PROVIDENCE, R.I. [Brown University] — On March 11, 2020, the World Health Organization declared COVID-19 a pandemic. In the five years since, more than 7 million people around the world have died, and political and economic systems have been left reeling. Experts say the it’s time for the United States to take lessons from the past to prepare for the inevitability of future pandemics.
In multiple settings, Brown University scholars and community members gathered to reflect on the lessons learned and progress made since the pandemic’s start. With the five-year anniversary having arrived, a selection of Brown experts shared thoughts and insights.
nnifer nuzzo 
Larry warner
Nuzzo: The pandemic resulted in a historic decline in life expectancy globally. We lost more than one million American lives — loved ones who are no longer with us as a result of this virus. Then there is the social disruption, the political disruption, the economic tolls… There are many profound impacts from the COVID-19 pandemic, some of which we are still trying to untangle. 
Mermel: The COVID pandemic was the most difficult challenge of my career. Most of the information needed to mitigate risk to our patients, staff and visitors was unknown early on. Many staff became ill, often from exposure in the community; many staff left health care, and those who remain have been deeply impacted by the magnitude of the experience, watching otherwise healthy patients succumb to COVID, knowing of ill colleagues, friends or family members. Moving forward, we need to have the support staff in place should another pandemic occur to deal with the emotional toll on our staff during such stressful times. Hospital planning is key. That's why at Brown University Health we've been meeting weekly to discuss preparation for a possible avian influenza (H5N1) human pandemic. We've also been having monthly meetings with our hospital system supply chain to be sure we have the personal protective equipment needed for next time.
Warner: Our experience with COVID-19 was a real-time lesson in health equity. We learned about the importance of addressing social needs and how that impacts people's vulnerability to COVID-19 and their ability to manage resources. Socioeconomic status, race, the opportunity to work from home, household density, community density, health literacy, access to information and to vaccines — all of those factors informed disease patterns. When vaccines and mass testing came online, I think we unfortunately took a lot of the best practices of health equity, and out of a sense of urgency, forgot some of them. In Rhode Island, we established mass testing sites in places that were not the easiest to get to by public transportation; when vaccines were rolled out, people were required to have an email address to register online, which restricted access. There are a lot of things that we are now working on, like bringing together community-based organizations, health systems and government to work on health disparities. We need to leverage those relationships and infrastructures to deliver timely information and resources, and we need to keep ears to the ground to make sure that we’re proactively reaching the most vulnerable people. We can't take a one-size-fits-all approach to intervention or education. 
Rivkees: One of the misconceptions is that red states and blue states did things differently. They didn't. Red states and blue states had lockdowns, closed their schools, widely promoted vaccines and vaccinations. Then in March and April of 2021, after the election of President Biden, we started seeing a shift. Blue states promoted vaccinations, mask mandates, school closures; in red states across the country, governors stopped promoting the vaccine. Then there were “anti” mandates in red states, kids going back to school. After 18 months, the biggest risk factor for dying from COVID-19 wasn’t old age; it was who you voted for, as studies showed those who voted for President Trump vs. President Biden had 
Nuzzo: A reporter recently called me to ask, “Did the lockdowns work or not?” That is the wrong question. Obviously, if you kept every person on the planet inside their house for two weeks, such that they had no probability of encountering another person so if they happen to be incubating the virus, they wouldn't pass it on, we would have stopped the virus. But there was no circumstance in which that would practically happen. So the questions need to be, “Are the measures appropriate given the disease control goals, and compared to the other impacts that they could have? Are they aligned with the values of the community? Is this the right approach for the case? Are there alternatives?” I'm struck by the fact that still, five years later, we keep asking the wrong questions and trying to reduce the conversation to binary choices. 
Jha: There is a temptation inside public health to want to give answers that are simple and clean, and the problem is that in a dynamic pandemic — in which the virus is changing, the population immunity is changing and our knowledge of the virus is changing — you cannot do that. Any answer you give that is simple and clean today is going to be wrong six months from now. What we needed to do — and I'm guilty of not always doing this — is explain the scientific process to people, and [explain] that this is the best that we know right now, but we may change our minds as we learn more. Being cautious about schools in June or July of 2020 made sense; being cautious about schools in October of 2020 made no sense, because we had new evidence that you could open schools safely. There's a whole series of examples like that. The inability to shift, because we had said ‘the science says X,’ really, I think, boxed public health into a lot of bad decisions that were difficult to get out of. Moving forward, if there are places where we as public health leaders need to acknowledge our errors, we should absolutely do that — and we should try to meet people where they are, understand their values, and move people forward toward a better understanding of how we're going to help folks lead better, healthier lives.
