How would you would assess the effectiveness of international cooperation to combat the COVID-19 outbreak? What are some examples of successful cooperation on past global public health challenges?

It is far too early to meaningfully assess international cooperative responses to COVID-19. As for the early headlines, the World Health Organization (WHO) made a timely finding of a “disease outbreak of legitimate global concern” thereby “internationalizing” the pandemic and expediting the mobilization of financial, technical, and human resources. China, for its part, gave more timely notice of the outbreak than it did in prior instances, consistent with the WHO’s revised 2007 requirements, although Beijing still delayed its report for domestic political reasons.

Initial recrimination between the United States and China about the crisis was unhelpful for global cooperation when leadership is needed from both nations because of their technological, medical, and logistical capabilities. Both countries have since struck a chord of cooperation. Possibilities for novel forms of cooperation have arisen too, for example, the prospect of sharing resources between Cuba and the United States, which is currently limited by U.S. sanctions. The same opportunity exists in U.S.-Iranian relations.

Lest these possibilities seem far-fetched, I describe in my book the hand-in-glove cooperation among Israeli, Palestinian, and Jordanian health professionals in 2006 and 2009 in meeting novel flu epidemics despite the overall tensions in the region and the lack of any ongoing high-level peace process. The same is true in Southeast Asia, where the six diverse countries (Burma, Cambodia, China, Laos, Thailand, and Vietnam) of the Mekong River Basin—a region of frequent interstate wars and violence—have institutionalized effective infectious disease surveillance and response and the sharing of materials and best practices for two decades. It is not easy or given, but the shared interests, expertise, vocabulary, and values that allow for public health cooperation, particularly in infectious disease that make us one epidemiological family, can be a leading edge of peace.

What has changed in the architecture of international cooperation on public health since you wrote “Pandemics and Peace”? Have epidemics like Ebola or Zika helped increase international cooperation?

Since the novel influenza, Ebola and Zika outbreaks of the past few years, the international community has made some progress in strengthening the abilities of countries to meet epidemic and pandemic threats. The major innovation was the creation of the Global Health Security Agenda (GHSA) in 2014 (renewed for five years in 2019), led by the United States and engaging 67 nations in improving national abilities to detect and respond to infectious disease outbreak.

GHSA initiatives, in concert with the WHO and other international organizations, have enhanced national capabilities in some instances and helped countries better conform with international health regulations by increasing domestic and international financial support for infectious disease response and developing independent protocols for assessing national preparedness used by more than 100 countries. Despite such efforts, many (perhaps most) countries remain inadequately prepared and extremely vulnerable to outbreaks. After this crisis, policy analysts will learn from the successes and the failures of efforts made under the GHSA initiative, and, perhaps more importantly, policymakers may develop the will to fully implement these lessons.

The U.S. has been a generous, lead contributor in international public health relief and expertise since the end of World War II. We cannot drop this baton. For example, we should not be worried about the cost or the possibility of producing a surplus of government ventilators. Instead, we could meet our immediate needs and become a source of international capacity in this critical technology as COVID-19 spreads to other parts of the world with limited public health infrastructures. During and after this crisis, the United States should remain fully engaged as a global leader in international public health.

In your book, you argued that the U.S. does a lot right when it comes to supporting foreign capacity in infectious disease response—but that it may not go far enough. Nearly 10 years later, how would you asses U.S. global health policy in this regard?

Here too, the picture is mixed. U.S. baseline funding for foreign infectious disease response programs has not increased, ranging from $400 to $500 million per year for the past decade. Special emergency federal funding for Ebola in 2015 and Zika in 2016 augmented baseline budgets, but such expenditures reflect the “crisis response” rather than the “capacity building” character of U.S. policy. The president’s initial 2020 budget request would reduce these baseline budgets by 4 percent. The current crisis and its human and economic toll will provide an opportunity to revisit the question of whether we are doing enough to staunch the spread of infectious diseases at their source and seizing opportunities for enduring international collaborations in public health that would both enhance our own national security and positively extend American influence abroad.

You laid out recommendations for U.S. global health policy in the book. Have any of them been implemented? And which of those recommendations would be particularly useful now as we deal with the COVID-19 pandemic? 

The generic problems afflicting America’s global health policy have not changed significantly, and the United States has not meaningfully altered the content or process of its policies. Substantively, I noted that policy effectiveness suffered from the tendency to respond to a particular disease during an emergency (usually after it reaches our shores) rather than building enduring multi-level, multi-disease surveillance and response capacity at the source of the outbreak. Procedurally, I highlighted the lack of formal mechanisms for interagency coordination and collaboration in U.S. policymaking and the lack of visibility for this issue at the highest levels of government.

American policy expertise is shared across several agencies; particularly the Departments of Health and Human Services (including the Centers for Disease Control and Prevention), the Department of State and its Agency for International Development, and the Department of Defense with its far-flung responsibilities for troops and civilians stationed abroad. Each of these actors has a legitimate, distinctive viewpoint and area of expertise. The CDC is the gold standard for infectious disease surveillance and recognized abroad as a non-politicized actor; the Defense Department can reach public health matters in areas of conflict that others cannot; and the State Department is finely attuned to our humanitarian and diplomatic interests. Still, there are areas of overlap and need for overall synthesis and strategy (especially in times of crisis) that could be provided by permanent, high-level coordination in the executive branch.

President Obama’s Global Health Initiative, announced in 2009, rhetorically addressed these two concerns, but as a practical matter fizzled out by 2012, with its functions subsumed within the State Department’s global diplomacy programs. Pandemic policy leadership at the National Security Council was nixed during the early years of the Trump administration. America still needs a greater appreciation that global interconnectedness requires that our security, economic, diplomatic, and humanitarian interests necessitate investment (not charity) abroad as well as at home. Bureaucratically, better interagency coordination and sustained attention at the highest levels of policy are needed now more than ever.

Dr. William Long was a Jennings Randolph fellow at USIP (2009-2010) and is the author of USIP Press’s 2011 “Pandemics and Peace: Public Health Cooperation in Zones of Conflict.” He is currently a professor of political science at Georgia State University and formerly dean of its College of Arts and Sciences.