Event 201 was one of dozens of simulations and evaluations over the past two decades that have highlighted the risks of a pandemic and identified gaps in the ability of governments and organizations around the world to respond.
The exercises anticipated several failures that have played out in the management of COVID-19, including leaky travel bans, medical-equipment shortages, massive disorganization, misinformation and a scramble for vaccines. But the scenarios didn’t anticipate some of the problems that have plagued the pandemic response, such as a shortfall of diagnostic tests, and world leaders who reject the advice of public-health specialists.
Most strikingly, biosecurity researchers didn’t predict that the United States would be among the hardest-hit countries. On the contrary, last year, leaders in the field ranked the United States top in the Global Health Security Index, which graded 195 countries in terms of how well prepared they were to fight outbreaks, on the basis of more than 100 factors. President Donald Trump even held up a copy of the report during a White House briefing on 27 February, declaring: “We’re rated number one.” As he spoke, SARS-CoV-2 was already spreading undetected across the country.
Now, as COVID-19 cases in the United States surpass 4 million, with more than 150,000 deaths, the country has proved itself to be one of the most dysfunctional. Morhard and other biosecurity specialists are asking what went wrong — why did dozens of simulations, evaluations and white papers fail to predict or defend against the colossal missteps taken in the world’s wealthiest nation? By contrast, some countries that hadn’t ranked nearly so high in evaluations, such as Vietnam, executed swift, cohesive responses.
The scenarios still hold lessons for how to curb this pandemic, and for how to respond better next time. Deadly pandemics are inevitable, says Tom Frieden, a former director of the US Centers for Disease Control and Prevention (CDC). “What’s not inevitable is that we will continue to be so underprepared.”
Part of the answer, as the title of their article suggests, is Donald Trump:
Confusion emerged in most pandemic simulations, but none explored the consequences of a White House sidelining its own public-health agency. Perhaps they should have, suggests a scientist who has worked in the US public-health system for decades and asked to remain anonymous because they did not have permission to speak to the press. “You need gas in the engine and the brakes to work, but if the driver doesn’t want to use the car, you’re not going anywhere,” the scientist says.
However, they also note that—regardless of who occupies the presidency—institutions also failed to respond to insights and warnings that emerged from many of these games.
Perhaps the biggest limitation of simulation exercises was that they didn’t actually drive policymakers to prioritize and fund improvements to the public-health system. Morrison now questions whether it’s even possible to do that through simulations alone, or whether people must experience an epidemic at first hand.
PAXsims has previously reported the development of a matrix game entitled After The Apex by Ben Taylor and Ben Williams. The game allows players to explore the challenges faced by the fictional country of Bretonia as it seeks to chart a course to toward the new normal once the first wave of COVID-19 infections had passed.
The developers have now been working with Anja van der Hulst of TNO to build a dilemma game based upon the same scenario. The dilemma game is implemented in software and allows the solo player to make a series of policy decisions based upon dilemmas faced but the Bretonian government. A range of advisors will offer perspectives on the issue and provide different rationales for accepting, or not, the proposed policy. The player is left with the decisions as to what to do.
The dilemma game plays much more quickly than the matrix game and so allows some of the same issues to be explored in a shorter time, but without the rich interpersonal interaction. This may be a better design choice for some applications. Those attending next week’s Connections professional wargaming conference will have two opportunities to play the dilemma game and to meet with the developers. A fuller write up will follow on PAXSims after the conference.