Jha: The real lesson of communication and of engagement is you've got to engage across a broad range of individuals. You have to understand what their values are, and you have to meet them where they are. I think when we did that well in the pandemic, it served us well. When we tried to be dogmatic — [along the lines of] “this is the right answer that everybody has to follow” — that did not do us as much good in some ways.
Levine: One thing we learned during Ebola outbreaks was that we need to use trusted messengers to convey important health information. In surveys, people said they trusted physicians, health workers, family members, religious leaders. We needed to do a better job, here in the U.S. and in many other countries, of using those trusted mediators to educate people about COVID vaccines. I'm not sure why somebody thought it was a good idea to just put Anthony Fauci in front of the entire country and tell everyone to get vaccinated and thought that that was going to work. We needed a much more nuanced approach.
Raimondo: I was working with nucleic acid-based therapeutics, which is the platform technology that enabled the COVID-19 vaccines, when our lab was shut down in 2020. This technology had already emerged as having great potential. In early 2020, Moderna was running nine clinical trials for mRNA-based technologies, including some that were exploring respiratory illnesses and vaccine technologies. Some of the challenges from a research perspective were that this had not been tested on a large clinical scale yet, and manufacturing capabilities needed to be built up. But steps were not skipped; phase one, two and three trials were conducted very rapidly and in parallel, but went through all the checks. Now we have the data analytics and the computational tools already put in place to say, once we have the sequence and the genetic information for a new virus, we know what pieces of it are going to generate a protective or therapeutic response. While we have more to learn, we now have a much more robust understanding of the safety, of how to get a vaccine through FDA approval, how to do quality control, and [what to expect in terms of] clinical response from patients with different backgrounds and comorbidities, and how to cover it. 
Nuzzo: There were also some moments of success and positive innovation that this crisis helped bring about. The development, within a year, of multiple safe and effective vaccines, was a historic humanitarian achievement. We also have whole new types of [disease] surveillance approaches: we can, in the privacy of our own home, test ourselves for not just single viral pathogens, but multiple viral pathogens, and use that information to decide if it's safe to go see our elderly loved ones or if we should stay home. We have wastewater surveillance as a totally new approach that was set up because we were scrambling to track COVID, despite the fact that our access to health care was suboptimal and that there are biases in our public health data sets. This platform is one of the best ways that we have right now to understand the H151 virus and where it is. 
Levine: In 2020, I was the primary investigator for the Rhode Island Hospital site that would become the largest trial of convalescent plasma for early treatment of COVID-19 ever conducted, led out of Johns Hopkins. We were able to get a 
Warner: I think science-wise, infrastructure-wise, we've learned a lot from COVID-19, but we are still challenged by misinformation and disinformation. I'm teaching a course on racism and health, and we talk about how we still struggle with systemic racism in addition to individual racism, and addressing the vulnerability of different communities. Those are the things that are going to challenge our response to whatever health threat comes next. 
Levine: There's no question that we learned a lot of lessons from the COVID-19 pandemic, as we have from many other epidemics and pandemics before it. The question is whether we can implement those lessons. For example, it's not certain that we'll be able to produce a new vaccine to H1N1 in the same timeframe as we produced a COVID-19 vaccine if there isn't that type of investment. We also learned many lessons about what works and what doesn't work in different communities with regards to public health interventions. But are those communities going to have the resources to implement those interventions in the future? At this point, I wouldn't say there’s a huge likelihood that will happen in the U.S. I think other countries, maybe even some lower-income countries, will do a better job in managing the next pandemic, because they'll be better able to apply some of the lessons they learned from the last one.
Jha: Policymakers need to think about this in the way they think about any other national security threat. We don’t wait until someone launches a nuclear weapon to start figuring out how to prevent a nuclear attack on the U.S. In the same way, we shouldn’t wait for the next biological emergency to decide to invest in preparedness. We should be making sure we’re investing in readiness now. That actually reduces the likelihood that we’re going to have serious consequences from biological threats.