Our Response to 9/11 Gave us Lessons for COVID-19

“America is no longer protected by vast oceans. We are protected from attack only by vigorous action abroad, and increased vigilance at home.”

– President George W. Bush, State of the Union Address, January 29, 2002.

The COVID-19 outbreak will likely prove to be the most consequential event since the Second World War and economically as destructive as any event since the Great Depression. Certainly, the global economic and social scale of the COVID-19 outbreak is far more extensive than the events of 9/11. Yet common features between the two crises exist.

The COVID-19 crisis and 9/11 attacks challenged policymakers to simultaneously respond to a long-expected attack while dramatically improving our response capacity in anticipation of a future wave of attacks.

The roll-out of COVID-19 destruction is occurring at a far slower pace than the violence of 9/11, which was conducted in a single terrible day. But in each case, U.S. government decision-makers have the same challenge:  To understand an ongoing attack while considering steps to mitigate further damage. During the months following the 9/11 attacks, U.S. security services remained concerned that a second al-Qaida attack – possibly one involving nuclear or biological weapons – would follow. The imperative to neutralize possible further al-Qaida attacks dramatically reshaped domestic and foreign policy priorities. Interagency groups focused U.S. policy efforts and energetically engaged counterparts throughout the world to drive a worldwide campaign against al-Qaida as well as its ideological and financial foundations.

Similarly, we should hope that international policymakers will prepare for a possible second wave of COVID-19 outbreaks in the U.S. and abroad.  The human and economic consequences of this pandemic and its successors are only beginning to be understood; the long-term political and social impact domestically and abroad will remain unclear for months.

The U.S. should begin steps to form a bipartisan group of current and former officials as well as private sector leaders to understand what we could have done better during this COVID-19 crisis (and the decades preceding the outbreak) and how to prepare for the next epidemic.  It is critical that this group be perceived as nonpartisan and capable of engaging counterpart entities abroad and within international organizations.

Like 9/11, we had sufficient warning to know that a global pandemic was likely inevitable. Only the timing was unknown.

Throughout the 1990s, U.S. law enforcement and intelligence closely followed – and often frustrated – al-Qaida and other militant operations around the world. But the drumbeat of high-profile terrorist incidents persisted with attacks including the 1992 Gold Mohur Hotel in Aden, Yemen; the 1993 bombing of the New York World Trade Center; the 1998 bombing of the U.S. embassies in Kenya and Tanzania; and the 2000 attack against the USS Cole. By 2001, it was no secret that al-Qaida was building an army of foreign operatives trained at facilities in Afghanistan.

In response, U.S. national security officials developed unified national strategies to deal with this threat. The White House and Department of Defense issued policies to improve interagency counterterrorism cooperation and effectiveness. President Clinton’s Presidential Decision Directives in 1995 (no. 39) and May 1998 (no. 62) reiterated that terrorism was a national security problem, not just a law enforcement issue. The Department of Defense responded with recommendations of its own. Congress allocated hundreds of millions of dollars to resource counterterrorism initiatives.

Policymakers, Congress, and Defense Department officials demanded and received routine briefings on the threat picture as well as the diplomatic, intelligence, and law enforcement architecture arrayed against it. The results were impressive. The State, Treasury, and Defense Departments made counterterrorism a priority. The Central Intelligence Agency and the Federal Bureau of Investigation developed robust domestic and global programs targeting al-Qaida and related groups. U.S. diplomats and intelligence personnel regularly engaged their foreign counterparts to improve information sharing, to silence pro-militant propaganda outlets, and to end recruiting hubs and finance streams that enabled al-Qaida operations.

Despite these efforts, conclusive progress against al-Qaida remained elusive, and the necessary access to its leadership planning never crystallized. But even an incomplete understanding allowed the U.S. Intelligence Community (IC) to alert policymakers in the months before 9/11 that al-Qaida appeared to be planning a “spectacular” attack against a high-profile target. Unfortunately, the IC could not identify the timing, location, or means of the attack.

Similarly, concerns over a potential global influenza pandemic are far from new. During the past 150 years, the world has endured significant epidemics at least twice per generation and with alarming frequency in the last two decades.

