Part of this effort will require building a stronger disease surveillance system in the United States.

Hospitals, testing labs, and local public health agencies already routinely report data about COVID-19
to the CDC. But the CDC must continue adding more innovative ways to detect outbreaks early on.
Already, epidemiologists around the world are experimenting with digital disease detection, combing
through data on pharmacy purchases and scouring social media and online news stories for clues of
new outbreaks. Taking advantage of electronic medical records, they are tracking the symptoms of
emergency room patients in real time. And they have created participatory surveillance systems,
such as the apps Outbreaks Near Me in the United States and DoctorMe in Thailand, which allow
people to voluntarily disclose symptoms online.

The global framework for pandemic response is broken.

Together, these reporting systems could capture a high percentage of symptomatic cases. To find
missed infections, epidemiologists can monitor sewage for virus shed in feces to detect unreported
outbreaks. And to capture asymptomatic cases, an especially important task for interrupting the
transmission of SARS-CoV-2, exposure notification systems will prove key. With these systems, users
are alerted through their cell phones if they have come into close contact with someone infected
with the virus, without that person’s identity being divulged—thus informing people who do not feel
sick that they may in fact be carrying the virus. At the same time as they are notified of possible
infection, users can be advised to get tested, vaccinated, or learn about government support for
isolation. Although such systems are still in their infancy, early reports from Ireland and the United
Kingdom, where they have taken off, are encouraging.

Adding newer forms of disease detection to conventional reporting systems would give public health
officials the kind of situational awareness that battlefield commanders and CEOs have long been
accustomed to. That, in turn, would allow them to act much more quickly to contain outbreaks. So
would faster and cheaper viral sequencing, which would enable scientists to rapidly identify
infections and variants. They could use that information to update diagnostic tests to ensure
accurate surveillance and modify vaccines to maintain their efficacy. If a particular variant was found
to be vulnerable to one vaccine and not others, the vaccine that worked best could be rushed to the
areas where the variant was prevalent. Such a custom-tailored approach will become yet more
important as new vaccines are created for new variants; those vaccines will inevitably be in short
supply.

Everyone should be grateful for the remarkable vaccines that won the race to be first. But the United
States and other wealthy countries must nonetheless invest in the next generation of COVID-19
vaccines, ones that are less expensive to manufacture, require no refrigeration, and can be given in a
single dose by untrained personnel. This is no pipe dream: researchers are already developing
vaccines that can survive heat, take effect more quickly, and can be administered through a nasal
spray, oral drops, or a transdermal patch. Thanks to these innovations, the world could soon have
vaccines that are as practical to distribute in rural India or Zimbabwe as they are in London or Tokyo.

SYSTEM REBOOT
Even though the United States must play a leading role in getting this pandemic under control, that
will not be enough without efforts to reform the global framework for pandemic response. The
current system is broken. For all the debates about who should have made what decisions
differently, a simple fact remains: what began as an outbreak of a novel coronavirus could have been
contained, even when it was a moderately sized epidemic. In a report released in May, an
independent panel chaired by two former heads of state, Ellen Johnson Sirleaf of Liberia and Helen
Clark of New Zealand, did not assign blame for that failure. But the panel did offer suggestions for
how to prevent the same mistake from happening again.

Its headline recommendation was to elevate pandemic preparedness and response to the highest
levels of the UN through the creation of a “global health threats council.” This council would be
separate from the WHO, led by heads of state, and charged with holding countries accountable for
containing epidemics. In order to rebuild public trust in global health institutions, it would have to be
immune from political interference. The report envisioned the council as supporting and overseeing a
WHO that had more resources, autonomy, and authority. One vital contribution it could make would
be to identify those diagnostic tests, drugs, and vaccines for COVID-19 that merit investment most
and allocate resources accordingly, so that they can be rapidly developed and efficiently distributed.
Although many details remain to be worked out, the recommendation of such a council represents a
brave attempt in the middle of a pandemic to reform how pandemics are managed—akin to
rebuilding a plane while flying it.

The most urgent need for global public health is speed. With a viral epidemic, timing is nearly
everything. The faster an outbreak is discovered, the better chance it can be stopped. In the case of
COVID-19, early and rapid detection would let decision-makers around the world know where to
surge appropriate vaccines, what variants are circulating, and how to triage resources based on risk.
Fortunately, when the next novel pathogen emerges—and it is a question of when, not if—scientific
advances will allow global public health institutions to move faster than ever before. Scientists at the
CDC and at the WHO’s Global Outbreak Alert and Response Network, or GOARN, have made huge
strides in compiling a range of data streams to quickly learn of new outbreaks. Twenty years ago, it
took six months to detect a new virus with pandemic potential; today, it can be done in a matter of
weeks.

COVID-19 is not yet the worst pandemic in history. But we should not tempt fate.

But the global system for disease surveillance has ample room for improvement. The latest
surveillance technologies—digital disease detection, participatory surveillance systems, and exposure
notification systems—should be available everywhere, not just in the richest countries. So should
viral-sequencing technologies. It is time to move beyond the old model of global health, in which
samples of pathogens were sent from poor countries to rich ones to be sequenced, with the
countries that sent the samples rarely sharing in the test kits, vaccines, and therapeutics that were
developed as a result. This is a matter not only of fairness but also of epidemiological necessity, since
the closer to its origin a new epidemic can be detected