The following is an excerpt from the book Uncontrolled Spread by Scott Gottlieb, MD. Copyright ©2021 by Scott Gottlieb. Published with permission by Harper, an imprint of HarperCollins Publishers.

The traditional planning for pandemics had always envisioned the US developing countermeasures against specific pathogens. When it came to threats that could spring from nature, there was an almost single-minded focus on flu. When it came to pathogens that could be harvested from a lab and deliberately turned into bioterrorist weapons, much of the emphasis was on anthrax and smallpox. These pathogens consumed most of our attention. The strategy was to stockpile countermeasures (therapeutics and vaccines) to these specific threats, so we would have them on the shelf, in a warehouse, to be employed immediately in the event that one of these dangers emerged. What SARS-1 and MERS showed was that we needed to prepare for the unexpected. Few predicted that a novel coronavirus would emerge that was such an efficient killer as SARS-1. Then it happened again with MERS.

It wasn’t by deliberate design that we had these capabilities to use against COVID. We got lucky.

The initial policy reflex was to try to develop specific medical countermeasures to these two threats, but when these viruses seemed to recede back into nature, so did the bulk of the efforts to counter them with drugs and vaccines. What we needed instead was sustained investment in broad capabilities that could counter a range of similar dangers—not specific countermeasures, but general approaches to designing and developing drugs and vaccines that could be employed against an array of adjacent risks. Among the diseases on the WHO’s priority list are: Crimean-Congo hemorrhagic fever; Ebola virus disease and Marburg virus disease; Lassa fever; Nipah and henipaviral diseases; Rift Valley fever and “disease X,” the risk that a pathogen will emerge that’s currently unknown to science. SARS-1 and MERS may have retreated, but their very emergence proved that new dangers could arise from unexpected places. We needed platforms for designing drugs and vaccines to target whole classes of viruses in the event that something new and dangerous suddenly appeared. 

We didn’t make these sorts of investments, not after SARS-1, not after MERS, and certainly not the way we should have. We remained too focused on flu and not enough on broad capabilities to protect us against unexpected risks. We nonetheless were fortunate, in some respects, that when COVID emerged, we were right at the cusp of a major inflection in science that enabled us to derive fully synthetic drugs and vaccines based largely on information about a virus’s genetic sequence, and to be able to quickly develop and mass produce therapeutic antibodies and genomically derived vaccines. We would swing each of these platforms into action to develop countermeasures to COVID. While the Defense Advanced Research Projects Agency, an agency of the Department of Defense that develops countermeasures to national security threats like bioweapons, had laid some of the foundation for using these technologies in the setting of a pandemic (through its work on developing antibody drugs and nucleic acid-based vaccines to address emerging infectious diseases), it wasn’t by deliberate design that we had these capabilities to use against COVID. We got lucky that the technology had advanced in the private sector to a point where it could be quickly pivoted to these national security endeavors.

Our ability to use these nimble platforms to develop specific remedies for COVID would be a powerful proof of principle for the value of having broad capabilities that could be used to counter a diversity of unexpected threats. Going forward, to reduce the risk posed by future pandemics, the lesson was clear: It’s too hard to guess where the next threat is going to come from. It could be a novel strain of flu, a new coronavirus, or something that mutates in an unexpected way to pose a completely novel risk. We’re just as likely to guess wrong if we try to guess at all. What matters most is having core capabilities that can allow us to quickly fashion countermeasures against a broad selection of potential threats and then manufacture drugs and vaccines in the quantities required to protect us.