I have shared in earlier blogs my excitement and optimism for biomedical innovation across broadly applicable biotechnologies such as gene therapy, immunotherapies, mRNA vaccines. I have also discussed the critical role biomedical innovation has played in the global response to the pandemic: from rapid genome sequencing of the virus, to novel diagnostics, monoclonal antibody therapy, of course the first mRNA vaccines, and hopefully soon, antiviral pills. All this biomedical innovation at this rapid pace has been breathtaking to follow.
Why then do we, in the US, have more people dead from this pandemic in 18-months than we had US casualties in all of World War II? What good is all this innovation if more people died from COVID-19 than did from the Spanish Flu pandemic a 100 years ago?
When I launched this blog site in spring of 2020, in the early days of the pandemic, I had articulated my underlying premise that our great societal challenges can not be solved by science alone. While scientific innovation is often necessary to solve these great challenges, it is not sufficient. Effective solutions need to be multidisciplinary and based on science, ethics, policy & law, and economics; my four PBH Lenses. Over time I added leadership as another important dimension to envision and then implement effective solutions.
Can I apply my PBH framework to the US response to the COVID-19 pandemic? I think it is worth testing.
This is indeed a sobering assessment. How can it be constructively used? We are still in the midst of the pandemic, especially in low and middle income countries. As I have said before, we are not truly safe, unless all of us are protected from this virus. Since the past is prologue, surely COVID-19 will not be the last global pandemic. We have already had MERS, SARS, Zika and Ebola threaten the health and well-being across countries and continents just in the past couple of decades. I believe the honest PBH assessment of our response to the current pandemic can help identify important learnings and lessons. The lessons that can help us, as a society, to be proactive – avoiding potential pandemics, limiting them to local epidemics – while also being better prepared for the inevitable next pandemic or global public health crisis.
Broadly speaking, I find myself organizing the PBH lessons learnt into two buckets:
- Keep doing, further strengthen, and build on what we are doing well especially in the areas of scientific and biomedical innovation, and economics.
- Aggressively and diligently fix those areas that have been lacking, especially in the areas of ethics and policy and law. The need to strengthen our public health infrastructure, capacity, and governance should be high on the list. So should the need to adopt Bioethics as a core value around which we build our public health systems.
Perhaps I will elaborate in more detail the specific lessons from the pandemic in a subsequent post. For now, I am happy that I was able to apply my PBH framework for this assessment, and that it has pointed me in the direction of potential answers to the question I raised. The reason the US has had more deaths from COVID-19 than from the Spanish Flu, in spite of all the incredible biomedical innovations over the past century, is that, we as a country, have neglected the PBH lenses of Ethics and Policy & Law while over indexing on Science and Economics. Narrow focus on science and economics alone cannot make up for the weakness in ethics, policy & law. This assessment makes the case for more comprehensive and lasting solutions, that cover ALL PBH dimensions, to effectively address our great societal challenges such as the global pandemic.
Finally on the PBH Leadership dimension: who is accountable for this tragic disconnect? I think, as a society, this Critical Disconnect represents a collective failure of leadership. Previously, in my Perspectives on Leadership, I have written of my admiration for Presidents Lincoln and FDR, who built coalitions and steered the country, and even the world, during times of crises. Can we even imagine the outcome of the Civil War or World War II without the leadership of a President Lincoln or FDR? As we face new, complex and deadly challenges, my unanswered question is: where are the Lincolns and FDRs of our time? Are we doing enough to educate and develop the next generation of multidisciplinary, transformational leaders who can comprehensively address the Critical Disconnect, and prevent it from recurring? To do so would be the most valuable lesson of all.