Imagine that the United States entered into a major land and sea war, and that only then, after the conflict began, did the government begin commissioning contracts to design and build the aircraft carriers, fighter jets, and other weapons systems we would need for the fight. Well, the imagination needn’t run too far, because in essence, that is what has happened as we were sucked into our war against the coronavirus. While there is much that can be faulted in our flat-footed response to this pandemic, especially at the federal level, one clear-cut failure should be even more obvious to anyone who has ever run a business: We had glaring gaps in our supply chain and no immediate plan to fill them.
Start with the basics: We did not have anywhere near the necessary number of N95 respirator masks, gowns, and other equipment to protect our frontline troops—the medical first-responders and hospital staff. Nor did we have enough ventilators to support our most severely stricken living casualties. Witness the scramble of state governors outbidding one another and the federal government to procure ventilators and personal protective equipment (PPE). While the U.S. does have a Strategic National Stockpile (SNS), an emergency repository of antibiotics, vaccines, chemical antidotes, and other critical medical supplies, it has never been sufficiently maintained. Indeed, no administration, including the present one, has supported funding an SNS robust enough to meet even the first few months’ worth of need during a severe pandemic.
So why do we have stockpile upon stockpile of arms and matériel for combat against human foes, but only a paltry supply of weapons against pathogenic enemies that could potentially claim millions more casualties? It comes down to this: We have failed to prepare for a war against microbes with the same urgency and resolve as we do a conventional war. And the difference shows in the business models we bring to each fight.
Even in non-pandemic times, more than 85% of the critical acute drugs needed each day to keep people alive are produced offshore. Nearly all are generic, with production concentrated in China and India. Sedatives critical to intubate for ventilation, such as ketamine, propofol, and pancuronium, are already in short supply. Despite their vital importance to our national health, these fragile, just-in-time supply chains show how reliance on foreign on-demand manufacturing leaves our country highly vulnerable. During a pandemic such as COVID-19, this vulnerability can translate into tens or perhaps hundreds of thousands of lost lives.
The only route to effective preparedness is to institute a military procurement and planning model similar to what we do for conventional warfare. This isn’t the first serious pandemic to hit American shores, and it won’t be the last. We need to plan and budget long-term for what we know we’ll need and steadily procure the right armaments. This model presupposes a certain amount of waste and spending on weapons that may never be used. But that is a price we have long been willing to pay on the military defense side. The infectious disease side should be no different.
Those who believe that the free market alone can serve our needs are likely failing to factor in the biological complexity of the challenge we face. For example, we desperately need new antimicrobial drugs to which the many disease-causing bacteria, viruses, and parasites have not yet developed resistance. But it’s nonsensical to ask a pharmaceutical company to spend billions of dollars developing a powerful antibiotic—then ask that it not be used or sold except in the most extreme cases, so the microbes won’t become resistant.
Similarly, the Pentagon doesn’t tell companies to develop and manufacture a new fighter plane and then only later decide if it wants to buy it. We need the same strategic capacity for PPE and ventilators as we do for rifles and tanks. The Defense Production Act is a critical tool in wartime. But it cannot magically make General Motors or Ford able to produce ventilators with more than 1,500 parts sourced from scores of countries in response to a fast-moving crisis.
The government needs to be a partner in developing microbial weapons and the muscle to quickly produce and distribute them. How might things be different if we had taken SARS more seriously in 2002, or MERS in 2012, and developed a coronavirus vaccine platform, even with little commercial market? We may not have had a vaccine targeted at COVID-19, but we would have been many months further along. And since it is beyond dispute that another flu pandemic like the one in 1918–20 is a matter of when, not if, an urgent large-scale enterprise to develop a universal influenza vaccine could be a tremendous gift to mankind.
Pandemics have become a threat on the scale of thermonuclear war. We must start treating them that way, making the investment and ensuring a stable supply chain for the tools and weapons we’ll need. We can see the consequences of past inattention right now. We must not again allow the unthinkable to become the inevitable.
About the writers: Michael T. Osterholm is Regents Professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Mark Olshaker is a writer and documentary filmmaker. They are the authors of Deadliest Enemy: Our War Against Killer Germs.
A version of this article appears in the May 2020 issue of Fortune with the headline “To battle a pandemic, think like the military.”
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