• The 1889 influenza (“Asiatic flu” or “Russian flu”) was the most lethal epidemic of the nineteenth century, spreading rapidly throughout Europe and the United States. Emerging from eastern Russia, the outbreak is estimated to have killed one million people worldwide.
• The 1918-1919 H1N1 influenza (“The Spanish Flu”) likely first appeared between 1900 and 1915 and had its origins in the oldest classical swine influenza strain. The 1918 outbreak may have begun in Haskell County, Kansas, before spreading to army bases whose soldiers carried the virus abroad.  In a world lacking vaccines and antibiotics, the only response involved a combination of hygiene and isolation. By the time the pandemic abated, it had killed between 20 and 100 million people worldwide, including an estimated 675,000 people in the United States.
• Psittacosis (“Parrot Fever”) was first identified in Germany in 1879 as a disease transmitted from exotic birds to humans. The lethality of the virus was dramatic, killing as many as 20 percent of those it infected throughout Europe and the United States. Psittacosis erupted in 1917 in New York, but its most dramatic international outbreak was in 1929 (shortly after the stock market crash) when it spiked throughout Europe, North Africa, as well as the United States. Alarm over the outbreak grew with news that it killed some of scientists at the U.S. Hygiene Laboratory (later the National Institutes of Health) who studied it an effort to develop a cure. The 1929 outbreak received extensive media coverage to include doubts by some (mainly bird dealers) as to its cause. Countries banned bird importation, many birds were destroyed, and the use of antibiotics reduced the mortality rate to near zero. The virus reappeared over the years, to include as recently as 2016.

• The 1949-1952 Poliomyelitis pandemic (Polio) involved a virus feared since ancient Egypt. Almost certainly present in the U.S. throughout the 18th and 19th centuries, the disease appeared frequently and spread rapidly. A summer 1916 outbreak resulted in 27,000 victims and 6,000 deaths. New York suffered 9,000 cases, of which 2,000 victims died. In 1921, the disease struck its most famous victim, Franklin Delano Roosevelt, and it continued to ravage thousands of victims throughout the 1930s and 1940s. In 1952, the virus struck 60,000 children in the U.S. alone, killing more than 3,000 and leaving thousands more paralyzed. Media attention was widespread, and the 1953 announcement of the Salk vaccine was considered a modern miracle. By 1979, the disease had been eradicated within the United States.  International cooperation through the Global Polio Eradication Initiative has reduced the disease’s presence to Afghanistan, Nigeria, and Pakistan.
• The 1956-1958 H2N2 virus (“The Asian Flu”) emerged in Guizhou province in China as a variant on an avian virus. By the time scientists developed a vaccine, the virus had killed between one and three million victims worldwide – 116,000 of which were in the U.S. The virus would reappear periodically as a global infection.
• The 1968 Influenza A subtype H3NS virus (“The Hong Kong Flu”) originated in China in July 1968 and lasted until 1970. The pandemic spread rapidly, reaching the United States and Europe by the autumn of 1968. Particularly lethal to those 65 years and older, the virus killed an estimated one million people worldwide, including 100,000 within the United States.
• The 1981-present Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic was recognized in the 1980s but the disease likely existed in Africa, Australia, Europe, North America, and South America since the 1920s.  The disease is believed to have transmitted to humans from African chimpanzees and sooty mangabeys.  By the 1990s, an international coalition of public and private sector officials resulted in policy focus and funding that produced dramatic improvements in testing and treatments although a cure remains unknown. The disease is believed to have infected 75 million people of which approximately 32 million died.
• The story of the 2002-2003 Severe Acute Respiratory Syndrome virus (SARS) foreshadowed the COVID-19 outbreak and deserves a more detailed review. In November 2002, the first known SARS case is believed to have appeared in the city of Foshan in central Guangdong Province, China. Beijing initially treated news of the pandemic as a state secret. The international community remained unaware of the disease until it had spread abroad. In February 2003, rumors of the pandemic forced Beijing to announce that a pneumonia-like virus had infected 305 people and killed five. Nonetheless, Chinese officials continued to downplay the outbreak’s severity and maintained a news blackout to avoid disruption of a National Party Congress gathering.

