Like it or not, the government needs greater power to fight pandemics

“The army is sickly with the smallpox,” fretted General George Washington in 1776. He wasn’t exaggerating when he called the contagion our “most dangerous enemy” — smallpox and other diseases accounted for 90 percent of his army’s deaths. Ultimately, Washington commanded the troops to get inoculated despite their fear of the procedure. 

Contagion is, once again, our most dangerous enemy. COVID-19 has killed more Americans than any war, right back to the Revolution. And, as Washington learned, pandemics threaten the United States as much as an enemy in the field. We normally reckon America’s competition with China, for example, by comparing military power and economic might. The rivalry may ultimately turn on how well each copes with the new world of global contagions. 

On this battlefield, the United States is getting slaughtered. With just 4 percent of the global population, the country lists 15 percent of the recorded deaths. Our death rate is 18 times higher than Japan’s, and three times higher than Canada’s

Why is the world’s great superpower failing? Because it is not organized to face the danger. The Constitution does not prepare a complex globalized society to control pandemics. The founders were acutely aware of military threats and gave presidents sweeping authority to meet them. Alexis de Tocqueville was astonished by the commander in chief’s power. “The President of the United States,” he wrote, “possesses almost royal prerogatives” over the military. 

But the Constitution conveys no such authority to combat biological threats whose casualties dwarf those of modern wars. The Supreme Court recently enforced the limitations when it struck down an OSHA requirement that large employers require vaccines or tests to combat COVID. The Court’s liberal dissenters put their finger on the national dilemma: “As disease and death continue to mount, this Court tells the agency that it cannot respond in the most effective way possible [and] undercuts the capacity of the responsible federal officials … to protect American workers from grave danger.”

Fifty-six states and territories continue to approach health care in their own ways. Each balances public health, economic growth and individual freedom in its own way. But disease pays no attention to political boundaries. No state can manage the complications of global monitoring, testing protocols, and international supply chains. National coordination and leadership are critical — as we’re learning the hard way. 

Of course, Americans have always been skeptical of their central government. But the resistance generally melts during great national crises — like wars and economic depressions. The 21st century requires us to treat epidemics in the same way. But today, we’re moving in precisely the opposite direction. The constant barrage against “the deep state” takes a toll on health agencies, forcing officials to move cautiously and cover their butts. The governmental weakness is exacerbated by a populist challenge to scientists and public health officials. This too is a spirit that runs through American history. Today, politicians lead the charge (“don’t Fauci my Florida!”) and accelerate the spread of infection.

What should we do? First, there’s no getting around the need for a centralized authority to act in the face of a national crisis. Our political system evolved in an era when no one could have imagined an infectious threat that would rip through North America a week after it was first detected on the tip of Africa. Facing the problem will take changes in executive authority, Congressional process and bureaucratic capacity. Over time and hard experience, Americans vested their national government with sweeping powers over both war and the economy. Today infections pose as grave a threat as a military invasion, domestic insurrection, or economic crash. And the contagions will only get worse. We need to rethink the constraints on national leadership. 

Second, the public health and medical communities need to do a thorough post-mortem on their work during the COVID pandemic. Despite the extraordinary efforts of many individuals, the nation’s scientific and public health establishment failed to influence a significant proportion of the American public. We need to reflect on how scientific methods — with their painstaking reliance on evidence — can operate in a world of charged partisans and instant communication. Led by a trusted authority, like the National Academy of Science, public health leaders will need to learn how to communicate with elected officials as well as the public in all its cultural, racial, political and ethnic diversity. 

Finally, Americans need to address their broken community and organize a national dialogue led by trusted spokespersons from across our diverse society — clergy, business leaders, celebrities and elected officials. Begin with the very question that animated the men who wrote the Constitution: What do freedom, liberty, and equality mean today? We need to find a way to balance rights with responsibilities, especially when one person’s freedom can mean another’s illness and death.  

How, in short, do we mobilize the United States against pandemics — while honoring its fundamental values? 

Our lives are at stake. We will need to come together and change if we’re going to meet the looming dangers. And, like it or not, that will require a powerful role from national officials.   

David Blumenthal is president of the Commonwealth Fund. James Morone, Ph.D., is the John Hazen White Professor of Public Policy at Brown University. They are coauthors of “The Heart of Power: Health and Politics in the Oval Office.”

Tags #coronavirus COVID-19 Contagion Global health Health policy Pandemic Public health Smallpox

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