Planning for the Wrong Pandemic

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Why did expertly Why did expertly devised planning tools both clarify and obscure the U.S. response to the COVID-19 pandemic, and how can this insight change our preparation for future crises?

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Institution: University of Southern California

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Why did expertly Why did expertly devised planning tools both clarify and obscure the U.S. response to the COVID-19 pandemic, and how can this insight change our preparation for future crises?

Image courtesy of interviewee. November 20, 2024

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This video is a reflection by a cultural anthropologist on pandemic preparedness and response, particularly in relation to the COVID-19 pandemic. The speaker discusses their previous work from 2017, where they published a book titled "Unprepared: Global Health in a Time of Emergency," which addressed the history of pandemic preparedness and the limitations of existing planning techniques, such as scenario-based exercises.

As the COVID-19 outbreak began in early 2020, many commentators referenced the book's title, interpreting it as prophetic. However, the author clarifies that the title was not meant as a diagnosis but as a call to action regarding an ethos of preparedness. They comment on the significant investments made in biological preparedness over the past two decades and observed that despite initial chaos in responding to the pandemic, many preparedness plans were implemented.

The author notes that while certain measures, like the Strategic National Stockpile, were intended for biological threats, they fell short when faced with the specific challenges of COVID-19, particularly regarding medical supplies. They also emphasize the importance of flexible planning, as different health crises present unique challenges.

Furthermore, they critique the governmental response under the Trump administration, which was characterized by a distrust of expertise. This video situation was compounded by inherent "blind spots" in pandemic planning that did not adequately account for the unique challenges posed by COVID-19 compared to previous health crises.

The author reflects on the need for transparent communication and humility from public health authorities to rebuild trust with the public, particularly in times of uncertainty. They suggest that investing in robust public health systems and biomedical research would be beneficial for both emergencies and ongoing health issues. Lastly, the speaker indicates a shift in focus toward climate change and water management issues, highlighting the need for experts to prepare for future uncertainties.

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Here are five key points from the video:

1. **Background on Pandemic Preparedness:** The author discusses their book, "Unprepared Global Health in a Time of Emergency," published in 2017, which addressed the history and practices of pandemic preparedness, emphasizing the importance of techniques like scenario-based exercises in preparing for biological emergencies.

2. **Initial Response to COVID-19:** When the coronavirus outbreak began in early 2020, the author reflects on the United States' poorly coordinated response, despite having some preparedness strategies in place. Although there were established plans and a stockpile for certain biological threats, these were not adequate for the specific challenges posed by the coronavirus.

3. **Non-Pharmaceutical Interventions:** The video highlights the concept of "flattening the curve," which was based on prior research from the CDC. Initial planning was influenced by past flu pandemic responses, leading to unexpected economic and social consequences as prolonged shutdowns occurred, showing the limitations of pre-existing plans.

4. **Political Climate and Trust in Expertise:** The author underscores the impact of the political climate during the Trump administration, which was characterized by skepticism towards governmental expertise. This environment hampered effective public health communication and response, further eroding public trust in experts.

5. **Need for Flexible Planning and Transparency:** The author advocates for more flexible planning tools rather than overly specific protocols for pandemics. They emphasize the importance of transparency and humility in communication from health authorities, particularly regarding uncertainty during health emergencies, to rebuild public trust in expert guidance.

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Here are some key quotes extracted from your video, emphasizing the main themes discussed:

1. **On Pandemic Preparedness:**
- "The title of my book had not really been meant as a diagnosis, but rather it was a characterization of an ethos, of a kind of injunction to prepare..."
- "I was struck by the notion that in fact, we had been quite prepared, but that... that preparedness had not led to an efficacious response."

2. **On Government and Public Health Response:**
- "At the very moment when we needed a coordinated, flexible, thoughtful public health response... we had a political administration... that was precisely suspicious of the role that the government would have to play in an emergency."
- "The experts suffered a real diminution in public trust."

3. **On Non-Pharmaceutical Interventions:**
- "The idea of flattening the curve... was actually the result of a plan that had been put in place by experts at the Centers for Disease Control based on the possibility of a bird flu pandemic."

