Iran Press/ commentary: Whether the coronavirus disease, or COVID-19, could kill a significant number of Americans is not yet clear, but it is vital that the US government proceed as if the answer is yes.
Hope now hangs on a combination of both human and natural factors that might slow the outbreak or mitigate its effects—a situation that does not inspire optimism.
Of particular concern are countries that are unable to effectively collect data and respond to the outbreak, due to weak health systems or weak governance, projecting their vulnerability far beyond their borders.
The more people infected with the virus globally, the more vulnerable Americans become, both from public health and an economic standpoint. Our common defense is only as strong as the weakest link, Foreign Policy reported.
The structures and policies of the US government contribute to this vulnerability. Addressing the problems is within the power of Congress and the administration. Doing so is of both immediate and long-term importance.
The coronavirus emergency spending bill before Congress now is an important vehicle to correct some of these problems, but the requirements are too big to be solved with a single piece of legislation.
The White House and Congress must also get their own houses in order.
The shifting White House leadership structure for the coronavirus response is both atypical and ad hoc, leaping from an interagency health security process run by National Security Council (NSC) staff to a cabinet-level process then to one led by the vice president.
White House leadership of the response is critical, since no matter how dedicated and capable any one agency or department may be, it simply cannot effectively coordinate across accounts, jurisdictions, missions, and personnel as required.
The interagency coordination will be led by Deborah Birx—a serious professional, as capable in interagency management and global health as anyone in government. With no time to spare, the White House has backed into the place it should have been all along, prior to the possibility of an outbreak.
While the leap from NSC staff to the vice president demonstrates an appropriate sense of urgency, it also reveals the gaping hole in the regular decision-making structure.
Prior to the creation of the president’s task force, the White House seemingly went backward on global health security, downgrading and eventually eliminating the global health senior director position at the NSC. It sent additional signals of disinterest to Capitol Hill, reluctantly producing an interagency global health security strategy only once Congress required it by law.
The leadership role is in part due to the desire to reverse creeping NSC staff bloat—a point on which National Security Advisor Robert O’Brien is correct. However, in this case, the limitation is not the number of seats at the NSC but the lack of value placed on the implications of health for US national security and on the significant interagency coordination demands.
Even outside of a crisis, global health is a priority to which the US government commits billions of dollars each year across many accounts, agencies, and departments. This type of challenge is why the NSC was created.
Even after this crisis is resolved, the question that must be asked is how the White House will plan for the next one. Even after this crisis is resolved, the question that must be asked is how the White House will plan for the next one.
Some structural leadership problems are architectural and cannot be addressed by policy course corrections alone. In health security, the division between domestic and international affairs that is reasonable and practical in many other areas can be especially problematic.
Disease respects no borders. Yet a decision-making framework established ahead of a crisis to provide clarity on thresholds for action, department and agency roles, and interagency chain of command can save precious time, money, and lives.
Critical policies and responsibilities can fall through the domestic-international divide to inattention or confusion, losing opportunities to act proactively outside the United States. If domestic health security and global health security are not understood as two parts of the same challenge, policymakers might look to fortify only the domestic health system.
With a disease like COVID-19, such a notion is folly, dangerously missing the implications of rapid, global mobility and the fact that those infected can be asymptomatic yet highly contagious, defying easy detection.
The emergency supplemental funding request from the White House is a timely example, appearing to go out of its way to avoid focusing on anything other than domestic capacity. Intentional or not, the White House is once again communicating that it does not view domestic health security and global health security as a single, continuous challenge.
The distinction, in this case, makes Americans more vulnerable ahead of an outbreak and can impose very steep economic and public health costs during an emergency.
Congress, where fractured jurisdiction and responsibility for global health security spans at least 10 different committees and subcommittee structures across both chambers, has some housekeeping to do as well.
Nearly all have their own leadership, membership, and staff. A comprehensive, funded global health security strategy theoretically could be considered in part by each and all—even before reaching congressional leadership and their staffs and coming to a vote.
Nothing remotely resembling that ever happens. The problem is not that too many parts of Congress are actively engaged in global health security but too few.
Divided between domestic and international, national security and public health, no committee has a clear mandate or a view of the full requirements of government. Pathways for asserting leadership are unclear, even for dedicated individual members. The sense of issue ownership is weak.
207/205
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