China’s decisions had lethal consequences. The absence of a coordinated domestic and international response enabled the virus to spread throughout China and neighboring regions. A Chinese professor who had treated patients in Guangdong traveled to a Hong Kong hotel on February 21. She died shortly after, but not before she and those with whom she came into contact infected 80 percent of Hong Kong’s cases. Infected tourists and businessmen then transmitted the disease to their home countries. By February 28, the World Health Organization (WHO) identified Vietnam’s first SARS victim. Within two weeks, SARS cases appeared in Asia, Canada, and the United States.

The WHO quickly alerted airlines to be vigilant for travelers with pneumonia-like symptoms. The U.S. Centers for Disease Control and Prevention (CDC) discouraged non-essential travel to countries with outbreaks of atypical pneumonia, expanding the advisory to China by the end of March. Schools and churches closed throughout in Asia.  Canadian officials ordered thousands of people, including health workers, to self-quarantine at home for ten days. The Department of State evacuated non-essential U.S. diplomats from China and Hong Kong.

Beijing’s cooperation remained limited despite growing international criticism. Chinese officials repeatedly declared the situation under control and denied WHO experts access to Guangdong until April 2.  Beijing was embarrassed by U.S. media reports showing that its officials attempted to conceal the number of victims treated at military hospitals. China eventually issued an apology for its slow handling of the epidemic and dismissed its health minister and the mayor of Beijing.

The SARS virus abated through syndromic surveillance, isolation of patients, and strict, state-mandated quarantine regimens. China declared the pandemic under control in late March, and the WHO lifted its travel advisory a month later. The epidemic infected more than 8,000 persons worldwide and killed 774. The actual number of persons infected and killed was likely higher.

• The 2009-2010 H1N1 novel influenza virus (Swine Flu) appeared in California in April 2009.  By the end of that month, the WHO declared the outbreak a pandemic. Infection quickly spread to all 50 states and Mexico with a second wave occurring in the fall.  In part due to the development of a vaccine, the WHO was able to declare an end to the pandemic in 2010. One estimate declared that the virus was responsible for as many as 575,000 deaths.
• The 2012 Middle East Respiratory Syndrome Coronavirus (MERS) has been traced to dromedary camels handlers in the Middle East as well as Egyptian tomb bats.  Outbreaks have been most frequently reported in Saudi Arabia, although it has appeared in 27 countries.  The infection carries a high mortality rate, killing approximately 35 per cent of its victims. The initial Saudi response to the outbreak drew international criticism as being insufficient, but the Kingdom’s efforts since 2014 are believed to have significantly reduced infections.  Since 2012, more than 2,400 persons have contracted the virus of which at least 842 died. Incidents of the disease have been reported as recently as 2019. There remains no vaccine for the disease.

The post 9/11 period saw the development of several plans to deal with the terrorist threat. In 2003, the Bush administration issued a National Strategy for Combatting Terrorism and refined the strategy in September 2006. In June 2011, the Obama administration released its own National Strategy for Counterterrorism. In 2018, the Trump administration issued a National Strategy for Counterterrorism. The Department of Homeland Security and the Department of Treasury issued strategies of their own over the next two years.  Successive administrations followed a similar path to address the pandemic threat. Based on lessons learned during its handling of the SARS and HIV outbreaks, in November 2005, the Bush administration issued a national strategy plan for dealing with an influenza pandemic. Using lessons from the 2014 Ebola outbreak, MERS, and Zika outbreaks, the Obama administration developed a detailed playbook for a whole-of-government response to a virus outbreak. This product was shared with the Trump administration when the latter took office.

Pandemic and counterterrorism strategies generally differed in terms of resource commitments and public profile.  Counterterrorism programs after 9/11 received large budgets and personnel shifted from other priorities.  The U.S. improved collaboration among government agencies and mobilized the private sector to achieve one goal: to prevent another catastrophic attack on the United States or our partners.  The effort was at times disruptive to other priorities and consumed billions of dollars, but the program has been an undeniable success. Working together with foreign partners, we developed institutions and expertise that prevented multiple terrorist attacks, killed Osama bin Laden, and destroyed much of al-Qaida’s capabilities as well as the Islamic State caliphate.  We also transformed how other countries viewed al-Qaida and militant threats in general.

With only two exceptions, pandemic prevention since 2001 rarely enjoyed such an aggressive approach.