4. **On the Flexibility of Preparedness:**
- "It's really hard to know what kind of disease one’s going to face in the future... developing plans that are too specific... is a problem."
- "I think it's better to invest in response tools that are quite flexible and that are useful not only in the case of an emergency, but also in the case of ongoing everyday health issues."

5. **On Rebuilding Public Trust in Experts:**
- "It's really important for authorities to be frank about what they know and what they don’t know at the outset of an emergency."
- "One thing I think we can learn is a certain humility at the outset of an outbreak, and letting the public know that scientific research... may not have the best answers, but... it's gonna get better."

6. **On Future Challenges:**
- "I’ve shifted my gaze a little bit to thinking about the future of climate change."

These quotes encapsulate critical reflections on the challenges of pandemic preparedness, the importance of adaptable responses, and the need for trust in public health authorities.

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A little bit more than two years before the pandemic.

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In 2017, I had published a book

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that was called Unprepared Global Health in

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a Time of Emergency.

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And the book was about the, the history of the field

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of pandemic preparedness,

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and a about the role that techniques of anticipation like

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scenario-based exercises had played in shaping

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experts understanding of

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what would be necessary in a future biological emergency.

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So then when the coronavirus outbreak began in early 2020,

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a lot of journalists

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and other observers noted the title of my book, unprepared

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and thought, I had somehow been prescient.

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Um, I had anticipated this disease,

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and I, I, I had issued a call to arms,

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and they asked me, well, you know, why?

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Why does the United States seem to be performing so badly?

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Why were we so unprepared?

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The title of my book had not really been meant

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as a diagnosis,

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but rather it was a characterization of an, of an ethos,

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of a kind of injunction to prepare,

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and one that had been relatively successful.

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The United States had invested massively in biological

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preparedness over the prior two decades.

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And indeed, in the first several months

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after the outbreak of the pandemic,

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even though there was a lot of chaos

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and disorder in the government's response, I also saw a lot

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of those, plans being put into action.

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Um, so I was struck by the notion that in fact,

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we had been quite prepared,

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but that, that, that preparedness had not led

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to an efficacious response.

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There were a bunch of, measures that had had been,

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the target of, of up to billions of dollars in investment

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by the federal government, for example,

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we had a massive stockpile called the Strategic National

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Stockpile, that had been built in the late 10,

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late 1990s and early two thousands,

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originally in preparation for a biological terrorist attack.

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Um, and so that stockpile contained, millions of doses

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of smallpox vaccine, anthrax, vaccine botulism, antitoxin.

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Um, and so we were ready for a bunch of things.

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We just weren't really very ready for the coronavirus.

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It didn't have enough, supplies like medical gowns,

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N95 masks ventilators.

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So you saw at the outbreak of the pandemic, you know,

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a run on these supplies and, and,

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and chaotic competition between states over

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who could have access to them.

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One response to the pandemic

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that was well known was the idea of flattening the curve.

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Uh, now that was actually the result of a plan

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that had been put in place by, experts at the Centers

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for Disease Control based on the possibility

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of a bird flu pandemic.

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Uh, those experts had looked at patterns of response

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during the 1918 Spanish Flu Pandemic

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and saw that in cities that closed down public events,

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they had a, a lower mortality rate to flu densities

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that did not immediately close down public

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events and gatherings.

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So they put in place a plan, that were, that involved

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what were called non-pharmaceutical interventions,

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Things like shutting down a non-essential businesses,

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closing schools.

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Um, but the idea had to do with the patterns that flu,

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tends to run, which is in waves,

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and the idea that, a vaccine

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for flu would be available within a few months.

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Uh, so the planners assumed that these non-pharmaceutical

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interventions, these efforts to flatten the curve in order

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not to overwhelm the medical system,

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would just be a matter of a couple of months.

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Um, they didn't really envision, a seemingly kind

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of endless series of such of shutdowns that led

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to public protests that had massive economic effects,

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effects on people's education

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and effects that were unequal depending on one's social

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class and occupation.

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I think that, you know, we, we happened to have in place

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a government, at the time,

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the first Trump administration that was avowedly suspicious

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of expertise and suspicious of, of government.

