After a significant event, government officials often undertake a formal review of how they reacted. These exercises, called hotwashes, produce “lessons learned” documents that governments use to prepare for the next event. With the swine-flu episode apparently receding, government and public-health officials are probably preparing such hotwashes right now, and there is plenty to be learned. A lot of things went right in the recent outbreak, but not everything, and it is worth taking a look at the key lessons that it yielded.
1. Planning and preparation can help stem the tide of a pandemic. Back in 2004 the Bush administration started working with foreign, state, and local governments to improve communications and response in case of a pandemic. It also made a serious effort to stockpile countermeasures, like masks and antivirals, and worked with vaccine manufacturers to improve their manufacturing capability. All these steps were important in responding to the outbreak and tamping down panic.
2. Governments need to be faster in detecting an outbreak. The Mexican government’s overall response was good, but its initial pickup was slow. A Seattle company called Veratect found evidence of a public-health problem in Mexico on April 6. Officials at the Pan-American Health Organization (PAHO) accessed this warning on Veratect’s website on April 10 and April 11, but PAHO issued no public alert until April 23. The disease entered the public consciousness on April 24. The 18 days between initial pickup and public awareness was an eternity. Earlier reactions by PAHO and the Mexican government could have greatly limited the disease’s spread.
3. Public-health officials can play a key role in keeping the public informed and calm. Rich Besser, acting head of the Centers for Disease Control and Prevention, stepped into the extremely problematic void created by the Obama administration’s failure to have any of its top 20 Department of Health and Human Services appointees confirmed when the outbreak took place (at least three have now been confirmed, including the secretary and deputy secretary). Besser appeared everywhere, working to foster preparedness but also to calm public fears.
The flip side of this lesson is that public officials need to watch very carefully what they say. Joe Biden added to his reputation for talking without thinking when he told the Today show’s hosts that he “wouldn’t go anywhere in confined places now,” adding that he gave his family the same advice. White House press secretary Robert Gibbs’s post hoc attempt to explain that Biden was merely telling sick people to avoid confined places was plainly contradicted by the video of Biden’s remarks. And Biden wasn’t the only one with foot-in-mouth disease. European Union health commissioner Androulla Vassiliou recommended that Europeans not travel to North America, only to recant the next day. Future scenarios for disease outbreaks must put more effort into briefing officials who talk to the press and must plan for the possibility that they will make mistakes, especially after political transitions.
4. The U.S. needs to promote policies that foster health-care innovation. Small, nimble companies with cutting-edge technologies were the big winners in this episode: Veratect’s detection system spotted the problem before government systems did; Meso Scale Diagnostics had a point-of-care diagnostic test that identified the new flu strain; Quest Diagnostics developed the first commercially available test for swine flu. Many of these technologies would not have come into being without both encouragement from the federal government and the possibility of government as a purchaser of their products. The U.S. needs to continue the work of the Biomedical Advanced Research and Development Authority (BARDA) in promoting innovative new technologies that can protect us from biological threats. It also needs to use tools like the Public Readiness and Emergency Preparedness Act, under which companies can be granted tort immunity for products used to combat public-health crises.
5. The way countries respond to a crisis can have significant economic and foreign-policy implications. China did not gain any friends by quarantining visiting Mexicans; neither did Egypt, with its planned slaughter of 250,000 to 300,000 pigs. Argentina hastily banned airline flights from Mexico. For their part, the Mexicans received an unwelcome jolt. The outbreak cost the Mexican economy at least $2.2 billion; worse, they learned that friends can be fickle. According to Jorge Chabat, writing in El Universal newspaper, swine flu “has blown up . . . one of the myths of our traditional foreign policy: that everybody loves us.”
Even though the worst appears to be over in the current outbreak, we are not out of the woods yet. One disturbing pattern from previous outbreaks is that a new strain can appear briefly in the spring and return with a vengeance the following flu season. This is what happened in the 1957 flu epidemic, which killed about 2 million people worldwide, including 70,000 Americans. That’s why public-health experts need to review their actions from this recent outbreak very carefully, and make sure they learn their lessons.