The pandemic: a series of failures, a few miracles — and a lesson for next time, global health experts say

As the nation exhales at the sight of descending curves of Covid-19 infections and deaths, top global health experts assessed the Biden administration’s handling of the pandemic, and the reviews weren’t good.

“I think we’ve done very, very bad this year,” said Michael Mina, an epidemiologist, immunologist, and physician who has been a leading voice — and an often critical one — during the Covid crisis. 

From a lack of preparation, to “an inability to look past the moment,” and stymied creativity in facing the nation’s public health crisis, U.S. leaders have repeated the same mistakes, year over year, said Mina during a panel discussion at Harvard Kennedy School’s Institute of Politics on Thursday. 

For the third year in a row, Mina and two other seasoned experts, STAT senior infectious disease writer Helen Branswell and Harvard professor Juliette Kayyem — all extra-wisened by two years of pandemic chaos — gathered at the JFK Jr. Forum in front of a few dozen attendees to reflect on what has happened since they last sat in those seats, and what is still to come. STAT executive editor Rick Berke moderated the discussion, also for the third year in a row.

A Ukrainian flag draped over a chair backstage, and a bowl of blue chrysanthemums and hyacinths in front of the panelists underlined another unfolding global crisis, the Russian invasion of Ukraine. As the panelists spoke, CNN flashed headlines about Russian troops gaining ground in southern Ukraine. 

Mina, who left a faculty position at Harvard’s T.H. Chan School of Public Health last year for a top position at rapid test startup eMed, said that he would have treated the Covid pandemic more like a war. Following the Trump administration’s inaction and missteps, he said, President Biden and his team should have made decisions as if thousands of Americans were dying every day, because they were, and they still are. “And we didn’t act like it. And we still have not acted like it,” said Mina, in one of his most scathing public critiques of the Biden White House to date.

Kayyem, who served as an assistant secretary at the Department of Homeland Security under President Obama, said the pandemic response was a series of logistical failures. 

“Wars are won and lost on logistics,” she said. “It’s not that hard. You’ve got to move stuff from point A to point B.”

That “squandering of time” and mismanagement of resources cost lives, and bred mistrust that grew when officials made unrealistic promises to the public, and agencies such as the Centers for Disease Control and Prevention wouldn’t own up to mistakes or offer clear guidance, the panelists said. 

“How does someone reasonably make sense of what’s right and what’s not right anymore? I mean, the CDC couldn’t do it,” Mina said. 

The first iteration of the panel took place almost exactly two years ago, mere days before the world began shutting down, before “Fauci” became a household name. The event was among the last hosted in person at Harvard in 2020. 

At the time, the panelists presciently warned of an impending crisis, even as most people remained blissfully ignorant of the threat. Branswell had written almost two months earlier about the “mysterious and growing cluster of unexplained cluster of pneumonia cases in the Chinese city of Wuhan” that the World Health Organization was monitoring. In 2021, the experts convened again, virtually, and reflected on the miracle of rapidly manufactured, incredibly effective vaccines.

But at neither of those events could they imagine just how catastrophically the pandemic — and the political and public health response — would unfold. The American death toll alone, and how many people have died since vaccines became widely available, is staggering. 

“900,000 [deaths] is about 800,000 more than I thought,” Kayyem said. 

On Thursday, Kayyem, Branswell and Mina reunited, masked up, less than six feet apart, and cautiously optimistic after 24 months that have often felt like a game of “Red Light, Green Light.”

Here are some highlights from their discussion. 

Getting ‘out of the woods’

The pandemic is in a period of transition, from full-blown emergency response to “adaptive recovery” mode, Kayyem said. Aside from very young children not yet eligible for the vaccine and people who are immunocompromised, the burden of the pandemic has clearly shifted mostly to willingly unvaccinated people. So now comes the work of rebuilding, finding a way out of the tangled mess and proactively creating infrastructure that will mitigate harm the next time around, panelists said. (And, yes, there will be a next time, Branswell and Mina said). 

While the nation may not be “out of the woods,” the immunological landscape has changed dramatically, Branswell said, thanks to a large share of the population having been exposed to the virus or having been vaccinated. It is miraculous that 10.8 billion doses of vaccine have been administered globally in 15 months, she said. 

But that protection isn’t absolute. “I think we should anticipate that potentially the [next] few winters of Covid are going to be pretty bumpy,” she said. Mina agreed, remembering the hopefulness many Americans felt last spring, and how those dreams were dashed by intense waves of infection in the summer and winter of 2021. 

“I think we knew that by the middle of January of 2020 that this virus was with us for the long term,” Mina said. 

That means other variants may bring on a strong resurgence of cases. The coronavirus variants like Delta and Omicron have tended to emanate from different branches of the genetic tree, accumulating dozens of antibody-evading mutations and making it difficult to plan for new vaccines. “I think we should assume we haven’t seen the last of them,” said Branswell. 

A long-term virus also requires long-term solutions, such as testing and treatment that is widely accessible to prevent future outbreaks. Biden’s recently announced “test-to-treat” framework is a start, Mina said, but it is still unnecessarily complicated to seek out a Covid test or care. 

Above all, leaders should be realistic, and tell people to expect another surge this winter, to stock up on at-home rapid tests and masks to wear — and then celebrate if it doesn’t happen, Mina said. 

The long tail of pandemic politics

One of the most prominent divisions to arise from the pandemic is the fight over vaccines. How hesitancy or outright antagonism toward incredibly effective vaccines will play out down the road is still to be seen. As of right now, only about 25% of eligible children are fully vaccinated. Parents are hesitant, Branswell said, and she fears that concern could extend to other vaccines. “It would be horrific to see backtracking and a rise in preventable childhood diseases as a result of this,” she said. 

Kayyem, who spent the past two years advising mayors, corporations, institutions and other groups on how to handle the pandemic, said much of what had to be done was risk mitigation. If the U.S. could do it over again, she’d advise leaders to do “more mandates earlier. That’s all … the numbers tell me they work and that they save lives.”

The fragmentation of society will be another challenge, as elected officials attempt to make headway in a deeply divided nation. Branswell predicts people will have the “wrong memories” of this crisis, and once again bristle at mandates during the next pandemic, and that vaccine nationalism will be worse.

Mina left Harvard over lack of support

Thursday night, Mina sat in the forum, back at the institution he left after a short stint as a professor. He started at Harvard just six months before the start of the pandemic, and quickly became a star for his expert analysis and commentary on the pandemic. But even as he got seemingly incessant press coverage, racked up tens of thousands of Twitter followers, he felt unsupported by the university, he said. 

He was working nonstop, advising organizations and governments on their pandemic response, doing media interviews, analyzing new research, teaching classes, and yet he couldn’t get someone to help organize his calendar, much less do anything else, he said. “I burned myself out,” he said. 

Being a faculty member at a prestigious university allowed him to speak out more and be willing to say things “that maybe other epidemiologists are too concerned to go out on a limb with,” he said, but the lack of resources for junior faculty at Harvard was ultimately unsustainable. And the academic environment itself ran counter to his desire to build things with collaborators, because of a rewards system that runs on competitiveness and publishing order.

“It’s really hard to build things that are lasting in academia,” he said.