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So, at the very moment when we needed a, a coordinated,

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flexible, thoughtful public health response

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and clear communication with the public,

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we had a political administration in place in the federal

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government that was precisely suspicious of, of the role

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that the government would have to play in an emergency.

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So that was one part of it.

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Um, but another part of it, I think, had to do with some

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of these built-in blind spots, that were, that,

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that were the result of planning for different kinds

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of events than what actually unfolded in the case

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of pandemics or epidemic outbreaks.

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Um, it's really hard to know what kind

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of disease one's going to face in the future.

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Uh, if you look just even at the last couple of decades,

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Ebola, H one N one flu, the coronavirus,

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they all created very different kinds of problems.

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Um, and so I think that,

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and certainly something like a smallpox attack

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or an anthrax attack would create

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an entirely different set of issues.

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And so I think one problem is in, developing plans

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that are too specific, as we saw with the case

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of the stockpile or in a certain way with, with, the,

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in the case of flattening the curve, I think it's better

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to invest in, response tools that are quite flexible

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and that are useful not only in the case of an emergency,

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but also in the case

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of ongoing everyday health issues that we face.

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So investing in basic biomedical research in immunology,

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investing in the strong public health system assuring

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that people have access to, to healthcare, equally,

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those are the kinds of things that are going to work.

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Um, you know, whether or not we have a massive health

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emergency, the experts suffered a real,

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diminution in public trust.

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And the question, I think is how to rebuild that trust,

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especially, again, facing,

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a political climate in which there's not a lot

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of confidence in government institutions.

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There's not, not a lot of confidence in,

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in experts in places like the, the government health,

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agencies.

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Uh, and so one thing that the field of risk communication,

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for example, has demonstrated is that it's really important

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for authorities to be frank

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Both about what they know

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and what they don't know at the outset of an emergency.

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And, and projecting overconfidence

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that is then undermined if the results don't unfold in the

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way that experts anticipated,

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I think undermines public trust.

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So it's one, one thing I think,

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we can learn is a certain humility at the outset

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of an outbreak,

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and letting the public know that scientific, research

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and discovery is a process of testing and revision.

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Um, and we may not have the best answers,

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but at the moment, but it's gonna get better.

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Um, and, and so demonstrating being transparent about one's

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uncertainty, I think probably will,

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will actually help in encouraging the public

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to trust the kinds of guidance that, that scientists

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and doctors are providing.

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I'm a cultural anthropologist

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and I'm, I'm widely interested in

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how experts think about the future,

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and I've, I've shifted my gaze a little bit

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to thinking about the future of climate change.

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Um, and, as someone who lives in California,

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I've been interested for a long time,

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especially in southern California, in the problem

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of water scarcity and, and availability.

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And so I'm developing a project now that's about

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how experts in water management

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and in climate are anticipating a future of volatility

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and trying to plan for that future.

Reflections on Pandemic Preparedness and Response

00:00:00 - A little bit more than two years before the pandemic. In 2017, I had published a book that was called Unprepared Global Health in a Time of Emergency. And the book was about the, the history of the field of pandemic preparedness, and a about the role that techniques of anticipation like scenario-based exercises had played in shaping experts understanding of what would be necessary in a future biological emergency. So then when the coronavirus outbreak began in early 2020,

00:00:33 - and other observers noted the title of my book, unprepared and thought, I had somehow been prescient. I had anticipated this disease, and I, I, I had issued a call to arms, and they asked me, well, you know, why? Why does the United States seem to be performing so badly? Why were we so unprepared? The title of my book had not really been meant as a diagnosis, but rather it was a characterization of an, of an ethos, of a kind of injunction to prepare, and one that had been relatively successful.

00:01:06 - preparedness over the prior two decades. And indeed, in the first several months after the outbreak of the pandemic, even though there was a lot of chaos and disorder in the government's response, I also saw a lot of those, plans being put into action. so I was struck by the notion that in fact, we had been quite prepared, but that, that, that preparedness had not led to an efficacious response. There were a bunch of, measures that had had been,

Pandemic Preparedness: Lessons from the Strategic National Stockpile

00:01:38 - by the federal government, for example, we had a massive stockpile called the Strategic National Stockpile, that had been built in the late 10, late 1990s and early two thousands, originally in preparation for a biological terrorist attack. and so that stockpile contained, millions of doses of smallpox vaccine, anthrax, vaccine botulism, antitoxin. and so we were ready for a bunch of things. We just weren't really very ready for the coronavirus.

