder in the global response, cope with the proliferation of variants, and lay the groundwork for long-term preparedness among our partners? How do we update our thinking on the true nature of the security threat that the pandemic poses to U.S. national interests? How can we achieve greater alignment and balance in the U.S. domestic and international approaches? Continuing to build much more muscular U.S. leadership remains the sine quo non both for achieving greater order and equity in the global response, including galvanizing other countries, international institutions, the private sector, civil society, and foundations to act with the urgency that the moment demands. The CSIS Commission on Strengthening America’s Health Security proposes eight recommendations to secure U.S. global leadership in the next phase:
This report is a product of the CSIS Commission on Strengthening America’s Health Security, generously supported by the Bill & Melinda Gates Foundation.