• The George W. Bush administration’s response to the HIV/AIDS pandemic allocated billions of dollars for global prevention and treatment The S. President’s Emergency Plan for AIDS Relief (PEPFAR) remains the largest single commitment by any country against a single disease in history. Led by the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy, PEPFAR aims to coordinate interagency and private sector activity against HIV/AIDS.  The impact of the global campaign has been striking. The death rate for HIV/AIDS dropped from 1.7 million in 2004 and 1.2 million in 2010, to an estimated (still dramatic) 770,000 in 2018.
• The Obama administration’s handling of the 2014 Ebola epidemic was also an example of thoughtful leadership. Although Ebola had been recognized by the international community as a pandemic threat since 1976, outbreaks were limited to remote areas of Africa and generally lasted only a few months.  Infection was believed to have occurred when individuals came into direct contact with blood of meat of infected fruit bats, chimpanzees, or gorillas.  In March 2014, the WHO reported cases of Ebola in West Africa which quickly spread to urban areas where the disease overwhelmed local response systems. Poor infection control exacerbated the problem and health care systems soon collapsed. By July, the virus had spread to Liberia, Sierra Leone, and Guinea. In September, the first Ebola death occurred in Texas. New York experienced its first case in October.

Recognizing the inadequacies of international organizations and countries affected by the virus, Washington drew upon the CDC’s experience in dealing with 20 Ebola outbreaks since 1976 to develop a concerted effort against this unprecedented pandemic.  This effort involved the mobilization of 2,800 U.S. troops, 4,000 CDC members, collaborative work with more than 6o countries, and used $1 billion from the Ebola Response Supplemental to establish labs around the world to detect novel virus outbreaks.

CDC’s Role and Accomplishments

CDC’s response to the Ebola epidemic was the largest emergency response in the agency’s history (8). During CDC’s activation of its Emergency Operations Center (EOC) during July 9, 2014–March 31, 2016, approximately 4,000 CDC staff members directly participated in the response, and of these, 1,897 deployed to Guinea, Liberia, Sierra Leone, and other African countries affected by the epidemic (e.g., Nigeria and Mali). CDC’s deployed teams included specialists in epidemiology, infection control, laboratory analysis, medical care, emergency management, information technology, health communication, behavioral science, anthropology, logistics, planning, and other disciplines.

Unfortunately, neither of these efforts sparked a broader reform of either U.S. or international response efforts to pandemics but their work offers a path to combat future pandemics.

The U.S. Intelligence Community did its job.

Over the past decade, successive Directors of National Intelligence routinely warned policymakers of the pandemic threat in annual, unclassified Worldwide Threat Assessments before Congress.

Director of National Intelligence (DNI) Dennis Blair addressed the problem at length in his 2010 Worldwide Threat presentation:

“The current influenza pandemic is the most visible reminder that health issues can suddenly emerge from anywhere in the globe and threaten American lives and U.S. strategic objectives. It also highlights many of the United States’ critical dependencies and vulnerabilities in the health arena. … Significant gaps remain in disease surveillance and reporting that undermine our ability to confront disease outbreaks overseas or identify contaminated products before they threaten Americans. The policies and actions of foreign government and non-state actors to address health issues, or not address them, also have ripple effects that impair our ability to protect American lives and livelihoods and impair Washington’s foreign policy objectives.”

“The pandemic highlights the need to avoid narrowly targeting surveillance and control measures on only one particular health threat. … We have warned in the past that surveillance capacity to detect pathogens in humans varies widely between countries. Of equal concern, the lack of consistent surveillance and diagnostic capability for diseases in animals is a formidable gap even in developed countries that undermines the United States’ ability to identify, contain, and warn about local outbreaks before they spread. Some 70 percent of human pathogens originated from animals, yet global surveillance of animal diseases remains chronically underfunded”

“The ability to detect and contain foreign disease outbreaks before they reach this country is partially dependent on U.S. overseas laboratories, U.S. relationships with host governments, and state willingness to share health data with non-governmental and international organizations. … However, a lack of transparency and a reticence to share health data and viral specimens remains a concern. Governments’ reactions to the current pandemic highlight how health policy choices can have immediate impacts, particularly disease-associated disruptions in travel and trade.”

“We assess that the United States has a critical foreign dependence on several pharmaceuticals, such that an overseas disruption in supply would adversely affect Americans’ health that would not be easily mitigated through an alternative supplier or product.”