00:02:09 - N95 masks ventilators. So you saw at the outbreak of the pandemic, you know, a run on these supplies and, and, and chaotic competition between states over who could have access to them. One response to the pandemic that was well known was the idea of flattening the curve. now that was actually the result of a plan that had been put in place by, experts at the Centers for Disease Control based on the possibility of a bird flu pandemic. those experts had looked at patterns of response

00:02:41 - and saw that in cities that closed down public events, they had a, a lower mortality rate to flu densities that did not immediately close down public events and gatherings. So they put in place a plan, that were, that involved what were called non-pharmaceutical interventions, Things like shutting down a non-essential businesses, closing schools. but the idea had to do with the patterns that flu,

Challenges in Pandemic Response Planning

00:03:10 - and the idea that, a vaccine for flu would be available within a few months. so the planners assumed that these non-pharmaceutical interventions, these efforts to flatten the curve in order not to overwhelm the medical system, would just be a matter of a couple of months. they didn't really envision, a seemingly kind of endless series of such of shutdowns that led to public protests that had massive economic effects, effects on people's education and effects that were unequal depending on one's social

00:03:41 - I think that, you know, we, we happened to have in place a government, at the time, the first Trump administration that was avowedly suspicious of expertise and suspicious of, of government. So, at the very moment when we needed a, a coordinated, flexible, thoughtful public health response and clear communication with the public, we had a political administration in place in the federal government that was precisely suspicious of, of the role that the government would have to play in an emergency.

00:04:12 - but another part of it, I think, had to do with some of these built-in blind spots, that were, that, that were the result of planning for different kinds of events than what actually unfolded in the case of pandemics or epidemic outbreaks. it's really hard to know what kind of disease one's going to face in the future. if you look just even at the last couple of decades, Ebola, H one N one flu, the coronavirus, they all created very different kinds of problems. and so I think that,

Flexible Preparedness and Rebuilding Public Trust

00:04:44 - or an anthrax attack would create an entirely different set of issues. And so I think one problem is in, developing plans that are too specific, as we saw with the case of the stockpile or in a certain way with, with, the, in the case of flattening the curve, I think it's better to invest in, response tools that are quite flexible and that are useful not only in the case of an emergency, but also in the case of ongoing everyday health issues that we face. So investing in basic biomedical research in immunology,

00:05:18 - that people have access to, to healthcare, equally, those are the kinds of things that are going to work. you know, whether or not we have a massive health emergency, the experts suffered a real, diminution in public trust. And the question, I think is how to rebuild that trust, especially, again, facing, a political climate in which there's not a lot of confidence in government institutions. There's not, not a lot of confidence in, in experts in places like the, the government health,

00:05:48 - and so one thing that the field of risk communication, for example, has demonstrated is that it's really important for authorities to be frank Both about what they know and what they don't know at the outset of an emergency. And, and projecting overconfidence that is then undermined if the results don't unfold in the way that experts anticipated, I think undermines public trust. So it's one, one thing I think, we can learn is a certain humility at the outset of an outbreak, and letting the public know that scientific, research

Embracing Uncertainty: Expert Perspectives on Future Challenges

00:06:22 - and we may not have the best answers, but at the moment, but it's gonna get better. and, and so demonstrating being transparent about one's uncertainty, I think probably will, will actually help in encouraging the public to trust the kinds of guidance that, that scientists and doctors are providing. I'm a cultural anthropologist and I'm, I'm widely interested in how experts think about the future, and I've, I've shifted my gaze a little bit to thinking about the future of climate change.

00:07:07 - I've been interested for a long time, especially in southern California, in the problem of water scarcity and, and availability. And so I'm developing a project now that's about how experts in water management and in climate are anticipating a future of volatility and trying to plan for that future.

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