NRPLUS MEMBER ARTICLE I remember the first time I thought about World War III. It was October 22, 1962. As President John Kennedy addressed the nation about the “unmistakable evidence” of nuclear-tipped Soviet missiles in Cuba, my dad whispered to my mom, “This may be World War III.”
Thankfully, Dad was wrong. But during the first two decades of my military service, the possibility of WWIII between the U.S. and the Soviets remained a serious threat until the collapse of the Soviet empire. By the time I became a professor and department chairman at the National War College (NWC) in 1998, I had become convinced that the most serious threat to national security was not Russian or Chinese missiles, but a pandemic — either man-made or naturally occurring. I was so convinced, I hired Dr. Robert Kadlec — the first physician to serve on the faculty at NWC. Several of the “old cold warriors” on the faculty could not understand. They asked, “What is he going to do? Give us flu shots?” (Dr. Kadlec continued his work on the national-security aspects of pandemic preparedness during two tours on the National Security Council, and he now serves as the assistant secretary of preparedness and response at the Department of Health and Human Services.)
Since the 1970s, scholars have defined national security with the acronym DIME: diplomacy, intelligence, military, and economics. (With the onset of the information age, some modified it to intelligence/information.) During the past several decades, many of my colleagues in the biosecurity and public-health communities, plus a bipartisan group of political leaders including senators Bob Graham (D., Fla.), Jim Talent (R., Mo.), Gary Hart (D., Colo.), Richard Burr (R., N.C.), and Joe Lieberman (I., Conn.), have argued to include public health as a key element in national security. Unfortunately, most national leaders failed to listen. I suspect that may be changing, albeit, a bit late.
Not since WWII have all Americans been engaged in a war requiring a national mobilization. Not only did 12 million serve in uniform, but virtually every man, woman, and child in America was involved in one way or another. From war-bond drives, victory gardens, and ration cards, to women taking on completely new roles outside the home — building airplanes, tanks, and battleships — the entire nation participated in a united effort.
Compare that with the nearly two decades following 9/11. Shortly after that tragic day, President Bush told Americans, “Go back to the malls.” Understandable at the time. We could not let 19 hijackers destroy our economy. But as the war on terrorism dragged on, only the military and their families made the sacrifices. Less than a fraction of 1 percent of the U.S. population have been asked to sacrifice.
Suddenly, everything has changed. We are once again back to a reality like that of 1943. All Americans are once again involved. WWIII has begun. And it is not just a war against COVID-19, it is a war against infectious disease. WWIII will be a “good war” — a war between the human race and infectious diseases.
Unbeknownst to most Americans, for years we have been losing the war against infectious diseases because of antibiotic resistance. Additionally, while we have dodged several bullets during the past two decades — SARS, MERS, Ebola, and a few different strains of influenza — we now find ourselves much like the American soldiers at the Kasserine Pass in 1943 and the Korean Peninsula in July 1950: outgunned and unprepared.
If ever there was a time to put public health on an equal footing with traditional national-security roles and missions, it is today.
America is now experiencing a new type of conflict. For most Americans, the attack has appeared to be in slow motion, but that is now changing. This attack by an invisible enemy may produce more casualties than we have ever experienced in our homeland. This will be a long and costly war, but it is a war we can win.
As in all wars, there will be mistakes, particularly in the early days. We have struggled with situational awareness, but that is rapidly changing. This is not the time for finger-pointing. It is the time to unite in common cause. Victory will require a “whole-of-nation” commitment — federal, state, and local governments along with the private sector and every man, woman, and child.
At the national level we must focus our efforts, in the near-term and long-term, on three key areas identified by Senators Graham and Talent in the WMD Center Report Card in 2011:
- developing the capability to rapidly produce and deploy point-of-care diagnostics,
- developing the capability to rapidly produce vaccines and therapeutics,
- significantly increase surge capacity in our medical facilities.
Until recently, all diagnostic tests for COVID-19 had to be sent to CDC in Atlanta in order to determine results — often delaying vital information to health-care workers for up to a week. Today, thanks to a partnership between the public and private sectors, the diagnostic tests can be completed at laboratories at state and local levels. In April, many hospitals will be using point-of-care diagnostics for COVID-19 — just like the diagnostics that have been available for many years for strep throat and the flu. This diagnostic capability — with results available in minutes, not days — will not only be valuable to public-health and medical personnel; it will also provide political leaders at the federal, state, and local levels the situational awareness needed to make informed decisions. This will be a game changer.
Many have expressed frustration when they hear that a COVID-19 vaccine will take at least 18 months to develop. For this pandemic, there is little to no hope of making it available for wide-scale use any sooner, but we must understand that the normal process requires more than ten years. For the next 18 months, our best hope for an effective medical countermeasure will be a therapeutic — a drug to take after one is infected. Many therapeutics are being tested today, and we may discover that one or more of these drugs are already FDA-approved and on the shelf. That will also be a game changer. For future pandemics, we must fund the research required to speed up the process of developing and producing new vaccines. That is something we should have been doing during the past two decades.
Improving surge capacity in our hospitals will save lives, but it is not about building “pop-up hospitals” in parking lots, as some have suggested. The answer is not more beds, it is “staffed beds.” There are no pop-up doctors, nurses, and medical technicians to staff temporary facilities. Some have suggested activating National Guard and military-reserve medical personnel, but that would not be additive. Almost all of those personnel are medical professionals in their civilian jobs. There are means to improve surge capacity in our hospitals, but that is a long-term program, not something that we can accomplish once a pandemic has started. The best thing we can do today is maintain current capacity by providing our heroic public-health medical professionals with supplies and equipment they need to do their jobs.
The strategies for success have been clearly defined during the past decade. They must now be aggressively implemented in partnership with the public and private sectors in a manner not seen since WWII.
April 1942 was a dark time for America, but we won WWII. April 2020 will also be dark, but if we fight WWIII with the same whole-of-nation strategy that we used in WWII, the human race will win, and America will lead the way as we band together to fight a good war.