The United States, among the richest, most advanced nations in the world, remains unprepared to combat new pathogens if it wasn't clear enough during the Covid-19 Pandemic.
The coronaviruses were a surprise opponent. Treatments and tests for monkeypox were already underway. The response failed to respond to both threats.
Some of the excuses that we were relying on to rationalize what happened in 2020 don't apply here.
The Centers for Disease Control and Prevention bungled the response to the coronaviruses, but no one is to blame.
Failure has a high price. More than one million Americans have died as a result of Covid. Cases, hospitalizations and deaths are all falling, but Covid was the third leading cause of death in the United States in 2021.
The spread of Monkeypox has never posed a challenge to Covid. The United States has reported more monkeypox cases than any other country and the virus is likely to persist as a low grade threat.
The nation has a framework to contain epidemics. There's a lot of distrust between health officials and those who treat patients and between the federal government and states. It's almost inevitable that there will be a confused response to future outbreaks.
Larry O. Gostin is the director of the O'Neill Institute for National and Global Health Law.
The rise in global travel and vaccine hesitancy is one of the reasons new infectious threats are on the way. Africa saw a 63 percent increase in outbreak of pathogens that jump to people from animals from 2012 to 2022.
The director of the Pandemic Center said that people think that the Covid thing was a once-in-a-century crisis.
She said it was the new normal. It is similar to the levees being built for a one-in-a- 100 years crisis, but then the floods keep happening.
The national response to an outbreak should be based on reports from clinics in the country. Wastewater monitoring might sound an alarm for known threats like it did recently in New York.
Monkeypox is what it is. The symptoms of monkeypox are not as severe as those ofpox. There was an outbreak in monkeys kept for research. Most of the people who have sex with men who have the virus are from Central and West Africa.
What does it do? The monkeypox virus can be spread by coughing or sneezing, or by touching items that have previously touched the rash, or by touching items that have not touched the rash. During and after birth, monkeypox can be transmitted from the mother to the fetus.
I'm afraid I might have a disease. I don't know what to do. You can't test for monkeypox if you only have flu symptoms. You can get a monkeypox test from an urgent care center or your primary care doctor. If you have to come in contact with other people for medical care, you should be isolated at home.
I live in the city. Is it possible to get the vaccine? Adult men who have sex with men and have had multiple sexual partners in the last 14 days are eligible for a vaccine in New York City. People with conditions that weaken the immune system or have a history of allergies are encouraged to get the vaccine. There is a website that people can use to book an appointment.
State and federal authorities would get the information. Federal officials would quickly allow and offer guidance for the development of tests, vaccines and treatments for everyone.
The steps didn't work well in the recent outbreaks.
"None of it looks like this, and I am very familiar with outbreak response and Pandemic Preparedness, and I have been studying epidemics for years."
Dr. Andersen assumed that the flaws exposed by the coronaviruses would be fixed. He said that we are worse prepared now than we were in the beginning of the epidemic.
Public health in the US has always been on a tight budget. The data systems used by the C.D.C. are old. Many public health workers were attacked and abused during the Pandemic and have left their jobs.
Several experts said that more money wouldn't fix all the problems. Public health departments could use more funding to hire and train staff, update their data systems, and invest in robust networks.
Pandemic preparedness is hard to sell in congress.
Congress has not shown any inclination to approve the budget request of Mr. Biden.
The United States spends between 300 to 500 times more on its military defense than it does on its health systems.
The United States was supposed to be the leader in the field of outbreak management. In an assessment of global health security in a year before the arrival of the coronaviruses, the nation was ranked first among all others and second only to the United Kingdom in its ability to respond quickly.
The public would follow instructions and leaders would move quickly when faced with a new pathogen. The analyses did not account for the politicized nature of the administration's approach to the Covid response.
Government officials tend to look for easy solutions in crises. There aren't any for managing swine flu.
It's a problem from hell. Bill Hanage is an epidemiologist at the T.H. Chan School of Public Health.
Officials should bet on combinations of imperfect strategies with an emphasis on speed.
The C.D.C. tried to maintain control over testing in both the coronaviruses outbreak and the monkeypox outbreak. Health officials were blind to the spread of the viruses because of the move.
Academic labs were discouraged by the Food and Drug Administration from developing alternatives for testing and encouraged to use the highest quality of diagnosis. Dr. Hanage said that all of them are better than not doing anything and that it may be reasonable for officials to ask which test is quicker.
Mr. Gostin has worked for most of his career with the C.D.C., and was one of the earliest defenders of the Pandemic.
As the United States was forced to rely on other countries for important information, he became more and more dissatisfied. Is the virus in the air? Is masks effective?
Mr. Gostin said that most of the time they got their information from foreign health agencies. He said that the C.D.C. was always last and weak.
He said that many at the C.D.C. were afraid of being held accountable if something went wrong. A lack of fire in their bellies is what it all boiled down to.
The biggest hurdle to a coordinated national response is the division of responsibility and resources between federal, state and local governments.
The laws governing health care in the US are complex and designed to protect confidentiality. According to the director of the Cornell Center for Pandemic Prevention and Response, they are not good enough to work with the public health system.
States don't have to give federal authorities the number of cases of infections or demographic details of vaccine recipients.
State laws don't allow officials to share information. Alaska may not want to give out patient information that could be used to identify them. Hospitals in small countries are hesitant to give up patient data.
The Biden administration's top medical adviser said that health care systems in countries like Britain and Israel use nationalized systems that make it easier to collect and analyze information on cases.
According to Dr. Fauci, our system isn't like that. There is a patchwork.
The current rules on data sharing made it difficult for the agency to understand the perspective of the states.
Kevin Griffis, a spokesman for the agency, said that it was not a matter of blaming states. It is a statement of the fact that we don't have access to the information that we need to respond in a better way.
Legislation may help remove those barriers. State and local health departments would have to report health data to the C.D.C.
The management of epidemics is done by public health agencies. Exchange of information between the two groups is needed for an efficient outbreak response.
Both the Covid Pandemic and the monkeypox outbreak were not communicated effectively. There have been procedures that have been convoluted because of the connection.
The C.D.C. does not include monkeypox in its disease reporting system. State officials have to manually type in data from case reports. The results of a faxed request for testing are usually routed through a state epidemiologist to the patient.
Most public health officials don't know how health care is delivered on the ground. Most people in the C.D.C. don't know what a hospital looks like.
C.D.C. staff should be embedded into local health departments to help understand the obstacles involved in responding to an outbreak according to Dr. Frieden.
The accountability metric proposed by Dr. Frieden is similar to the H.I.V. epidemic strategy. Every new disease should be reported to public health authorities within a day and responded to within a day.
He said that the strategy may give the government a better idea of what's going on.
There are repeated cycles of panic and neglect in the US. Break that cycle is the most important thing we need to do.