“My husband works for NASA, so I've gotten to see what it means when a government agency has well-exercised playbooks and implementation plans,” Nuzzo said. “We don't send a rocket to space without having data to understand if that rocket is on course. Unfortunately, in the case of the pandemic, the country didn’t collect the data that was needed in order to understand if our response was having the right impact, or if there were ways the response could be improved.”

That’s where places like the Pandemic Center can play a role, Nuzzo said. A major goal of the center is for its scholars to generate, synthesize and translate evidence. To that end, its leaders are currently building and integrating better global, national and local data systems for detecting and responding to pandemic threats and mitigating their impacts. A new satellite office in Washington, D.C., will soon open, enabling close partnership with the Brown in Washington program, where students will have opportunities to complete internships, and where Brown researchers will have more direct access to policymakers.

“Our goal is to do actionable research at the Pandemic Center and then ensure it gets translated to policymakers and quickly and efficiently implemented in communities,” Nuzzo said.

Lesson 2: Pandemic planning needs to reflect the political and social realities of the country as it is

Not long into the pandemic, it became clear that the zero-COVID approach adopted by China’s government would not work in the U.S. Instead of expecting the country to change so drastically, Nuzzo said, an effective response needs to engage people in defining the response strategy, to ensure that approaches work for communities and align with their values. Crucially, she added, it’s important that future pandemic response efforts are equitable and don’t leave behind the most vulnerable.

Organizing the conversation and report — titled “American Democracy and Pandemic Security” — with the COVID Collaborative and the Global Health Policy Center is one way the Pandemic Center is trying to understand what that means and engage a diverse group of leaders in identifying new solutions. The conveners of the roundtable discussion said they were struck by how much agreement there was around the fact that the country doesn’t have enough tools for communities to be able to function even somewhat normally in a pandemic.

According to the report, many leaders felt that pandemic responses put Americans in a position of choosing between health or the economy, online or in-person education, locking down or lifting restrictions, and individual freedom or collective responsibility. These blunt, binary options created divisions within and among political parties and forced some Americans to take sides, Cameron said. The choices also weren’t adaptable for the wide range of communities in the country, from rural to urban to tribal.

“What we need are tools that allow communities to stay as safe as possible while preventing spread, so that they don’t always have to make impossible choices and can more easily open schools and businesses, scale community testing, and improve equitable access to vaccines and treatments,” Cameron said.

To that end, and to engage people in solution-planning, Pandemic Center leaders plan to work with partner organizations to host a series of discussions in communities with a wide variety of political demographics to capture experiences and local successes, and to understand when communities had to make do and what worked for them. The plan is to combine the feedback from those discussions with additional research to create playbooks that give communities what Nuzzo has referred to as “a menu of options” to prepare for and respond to future pandemics.

“We plan to define different measures and when they can or should be used,” Nuzzo said.

She added that lockdowns and shutdowns made many Americans equate public health with restrictions and mandates. “It’s time to get back to that point where the public is engaged in public health, and sees it as helping them do the things they care about in a safer and healthier way.”

Lesson 3: Social vulnerabilities are pandemic vulnerabilities

Early on, many experts believed that simply sharing science with the public would be enough to change human behavior. The problem, Nuzzo said, is that even when people understood the science, they weren’t always able to act upon it.

For example, while many Americans were able to avoid large groups by working remotely, others had jobs that required them to report to work in-person; they couldn’t “Zoom in” to the nursing home, the warehouse or to a restaurant shift. Then there were those who worked in-person and didn’t have paid sick leave, which meant that following public health recommendations and staying home after testing positive would mean forfeiting compensation. Nuzzo also cited the high cost of high-quality N95 and KN95 respirator masks, which meant that many people weren’t able to wear them as health experts advised.

She stressed that social vulnerabilities exacerbated the pandemic’s effects.

“We saw that social vulnerabilities like having a low income, being uninsured, and lacking a safe place to isolate were associated with a higher risk of getting sick,” Nuzzo said. “Vulnerable populations can’t be considered a special case; we need to recognize that these individuals should be the highest priority to attend to. Protecting our vulnerable populations is central to the goal of protecting society and keeping the public safe.”

Moving forward, Nuzzo said, equity needs to be a focus of pandemic preparedness plans, not an addendum. Future interventions need to recognize where society falls short; and sick leave policies, housing policies, childcare availability and transportation options all need to be factored into a pandemic response strategy.

Nuzzo pointed toward the Biden administration’s equity-focused COVID-19 vaccination program as a public health success story. When the administration made efforts to engage underrepresented communities in planning and organizing, vaccination rates among Black and Hispanic populations increased significantly, and as a result, the racial gap in death rates disappeared.

“That’s the kind of lesson we can learn from,” Nuzzo said.