In the 2011 report, DNI James Clapper stated:

“It is unlikely that any country will be able to detect cases early enough to prevent the spread of another new, highly transmissible virus should one emerge during the next five years, despite pandemic preparedness efforts by the World Health Organization (WHO) and many nations over the past decade. Once such a disease has started to spread, confining it to the immediate region will be very unlikely. Preparedness efforts such as the stockpiling of medical countermeasures will be critical to mitigating the impact from a future pandemic.”

The 2013 assessment starkly advised:

“… an outbreak would result in a global pandemic that causes suffering and death in every corner of the world, probably in fewer than six months. This is not a hypothetical threat.”

Finally, in the assessment presented by DNI Dan Coats in 2019, he observed:

“… the United States and the world will remain vulnerable to the next flu pandemic or largescale outbreak of a contagious disease that could lead to massive rates of death and disability, severely affect the world economy, strain international resources, and increase calls on the United States for support.”

The clarity of this language over successive administrations provided U.S. policymakers and international partners with the warning required to develop a response program.

What specific lessons from the War on Terror should we consider in coming weeks and months?

We must accept future virus outbreaks as inevitable and address existing insufficient global pandemic response efforts with a minimum of political finger-pointing. As we address unmet requirements for the current pandemic, we will likewise improve our capability to respond to the next outbreak. In addition, we should consider the following lessons learned in the counterterrorism fight:

U.S. global leadership remains essential.  International cooperation at this point in history is at its lowest ebb since the 1930s. Distrust among former allies and enemies, the decline of western liberalism, the failure of collective security, and even indifference characterizes the current state of international relations.   Yet, it is now accepted that the global economy is now inextricably interwoven.  Economic disruption in one region can no longer be kept to that area alone. 

Coming months are likely to see strains on poorly resourced countries with fragile governments.  Revisionist countries such as Russia, China, and Iran appear poised to exploit this moment for their national interests, even while they themselves are rocked by the COVID-19 after affects.  U.S. failure to assume its historic role puts the world and U.S. national security at peril.

 The U.S. responses to the HIV/AIDS and Ebola outbreaks were driven, in part, by a recognition that international organizations cannot replace our leadership. The international community’s response to COVID-19 has been fragmented and, at times, competitive.  The United Nations has issued a Global Humanitarian Response Plan to COVID-19. Although well-meant, this $2.01 billion plan seems insufficient to address either global needs or to drive international collaboration. The engagement of the G20 and G7 also failed to unite the international community.

• We need to reframe how we view pandemic responses and reshape domestic institutions to respond to the long-term pandemic threat.Washington dramatically restructured the decision making and bureaucratic structure of national counterterrorism efforts following 9/11. In an effort to nurture interagency and improve information sharing, the Bush administration created the Department of Homeland Security, the Office of the Director of National Intelligence, the Department of Treasury Office of Terrorism and Financial Intelligence, and the National Counterterrorism Center. New federal, state, and local partnerships were created and resourced to improve domestic counterterrorism capabilities. Building these relationships and understanding local requirements took time to overcome bureaucratic opposition.

The U.S. response to the COVID-19 virus shows that the assignment of federal, state, and local pandemic responsibilities remains unclear and insufficient.  The bitter debate over from whom states should rely on to obtain medical equipment has become another divisive chapter in our history and cannot be repeated.  Any review of our response to this crisis should consider whether we need changes in our bureaucratic structures and how to periodically review these changes for effectiveness.  For example, Congress should conduct annual public hearings involving the relevant U.S. agencies to determine whether resources exist to respond to future pandemics.  The Department of State should be tasked to describe the status of international cooperation and openness on pandemic issues.

• The role of the private sector and academia is critical. Just as the private sector played a significant role in developing technologies and solutions for security problems, it will inevitably become a critical player in the pandemic problem.  The innovation of the private sector should be harnessed to exploit artificial intelligence and other technologies to resolve the challenge posed by the complex data sets associated with pandemics.  The Internet-of-Things (IOT) could be harnessed to anonymously gather data from electronic thermometers.  Can noninvasive coronavirus detection systems be developed to test large number of travelers with little notice? How can we more efficiently produce personal protective equipment, masks, and ventilators in times of crisis?  The academic community should be tasked to foster the multidisciplinary approach pursued to build a new generation of epidemiologists much as we created counterterrorism experts
• Like successful counterterrorism campaigns, effective pandemic policies require a global approach. Our many successes in the War on Terror were often made possible only because of productive partnerships untouched by prevailing political winds. U.S. leadership was decisive in counterterrorism, but we routinely relied on other partners who brought capabilities we simply could not replicate. Simply put, thousands of Americans are alive today because of partners in Africa, Asia, Europe, and the Middle East.

