Crisis of Command
America’s Broken Civil-Military Relationship Imperils National Security
For perhaps the first time in modern history, the entire, interconnected world is focused on solving a single problem. The novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, have transfixed the global community, as leaders and citizens seek to respond to a threat whose dimensions are neither entirely certain nor entirely known.
Members of the scientific community around the world are stepping up to find answers to the many questions the pandemic raises. Experts are working together, both inside and outside of laboratories, to provide the best information directly to the public (for example, through the Federation of American Scientists’ crowd-sourced website), to coordinate global research priorities, and much more. Arguably, no expert community has a more important role to play in finding the solutions the world needs and communicating trustworthy information to the public.
With remarkable speed over these last three months, scientists have uncovered fundamental insights about the novel coronavirus and the interventions that might best address the disease it causes. In December, a group of Chinese researchers published the genetic sequence of the new virus online through the Global Initiative on Sharing All Influenza Data. That data allowed the international scientific community to start developing diagnostic tests and explore treatment options. The site now holds the genetic sequence of the virus as found in hundreds of patients across six continents. By mid-January, researchers in Germany, along with collaborators in other European countries and in Hong Kong, published details of a diagnostic test to detect the novel coronavirus. The World Health Organization dispatched kits based on these findings to laboratories worldwide and hosts the protocols from kits from seven countries on its website. BioRxiv and medRxiv, open online repositories of not-yet-published studies in biology and health sciences, currently host more than 420 papers on the new coronavirus. The WHO has reported more than 390 clinical trials on its international registry platform, and the National Institutes of Health’s first vaccine clinical trial commenced on Monday.
As impressive as this progress is, the world needs more, and quickly. Much remains that scientists don’t fully understand about the novel coronavirus, including its transmission dynamics, its potential to reemerge in waves like the 1918 Spanish flu, whether it is mutating, where it came from, and how environmental factors, such as temperature, may affect its spread. About the disease, too, questions remain, including why the response of patient populations to infection may differ and whether those who have been infected develop short- or long-term immunity. Researchers are racing to develop treatment options and tests that are accurate, sensitive, rapid, and locally deployable. Epidemiologists and social scientists seek to understand which mitigation measures will be the most effective in controlling the spread of the virus; how valuable extreme measures, such as quarantines and travel bans, really are; and what consequences such policies may have on other areas of public health.
Infectious diseases, it is commonly said, know no borders, and neither does the knowledge needed to fight them.
In the search for answers to these and other burning questions, every nation has something to give and something to gain. Infectious diseases, it is commonly said, know no borders, and neither does the knowledge needed to fight them. Scientists around the world routinely share information and collaborate across borders. The current pandemic has scientists working together on platforms such as Slack, and using new tools, such as machine learning, to rapidly detect the novel coronavirus in tests that use large amounts data from multiple sources. This outbreak has demonstrated in real time how scientific understanding can indeed be a global public good.
In recent years, geopolitical competition, particularly between China and the United States, has given rise to discomfort in some quarters with the collaborative nature of the scientific enterprise. To the extent that scientific advancements lead to new products and technologies, countries seeking to advance their own national or economic interests tend to view science more through a competitive, rather than cooperative, lens. Drugs and vaccines can generate huge revenues. But one country’s fight against a fast-moving contagion is inherently linked to that of its neighbors—whether friends or foes—so everyone needs to win the battle. In a global pandemic, the value of open collaboration is obvious. Its usefulness in confronting other shared threats, such as climate change, should be obvious, as well.
The COVID-19 pandemic comes at a time of rising nationalism around the world. But insularity and xenophobia cannot possibly produce an effective response to this global crisis. The magnitude of this moment calls instead for the sharing of expertise and cooperation among nations and for informed, evidence-based, coordinated responses from national governments.
Fortunately, many institutions across countries and sectors have risen to meet the need. The Bill & Melinda Gates Foundation, the Wellcome Trust, and Mastercard have dedicated $125 million to the COVID-19 Therapeutics Accelerator, which seeks to identify potential treatments, accelerate their development, and prepare to manufacture millions of doses for worldwide use. The WHO is working to finalize a “master protocol” for clinical trials, which will increase the size of the trials by pooling patient groups around the world and thus potentially identifying differences in responses across patient populations. The G7 leaders met on Monday and discussed commitments to research cooperation, among other shared concerns.
Much more remains to be done in order for global cooperation to be effective. For example, at a recent meeting led by the WHO and the Global Research Collaboration for Infectious Disease Preparedness, more than 300 experts highlighted the need to share materials about the virus and clinical samples as an immediate research action. And calls to harmonize regulations across national and regional bodies have never made more sense, as requiring each country or region to separately approve diagnostics and treatments creates bottlenecks whose detrimental consequences are now abundantly clear. The United States furnished a striking example: the country could not use tests developed elsewhere, such as those from the WHO, because they had not been approved for use in U.S. patients.
Tensions between China and the United States threaten to dampen progress on coronavirus research.
In the past, the United States prioritized its global leadership role, including in public health. For example, in 2003, the White House responded to the global HIV/AIDS epidemic by initiating an emergency plan and dedicating more than $80 billion in funds to the worldwide struggle to contain the disease. The United States led international efforts to counter the outbreak of the Ebola virus in West Africa in 2014 and assisted in developing the Africa Centers for Disease Control and Prevention. But priorities have changed. The White House’s Office of Science and Technology Policy (OSTP) has recently convened with its counterparts around the world to discuss COVID-19, and the U.S. Food and Drug Administration co-chaired the first global regulatory workshop on COVID-19 vaccine development, but the U.S. government has not been a robust participant in other international forums, nor has it modeled an approach that values global engagement or involves the whole of government.
Tensions between China and the United States further threaten to dampen progress on coronavirus research. In recent years, U.S. concerns about Chinese espionage and technology transfer have quelled U.S.-Chinese scientific cooperation, as demonstrated by the prosecution or firing of top U.S. academics who allegedly covertly participated in programs to develop China’s scientific enterprise. These tensions also limit high-level engagement, as evidenced by the fact that the OSTP did not include Chinese officials in its discussions with foreign counterparts. In the past, the United States would have used government channels to address its concerns even as it looked for ways to continue working with Chinese scientists on matters of shared priority. The two nations possess the world’s greatest biomedical scientific expertise. But although institutions might still collaborate to combat COVID-19 (for example, the U.S.-based pharmaceuticals company Gilead is working with Beijing’s China-Japan Friendship Hospital to test an antiviral drug on patients in Wuhan), government links are strained, just when engagement could help expand the data and sample sharing needed to address this crisis.
South Korea lived through the 2003 SARS outbreak, and its response to the COVID-19 pandemic reflects better preparation on account of lessons learned. The country effectively “flattened the curve” of infection such that its health-care system could manage the illness. South Korea’s experience demonstrates the importance of sharing lessons learned—and the fact that the foundation set in good times is most critical in bad times.
The global scientific community entered this crisis with a strong foundation of shared objectives and interconnection—one that scientists have built and maintained through collaborative projects, exchanges, international meetings, and engaged dialogues. These links are always beneficial, but they are crucial in times of crisis. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases in the United States, recently pointed out that the relationships he has cultivated with Chinese researchers over the years have helped him navigate beyond official channels.
The national and global institutions of today will surely be much changed on the other side of a crisis that is also a harbinger of new contagions to come. The outbreak underscores the importance of a U.S. policy that recognizes human interconnectedness, shared responsibility, and the understanding that the United States is most powerful when it chooses to lead. International collaboration in science offers both the best hope for a solution to the current crisis and a model for other institutions to follow in order to build a better and safer shared future.