We’re Still Getting Our Pandemic Preparation Horribly Wrong

We’re Still Getting Our Pandemic Preparation Horribly Wrong

We’re Still Getting Our Pandemic Preparation Horribly Wrong

Until we focus on the combustible social conditions that made Covid so devastating, we’ll never be truly ready for the next pandemic.


When a single flame fell to the floor of the Triangle Shirtwaist Factory on March 25, 1911, it found the ideal conditions to spread: crowded rows of garment workers feverishly stitching flammable fabric in poorly ventilated rooms locked by managers to prevent theft. The fire worked with devastating efficiency; in just 18 minutes, 146 workers lay dead—some so badly burned that they could not be identified.

Future secretary of labor Frances Perkins was one of the first witnesses to arrive on the scene of the fire. She would later recall a collective sense that “something must be done. We’ve got to turn this into some kind of victory, some kind of constructive action.” Within a year, New York State began to enforce comprehensive new workplace safety standards that laid the groundwork for the establishment of OSHA. A newly formed Factory Investigating Commission pursued legislation “to prevent hazard or loss of life among employees through fire, unsanitary conditions, and occupational diseases.” Out of the ashes of the factory rose the architecture of modern labor protections.

More than a century later, the SARS-CoV-2 virus tore through the fissures of American society just as brutally as the fire tore through that building in Lower Manhattan. Once the virus breached biosafety systems that had been lauded as impenetrable, it encountered decrepit social infrastructure. It found “essential workers” laboring in meatpacking plants, shipping facilities, and grocery stores. It followed them home to multigenerational households in disproportionately Black and brown communities. Those low-paid workers made up most of the deaths among working-age Americans in the first year of Covid-19. The pandemic also ripped through neglected nursing homes, whose medically fragile residents accounted for up to 80 percent of total deaths in some states in 2020. It engulfed prisons in devastating outbreaks that functioned as “epidemic engines,” sending the virus on into neighboring communities.

The US government declared the Covid-19 pandemic officially over on April 10—terminating the national health emergency. But experts predict the likelihood of a similar pandemic occurring in a given person’s lifetime at 38 percent—and suggest that this already high probability “may double in coming decades.” Yet, unlike the policy response to the Triangle Shirtwaist Factory fire in 1911, our preparation for future pandemics remains largely focused on the spark—infectious pathogens—and not on the combustible social conditions that have made Covid-19 so devastating in the United States.

To a startling extent, the experience of a multiyear pandemic has not redefined our collective understanding of what “preparedness” means. In 2021, the Global Health Security Index (GHSI), which assesses and ranks country-level pandemic preparedness around the world, ranked the US first globally for pandemic preparedness—just as it had in 2019, before the emergence of SARS-CoV-2. Though the US has performed far below its peer nations, contributed disproportionately to global totals of cases and deaths, and registered large and persistent disparities in our Covid outcomes, we are still—on paper—number one.

It is true that the United States has spent vast sums on biosecurity initiatives. And to a certain extent, some of these investments paid off: The development of a vaccine in under a year remains a remarkable accomplishment. But absent from the GHSI—and from our broader understanding of pandemic preparedness—is an accounting of the social vulnerabilities that enabled the disease to spread unchecked in this country.

As a result, we are failing to invest meaningfully in reforms that could serve as future firebreaks. Plans to develop a vaccine in 100 days have taken center stage at global forums and in “next pandemic” conversations. But plans to protect poor, minority, and medically vulnerable populations, all overwhelmingly represented among the more than 100,000 Americans that died in the pandemic’s first 100 days, remain conspicuously absent. As journalist Amy Maxmen has written, “If pandemic preparedness plans leave out discrimination, labor protection, fairer wages & access to healthcare and education, we fail again.” The usual rule is: Once burned, twice shy. Yet the United States remains a tinderbox for new infectious pathogens to be set alight.

Accordingly, the US must lay the blueprint for a less flammable society and not simply—as Bill Gates recently suggested in the New York Times “Next Pandemic” series—a “better fire department.” Our preparations for the next pandemic should begin in the places and communities that Covid hit hardest and first. Upgrades to the infrastructure of our nursing homes, factory floors, and crowded public spaces must be a first order of business. A safety net that includes paid leave should be part and parcel of our public health infrastructure, so frontline workers don’t have to choose between community health and making ends meet. Meaningful plans for protecting the highest-risk members of our society in public and private spaces should be our top priority.

Instead of defining “pandemic preparedness” as the task of scientists alone, we might choose to think differently about what it means for life and health to be truly secure. We should see the lack of universal health care and underinvestment in safety net hospitals and primary health care as critical vulnerabilities and build on the temporary expansion of Medicaid, rather than roll back these protections. Policy measures such as eviction prevention, the use of non-congregate shelters, and decarceration should also be seen as “primary tools of pandemic control.” Many of these measures would not only be part of our pandemic arsenal but would also leave the population in better underlying health.

After witnessing the fire at the Triangle Shirtwaist Factory—an indelible spectacle, which had horrified a crowd of New Yorkers—Frances Perkins was galvanized to combat not just the immediate hazards of fire-prone workplaces but also the broader “ongoing assault on the common order that the fire came to symbolize.” Her activism—and the efforts of labor organizers, public safety advocates, and public officials—achieved national reforms to systems that put American workers at risk. We are at a similar crossroads. Amid the still smoldering fires of the Covid pandemic, we can fortify the architecture of society and embrace a vastly more expansive view of preparedness and public health.

Correction: This piece originally stated that the Biden administration terminated the national public health emergency on April 10. In fact, only the national emergency was terminated; the public health emergency, which is a separate executive order, will end on May 11.

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