Not every counterterrorism relationship progressed smoothly. Counterterrorism work with Russia and Turkey has sometimes been difficult. Prior to 9/11, some Arab countries refused to share information on extremists or argued that their local militants were insignificant.  It took years of diplomacy to compel foreign partners to adopt laws and regulations to halt the flow of money to extremist groups. Governments tended to accelerate cooperation when they recognized the threat to their populations and when their collaboration could be framed as part of an international effort vice a requirement placed on them alone.

Despite its mixed record of openness with the international community on pandemics, China must become a pillar in the efforts to control global pandemics. Ironically, it was 62 years ago that Chairman Mao memorialized the Chinese effort to eradicate the parasitic liver disease schistosomiasis (“Snail Fever”) in the poem “Farewell to the God of Plague.” China will welcome a larger international voice but will be far less enthusiastic about international scrutiny.

• We must empower existing institutions with the same urgency assigned to counterterrorism after 9/11. Prior to 9/11 U.S. and allied intelligence services had maintained counterterrorism organizations for decades but these programs were dramatically overhauled after 9/11.  Much like their pandemic response counterparts, counterterrorist specialists understood that national defenses begin abroad. Ideally, the international community will view pandemic outbreaks much as power companies in the U.S. handle such natural disasters as hurricanes.  In such a crisis, power companies from throughout the U.S. and Canada flood the site with expertise and equipment to restore local operations. Each participating company knows that they will receive the same level of support should they be a victim of a similar disaster.

However, it is less clear that pandemic response elements are equipped to deal with countries which hide evidence of pandemics.  China’s initial refusal to disseminate details of the COVID-19 outbreak mirrors its handling of SARS. Similarly, Iran also withheld details of the extent of its tragic outbreak.  Turkmenistan reports no cases and has banned public reference to the coronavirus. We should worry that authoritarian countries will continue to subordinate pandemic responsibilities to political considerations.

A key priority must be the establishment of a global system that provides automated collection and sharing of illness surveillance data, i.e., reporting from doctors reporting pandemic-like symptoms in particular geographies. Such a system could serve as a global alarm akin to international cooperation on seismic issues. The international community has several organizations to lead this effort.  In addition to the WHO, the Global Health Security Agenda was launched in 2014 to coordinate global responses by international organizations and non-governmental organizations in more than 50 countries against infectious disease outbreaks.  Within the U.S., the CDC and the Department of Health and Human Services Office of Pandemics and Emerging Threats (PET) will play an important role in any collaboration to prevent, detect, and respond to pandemic threats.

• Where people travel and gather require special attention.  During the fight against al-Qaida, security services monitored transportation routes used by terrorists. Pandemic threats require tight partnerships with countries hosting major transportation hubs, tourist destinations, and religious sites.
• The pandemic and our responses to it could reshape the geopolitical landscape.  In coming months, COVID-19 will weaken already fragile states. Some countries will move towards autocracy. In this regard, it is notable that COVID-19 has dampened protests in the Middle East. But similarly, poor handling of the virus will inevitably foster deeper resentment among already restive populations.

Our pandemic responses could bring unintended consequences much as did our campaign against counterterrorism.  Proper handling of the al-Qaida threat saved countless lives in the aftermath of the 9/11 attack, but our responses also led to the war in Iraq and Afghanistan.  Currently, voices traditionally opposed to the Trump administrations’ pressure campaign against Iran call for a complete lifting of sanctions against that country and support for a $5 billion International Monetary Fund loan to Tehran. Their argument – and that of the Iran’s leaders – is that only a revived economy can truly empower Iran’s pandemic response. Failing to lift sanctions, according to these voices, will increase the suffering on innocent Iranians and allow the virus to spread abroad. The international community should aggressively support the provision of any humanitarian and medical equipment to Iran but lifting sanctions will inevitably allow Iran to resource regional operations which have killed far more innocents than the pandemic. The consequences of allowing Iran to resource its regional, terrorist, and missile programs will likely bring about new and likely profoundly damaging long-term consequences for the region’s populations, to include the millions of foreign nationals who live there.  Likewise, finite IMF funds will face many demands in coming months.

