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Global Health Security is Global Security: The lessons of Clade X.
By: Myers, Nathan, World Affairs, 00438200, Dec2018, Vol. 181, Issue 4
What if the Cuban Missile Crisis had not ended so well?
In the midst of the Cuban Missile Crisis in 1962, an Executive Committee of the President, or ExComm, was established and chaired by Attorney General Robert Kennedy to provide President John F. Kennedy with recommendations on how to remove Russian nuclear missiles from Cuba without instigating a world war. As we know, that situation ended without calamitous results for the United States, Russia, and the world. Much of the credit is given to the work of ExComm, which gave President Kennedy options other than the invasion of Cuba.
Fast forward to May 15, 2018. The Johns Hopkins University School of Public Health's Center for Health Security hosted a major tabletop exercise titled Clade X. The exercise brought players with a broad range of government experience in the legislative and executive branches together to consider policy options and produce hypothetical policy recommendations in response to a global pandemic. The name given to the group charged with addressing this fictional, but not unrealistic, scenario was ExComm. However, this version of ExComm did not fare as well as Kennedy's. At the conclusion of the exercise, the fictional Clade X virus left the United States and the world socially, economically, and politically devastated.
To be fair, the result of this exercise was predetermined. The participants could not have made alternative choices that would have led to a positive outcome. Their purpose was not to avert disaster but to consider the policy choices and hard questions that would have to be addressed during a global health emergency. This ExComm, like the original ExComm, was frequently frustrated by constraints on their ability to act, particularly at the international level.
The Clade X virus first appeared in Germany and Venezuela. Due to the fractious relationship between the United States and Venezuelan governments, American agencies were severely limited in their ability to gather intelligence to refute Venezuelan claims that there was no outbreak. In addition to ongoing gaps in global surveillance systems, diplomatic obstacles made it very difficult to confirm the existence of a new threat and begin collecting epidemiological data in the critical early stages of the response. These gaps were exacerbated by the fact that Venezuela was not abiding by the International Health Regulations, which require countries to disclose information regarding a potentially pandemic outbreak. The fact that U.S. rivals such as Russia, Iran, and China were being given access to the country created concerns on a couple of fronts. First, it created the perception that the United States was not taking a leadership position on the crisis. Second, it raised the possibility that a hostile nation could obtain important biological samples of an emergent pathogen and not share them with the United States ([ 3]). We are seeing a less urgent version of the latter scenario play out today, with China refusing to share samples of the dangerous H7N9 avian influenza virus for the last year ([ 2]).