Leana Wen
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Of the many lessons learned from the COVID-19 pandemic thus far, two of the most critical are the need for effective national leadership and clear, consistent communication. Countries that fared well had both in abundance; those that didn’t often faltered.

The TIME survey results reflected this, with “leadership and public communication strategies” as the only category in which every proposal was rated, on average, at least a 4 out of 5 for priority. The highest ranking went to “ensuring strong, federally coordinated responses that provincial, state, and local jurisdictions can rely upon for guidance.” The importance of this strategy cannot be overstated. In a country like the U.S., for example, it made no sense to have 50 states that had to secure their own supply of masks and tests, and to have 50 different sets of rules to contain (or not) the disease. This piecemeal approach leads to inefficiency and confusion at best—and chaos and inability to control the virus at worst.

What needs to happen in a public health crisis? The federal government must establish a national roadmap with clear goals and evidence-based policy guidance. Rather than limiting local autonomy, such a roadmap empowers those closer to the ground to tailor the specifics to their communities. As a former local health official, I can tell you that local health departments are chronically understaffed and do not have the capacity to analyze scientific reports and synthesize them into policies and regulations. They rely on federal entities to formulate this guidance, which they can adapt to local circumstances. In addition, being able to point to federal guidelines helps serve as political cover—important when the recommendations are unpopular and ask people to take difficult actions, such as shuttering businesses and imposing stay-at-home orders.

The TIME survey also identifies global health governance as a top priority, including to “reform the World Health Organization’s regulatory authority so that it can implement and enforce global health policy in member states….” Interestingly, and unfortunately, the feasibility of this intervention was rated a 2.86. I agree with this low ranking. Reforms at the WHO, if they do take place in a meaningful way, will be a long and tedious process. Global health governance needs to occur, but there is an urgency to what actions must take place now.

Individual governments can take matters into their own hands. First, they must get their own shops in order. They need to rigorously evaluate their country’s pandemic response and make necessary investments to the local public health infrastructure and to improve local, regional, and national coordination. Second, they should strengthen international scientific collaborations that, in the case of COVID-19, were clearly identified as the savior in such rapid development of safe and effective vaccines. Third, willing countries can initiate multinational agreements for transparency, mutual aid, and partnership.

Improvements in global public health must begin locally, and must be driven by leaders who will learn the hard lessons from COVID-19. If we can agree on the key factors that need reform, then we must agree to doing what it takes to prevent another tragedy.

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