• We can’t ignore adversaries or failed states.  Adversaries in the War on Terror exist, and there is no better example than Iran. Never a formal ally of al-Qaida, Tehranallowed thousands of its trained members to escape from Afghanistan in one of the most consequential actions following 9/11. It would take years for security services to locate and detain these dangerous militants. Tehran also allowed al-Qaida’s leadership to find a haven in Iran and gradually permitted them to travel abroad.

The COVID-19 virus has infected thousands of Iranians and killed more than 2,500. In an echo of China’s handling of the 2003 SARS outbreak, Iran sat on news of the pandemic to allow a parliamentary election to proceed. During this time, Iranians and foreign nationals visiting Iran traveled to the Gulf, Europe, the United States, and Asia, unwittingly spreading the virus. Iran has also fostered claims that the U.S. developed the virus as a weapon against China and Iran. Iran has rejected aid from the U.S. as well as an offer of help from the international humanitarian organization, Médecins Sans Frontières (MSF).  Tehran rejected the latter offer declaring the group to be western spies. Yet not including Iran or any other country in a pandemic response is morally unthinkable and strategically unwise.

Syria, Yemen, and Libya all suffer from a witch’s brew of non-existent medical systems, porous borders, refugees, and militias that value power over civilians. Such countries routinely receive foreign aid and medical assistance, but the extent of the ongoing violence and corruption leave the situation essentially unchanged. Since a pandemic knows no borders, we must focus additional international attention against failed states.

Intelligence agencies will have an important role.  Robust intelligence collection on adversary decisionmakers is a standard requirement for the IC but responding to the pandemic threat may require some shifts in collection focus. The COVID-19 and 2003 SARS outbreaks underscore the importance of knowing of outbreaks as soon as they occur as well as how leaders in those countries respond. China and Iran both refused to share information on this outbreak and have issued propaganda blaming the virus on the U.S. Russia, Syria, North Korea, and other countries are believed to be understating the extent of the pandemic in their territories.

The IC contains several institutions capable of work against pandemics.  The Defense Intelligence Agency’s National Center for Medical Intelligence.  Created in 2008, NCMI was tasked to produce medical intelligence for global force protection and homeland health protection.  But with a broad mandate, limited staff, and military-orientation, the little office remains little known even within the IC.  The largest IC elements all either have small analytic elements which follow pandemics or the agility to direct collection against such targets.  But the IC will need a new architecture to improve the integration of IC work against pandemics.  This may – or may not – require a new organization much like the national IC centers devoted to terrorism, proliferation and counterintelligence threats.  The IC should also expand cooperation with the CDC to ensure that data from global syndromic surveillance is captured in IC assessments.  Open Source collection – aided by artificial intelligence and partners with specific language skills – can be especially useful to monitor social media and press reporting for signs of an outbreak.

• We may face new and difficult moral issues.  It is almost two decades after 9/11, and we continue to debate the value of enhanced interrogation techniques. We should expect other questions in the coming months:  Should we invest in technologies to automate illness surveillance if these technologies can be turned against populations to maintain autocrats?  What will the use of illness surveillance technology mean for privacy concerns?  Should we condition foreign aid or access to U.S. markets on a country’s willingness to share pandemic information?  Should we allow another country to control essential vaccines, the chemicals required to develop tests, or is the primary source of parts required to build ventilators? How will we handle the coronavirus vaccinations in a world where a disturbingly large portion of the population rejects vaccines claiming they either do more harm than good or prefer to rely upon herd immunity?

Developing and institutionalizing a better pandemic response system will be a difficult and lengthy challenge. But counterterrorism efforts since 9/11 showed that we could successfully mobilize against such problems if we led transformational coalitions. We should not be starry-eyed as to how this effort could overcome traditional international animosities that have hampered cooperation to date, but our collective success will inevitably make engagement easier. Time is not on our side, and we confront an existential threat. For all we know, the next novel coronavirus could already be among us.

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