In the middle of May, 2018, a few days more than two years ago, a virus surfaced in Frankfurt, Germany. Mid-May is after the end of flu season, but this virus behaved like the flu, causing coughing and sneezing, which helped it spread from person to person. More than 300 people fell ill, and 32 – 10 percent of them – died.
Next, about 100 people got sick with what looked like the same syndrome, an ocean away in Caracas in Venezuela. Some of them developed encephalitis, swelling in the brain that caused them to fall into a coma. In that country, 20 people died. But Venezuela’s president denied there was any outbreak. The virus continued to spread.
It came to the United States via a college student returning from a summer abroad, and then moved onto military bases where it infected dozens of troops. As the pathogen raced around the globe, health experts realized that there was no treatment that could work against it, and no vaccine available. By the time a vaccine was expected to arrive, 20 months later, 150 million people would die around the world.
If this massive epidemic sounds unfamiliar, it should: It didn’t actually happen. It was a simulation, played out in a war game written and hosted in May 2018 by researchers at Johns Hopkins University in Baltimore.
The writers of the simulation called their fictional disease by a fictional name: Clade X. But the conclusion they drew from their war game was entirely factual. They said that if an actual pandemic pathogen arose, the world would not be prepared.
And now we know how right they were.
This coming week, we’ll pass the 5-month mark since the first notice outside China was published alerting epidemiologists to a small cluster of cases of an unexplained pneumonia. From that first spark came the fire that scorched the world: more than 5 million known cases so far of Covid-19, and more than 336,000 known deaths.
Almost everything that the Clade X exercise predicted might happen has come to pass. It demonstrated that a new pathogen will travel faster than we could track it, that vaccines cannot be created at a moment’s notice, that politics can get in the way of public health.
What’s striking is that Clade X also predicted that those points of vulnerability could be shored up, given attention, and funding, and political will. Yet though the exercise’s conclusions were reached almost exactly two years ago, almost nothing was done to respond to them.
It might be possible to dismiss the findings of Clade X as a single academic exercise whose findings could not have been expected to circulate outside a thin slice of the Washington, DC policy world. But Clade X was not a singular event. It was one of dozens of exercises and reports and simulations and predictions that issued from universities and think tanks and government agencies over years, all of which warned that a fast-moving respiratory infection could sweep the world and disrupt societies, dating back to the federal government’s own National Strategy for Pandemic Influenza, first published in 2005.
That such warnings were not adequately attended to is not only the responsibility of the current White House, though there is evidence that the incoming Trump administration ignored preparations made by the Obama administration. (See, for instance, the Obama White House’s Ebola czar, Ronald Klain, tweeting photos of their “pandemic playbook,” which warns specifically against both novel flu viruses and coronaviruses such as the cause of Covid-19.)
It is also the responsibility of previous administrations and Congresses, which chose not to push for big, difficult investments: fully stocking the Strategic National Stockpile of medical countermeasures; fully investing in the Biomedical Advanced Research and Development Authority, the in-government research accelerator for novel drugs and vaccines; fully funding the dormant federal Public Health Emergency Fund that allows federal health agencies to move rapidly without waiting for Congressional appropriations.
And it is equally the responsibility of private business that, lacking any incentives to do otherwise, elected to withdraw from making new drugs unless the formulas guaranteed blockbuster profits, and elected to move manufacturing of crucial medical equipment offshore, where labor and materials are cheaper. (Two years ago, the founder of the only large surgical-mask maker that remained in the United States predicted to me that, if a fast-moving epidemic began in China, masks ordered from there by US hospitals would never arrive. He was right.)
We are nowhere close to the end of the coronavirus pandemic; we are unlikely to see it subside until the achievement of herd immunity, either through the virus spreading widely or through the achievement of a vaccine. But we are possibly at the end of the beginning, a moment where we can exhale, assess the emergency, and decide what it is most important to do next. One of the those most important things is to now, already, gather the crucial instructions that were ignored in past plans, as well as the lessons that have been learned in these crushing months.
One of those lessons is that a new pathogen is always coming. The novel coronavirus is not our last pandemic. The next one could be minor, the equivalent of MERS, which since its emergence in 2012 has caused only about 2,500 cases around the world. Or it could be Ebola in 2014 – devastating, but confined to West Africa – or Zika in 2015, rapidly expanding to 87 countries. Or it could be the globe-spanning, millions-killing 1918 flu.
We cannot say which pandemic we are risking, until the next one arrives. But we can do a much better job of being prepared.