“We choose to go to the Moon.” With those words in 1961 President John F. Kennedy rallied Americans toward a shared goal of astounding ambition. The task was daunting, even implausible. At the time the longest manned U.S. space flights had lasted barely over 15 minutes and had yet to orbit the planet. But government leadership paired with private sector ingenuity and broad public support made the implausible possible, and eight years later the United States landed the first humans on the moon.
Today, we face a similarly daunting challenge: a viral pandemic that has spread to every state and is on track to kill hundreds of thousands of Americans while ravaging our economy and sequestering our society. Meeting this national challenge will require the same kind of ambition, government leadership, and ingenuity that the country mustered in going to the moon. We need to launch—and right now—a public health Apollo program engaging all states and all Americans to end this crisis and prevent future ones.
There are things we can learn from other countries. Progress in South Korea, Singapore, and China suggests that COVID-19 can be slowed through social distancing measures, but it can only be kept under control through aggressive testing and surveillance to identify cases and comprehensive public health measures to identify and quarantine their close contacts. We are now employing social distancing strategies, but we lack the scale of personnel, resources, and systems needed to apply the rest of that formula here.
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And due to the slow and chaotic federal response to date, we also face a vastly larger containment challenge. China’s aggressive action to contain transmission meant that no province outside the epicenter of Hubei has officially registered more than 1,500 cases. At this moment, 25 U.S. states and territories have more than 1,500 cases apiece, and those numbers continue to mount daily.
Meanwhile the pandemic has abruptly halted economic activity and human mobility across the country. With widespread vaccinations likely at least 18 months away, we cannot hope to sustain these burdensome restrictions indefinitely. But relaxing them prematurely would simply send new waves of sick Americans flooding into overwhelmed hospitals.
Escaping this dilemma—protecting our country’s health while preserving our economic prosperity—will require the public health equivalent of the Apollo program. We must begin building the conditions that will enable a resumption of normal economic activity without putting American’s health back at risk. And once we have slowed transmission, we have to employ vigilant monitoring to keep it suppressed for the 18 or more months it could take before a vaccine becomes widely available.
The federal government has repeatedly tried to shift responsibility for decisions on social distancing and capacity needs onto state governors. But—like Project Apollo—the pathway out of our current national lockdown cannot be left to states or the private sector. The federal government must put this into motion with a clear, actionable, and well-resourced strategy. And unlike the Apollo program, we have to build, launch, and implement this program in a span of weeks, not years. It must go big, fast, on the following four elements.
1. Rapidly bracing the health system. First, we must urgently address resource gaps and build surge capacity throughout the country’s medical systems. The growing catastrophe in New York today is just a taste of what is coming elsewhere tomorrow—and New York is more equipped to handle such a crisis than most hospital systems in the country. Hospitals in many major U.S. cities are approaching an impending flood of cases without sufficient personnel, equipment, and supplies. Hospital conditions in rural areas are even worse, and cases are growing in those areas as well; every county in New York state, even the rural counties, has reported cases. Efforts currently underway in major hotspots to bolster treatment capacity and access to personal protective equipment, lifesaving medical equipment, and supplies are important. But hotspots will shift and future waves of new cases will remain a threat even after the current wave passes—so these efforts must extend throughout the country. This will be a massive logistical and administrative effort requiring a comprehensive picture of the needs throughout the country—a responsibility that cannot be carried principally by governors.
2. Testing, testing, testing. Shelter-in-place measures will eventually begin to show impact, but the country will need dramatically more testing capacity to confirm that declines are real. Testing levels, though improved in recent weeks, still fall well short of what is needed. To actually see what we are fighting, the U.S. needs to scale up a nation-wide infrastructure for free on-demand testing and invest immediately in producing the supplies of PPE and testing materials required to make that happen.
In addition to diagnostic testing, serological tests must be developed so that communities not only know the level of current COVID-19 infections, but they can also know who has already recovered from the disease with plausible immunity for a period of time. These recovered individuals will be vital to helping essential services in the community like supporting high-risk populations, such as the elderly, receive services for a longer period of home isolation.
3. Constant monitoring. Alongside a testing scale-up, the U.S. must invest in a nationwide disease surveillance platform for COVID-19, akin to the monitoring and early warning function that the National Hurricane Center provides in monitoring hurricane hazards. This surveillance platform would enable us to confirm that apparent case declines are real and alert all levels of government if cases begin rising again.
4. Going BIG on public health. Investments in testing and surveillance will be for naught if they cannot link effectively to nationwide contact tracing, targeted quarantine of contacts, and precise isolation of cases. Right now, the United States lacks the personnel or technology to carry this out at national scale. China and South Korea both deployed large teams of contact tracers to keep tabs on contacts of known cases and ensure they complied with quarantine measures. In Wuhan, China reportedly activated 18,000 people to carry out these activities at the peak of the outbreak. These countries also used a combination of extensive (and intrusive) big data tools and mobile technologies to scale up identification and tracking of contacts.
We need immediate, sweeping investments to bolster capacity of local public health departments to carry out this expanded mission. This could take the form of an AmeriCorps-style program to mobilize, hire, and train a public health firefighting force that could extend essential public health functions—not just contact tracing, but also expanded testing, and hygiene support to high-risk facilities like prisons, shelters, or assisted-living homes. A good place to start would be to hire back some of the more than 7,000 Peace Corps volunteers who have been recalled from overseas, many of whom have public health training.
We must also close the technology gap. New data technologies, advanced analytics, and mobile applications for public health will be a critical force multiplier in this effort. We must rapidly develop culturally acceptable means of using such technology to support contact tracing and other public health interventions at scale. America invented the digital revolution. Now we have to apply it responsibly, rapidly, and effectively to save lives without compromising our freedoms.
None of these tasks will be cheap or easy, but their cost pales in comparison to the $2 trillion that has already been committed to prop up the U.S. economy and the trillions in value lost from the stock market. Investments of well under a tenth of that figure would go far and have real impact as we wait for effective vaccines and drugs. The longer we wait to invest in a public health Apollo program, the more this economic damage will compound. While ideally the federal government would lead this effort, the painful reality is that the federal response remains reactive and messy. So if the administration is not forward-looking enough to outline and jump-start this effort, Congress and the governors should lead by laying out and financing the effort themselves, and pressing the administration to get on board.
We know what to do. Social distancing will enable us to bring case counts down and protect our health-care system; testing and surveillance will enable us to confirm that those declining counts are genuine while rapidly flagging any backsliding; robust investment in capacity will give us the tools to keep those numbers under control on a sustained basis. Now we must get on with it.
Jeremy Konyndyk is a senior policy fellow at the Center for Global Development, who previously led the office of foreign disaster assistance at USAID and served as the Ebola response co-coordinator in the Obama administration.
Beth Cameron is the vice president for global biological policy and programs at NTI, who previously served as the senior director for global health security and biodefense on the White House National Security Council.
Dylan George is a vice president of technical staff at In-Q-Tel, who previously served as a senior policy adviser for biological threats defense in the White House Office of Science and Technology Policy.
