Marc Lipsitch is professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. Mark McClellan directs the Duke-Margolis Center for Health Policy and is an independent board member for Cigna and Johnson & Johnson. Robert Rodriguez is a professor of emergency medicine at the University of California San Francisco School of Medicine.
The unprecedented development and rollout of coronavirus vaccines is enabling the United States, and a growing number of other countries, to emerge from the worst national and global crisis since 1945. Although the pandemic continues to rage across other parts of the world, it is not too soon to begin a systematic, comprehensive process to learn from both the failures and successes in responding to the outbreak.
That is why the three of us have been part of a planning group for a national covid-19 commission that would undertake a dispassionate study of the pandemic’s course. Such a commission would also examine the vulnerabilities and decisions that affected the pandemic’s health and economic impacts.
The planning group includes epidemiologists, biologists, clinicians, ethicists, and experts in health policy and economics. It was organized, with the support of four foundations, by Johns Hopkins University and the Miller Center at the University of Virginia.
The Senate’s rejection of a bill to create a commission to investigate the Jan. 6 attack on the Capitol may discourage many about the prospects for nonpartisan investigation of the pandemic. It shouldn’t. The pandemic united Americans in suffering, and it prompted a wide range of responses across many institutions. Even if every response didn’t meet with universal approval, the country can and should unite to learn from them. There are multiple ways to establish such an independent commission successfully.
If simplistic narratives about the pandemic are allowed to prevail, the world will be woefully ill-prepared for the next virus. Only data-based, nonpartisan investigation will help experts and the public alike understand how some countries that employed ill-informed, nonscientific approaches suffered badly in the pandemic — and why some that used technocratic, science-based responses suffered severe tolls as well.
Sorting through the evidence to help guide pandemic policy is essential to protecting U.S. biological security and economic welfare. It would also shore up the weakening public trust in institutions.
Certain basics are understood. High levels of obesity, hypertension and other comorbidities left people vulnerable to a virus that disproportionately affects those with preexisting conditions. Despite heroic work by emergency responders and front-line clinicians, the health-care system struggled to diagnose and treat cases early, or even count them reliably.
Disparities in the virus’s effect have been an overarching theme. African Americans, Latinos and Native Americans faced about three times the risk of hospitalization and twice the mortality of White people. Cases and deaths often reflected income and occupation, hitting the least-advantaged hardest. Florida’s experience was not New York’s, and neither was like North Dakota’s. Finding out why could save many thousands of lives next time.
There are myriad other pandemic subjects that demand rigorous study, including the efficacy of mask-wearing, especially in specific settings; the usefulness of lockdowns; and the advisability of shutting schools.
Getting the pandemic history right is also essential to capturing the benefits of the 21st-century bio-revolution. The coronavirus vaccines are a success beyond anyone’s expectations a year ago. Operation Warp Speed contributed to that success, as did other pre-pandemic global efforts to build a system for rapid vaccine development in a crisis.
Decisions about the vaccines’ production and distribution merit close analysis. The lessons they provide may extend beyond vaccines to the development of other countermeasures — and could enable a level of biomedical readiness never before possible.
The next challenge will be different, just as covid was different from the pandemic flus in 1918 and 2009. We should not prepare to fight the last war. Some may argue that enough information about the pandemic already exists, or will. But the volume, disorganization and often tendentious nature of that information is precisely why a balanced commission is needed.
Data-driven, systematic consolidation of the vast covid-19 literature into a concise library would lead to more-informed debates and decisions by policymakers, scientists and the general public.
The philanthropies supporting the planning group have signaled their willingness to support an independent commission, and one that would work with, but not within, governments — providing insulation from political interference. Another possibility is a congressional or presidential charter, which could help with access to data and sources, but the group would need to guard against partisan bickering.
Whatever the arrangement, it is clear that the commission should represent the breadth of pandemic experiences and adopt a research-intensive approach. This would mean a large staff working for at least a year, and probably more. Its aim should be to produce a foundational report — one that could produce tangible benefits for the entire world. The project should start as soon as possible, while memories are fresh.