Looking Back, Looking Foward
Looking Back, Looking Foward
Introduction
Early 2020 was unlike anything Americans had ever experienced. Gradually and then all at once, we were faced with a global pandemic—a new and lethal coronavirus upending every aspect of our lives. In early January, it had seemed to many Americans like little more than a minor news item. By March, it was a devastating contagion—an invisible killer racing across the country and around the world.
The swiftness with which the pandemic took hold sparked widespread fear, anxiety, and stress. As refrigerator trucks lined up outside New York City morgues and emergency field hospitals sprang up from coast to coast, Americans braced for the worst—wiping down packages, washing groceries, canceling long-anticipated plans, fearing illness and worse, and worrying about what was to come.
But even amid that terrifying early spring of 2020, we never imagined that our nation would struggle so mightily to meet the moment, spectacularly failing to launch a rapid, effective, equitable response. We didn’t anticipate that public health would become so polarizing, or that the tension between individual freedoms and collective interventions would become so divisive. We didn’t foresee that by 2023, COVID-19 would have claimed more than 1.1 million American lives—a massive loss our nation has neither collectively marked nor mourned—or that our advanced and powerful country, with 5 percent of the world’s population, would account for 15 percent of its officially reported COVID deaths.
Four years later, we’re still suffering.
In part, that’s because new COVID variants continue to circulate and because not all Americans have been willing or able to use tools, like boosters and antivirals, to prevent severe illness. In part, it’s because Americans, including the 355,000 children who have lost a parent or caregiver to COVID, are still experiencing the pandemic’s aftereffects, even as the attention of policymakers and the public has moved on.
Yet, it’s also because the pandemic afflicted our democracy as a whole. Confronting COVID-19 threatened more than Americans’ physical and mental health: it intensified divisions and mistrust among us—politically, racially, socially, economically. Faith in governing institutions plummeted; cynicism deepened. Our sense of safety was shaken, our divisions intensified, our faith in our democracy fractured.
In meaningful ways, the health of our body politic was—and is still—in critical condition. A Pew research report released in September 2023 found that only 16 percent of the public say they trust the federal government always or most of the time; and 63 percent express “not too much or no confidence at all in the future of the U.S. political system.” Nearly eight-in-ten Americans would choose a negative word or phrase to describe contemporary U.S. politics, from “messy,” “chaos,” and “broken” to “disgrace” and “dumpster fire.”
Meanwhile, there is a sobering possibility that the United States now is even less prepared to handle – and the public is less willing to accept – certain measures to confront a large-scale biological emergency than it was in 2020. Tensions persist between what the future of American democracy is to be and what the future of health security for Americans is to be. Far too often they collide, when the challenge is to address both together.
America’s success in facing the next crisis, be it biological or something else, will depend not only on how prepared we are, but also on the mindset we have as a nation in the face of adversity.
Will we succumb to our worst impulses or summon the better angels of our nature? Will we fall apart or pull together?
Introduction
Early 2020 was unlike anything Americans had ever experienced. Gradually and then all at once, we were faced with a global pandemic—a new and lethal coronavirus upending every aspect of our lives. In early January, it had seemed to many Americans like little more than a minor news item. By March, it was a devastating contagion—an invisible killer racing across the country and around the world.
The swiftness with which the pandemic took hold sparked widespread fear, anxiety, and stress. As refrigerator trucks lined up outside New York City morgues and emergency field hospitals sprang up from coast to coast, Americans braced for the worst—wiping down packages, washing groceries, canceling long-anticipated plans, fearing illness and worse, and worrying about what was to come.
But even amid that terrifying early spring of 2020, we never imagined that our nation would struggle so mightily to meet the moment, spectacularly failing to launch a rapid, effective, equitable response. We didn’t anticipate that public health would become so polarizing, or that the tension between individual freedoms and collective interventions would become so divisive. We didn’t foresee that by 2023, COVID-19 would have claimed more than 1.1 million American lives—a massive loss our nation has neither collectively marked nor mourned—or that our advanced and powerful country, with 5 percent of the world’s population, would account for 15 percent of its officially reported COVID deaths.
Four years later, we’re still suffering.
In part, that’s because new COVID variants continue to circulate and because not all Americans have been willing or able to use tools, like boosters and antivirals, to prevent severe illness. In part, it’s because Americans, including the 355,000 children who have lost a parent or caregiver to COVID, are still experiencing the pandemic’s aftereffects, even as the attention of policymakers and the public has moved on.
Yet, it’s also because the pandemic afflicted our democracy as a whole. Confronting COVID-19 threatened more than Americans’ physical and mental health: it intensified divisions and mistrust among us—politically, racially, socially, economically. Faith in governing institutions plummeted; cynicism deepened. Our sense of safety was shaken, our divisions intensified, our faith in our democracy fractured.
In meaningful ways, the health of our body politic was—and is still—in critical condition. A Pew research report released in September 2023 found that only 16 percent of the public say they trust the federal government always or most of the time; and 63 percent express “not too much or no confidence at all in the future of the U.S. political system.” Nearly eight-in-ten Americans would choose a negative word or phrase to describe contemporary U.S. politics, from “messy,” “chaos,” and “broken” to “disgrace” and “dumpster fire.”
Meanwhile, there is a sobering possibility that the United States now is even less prepared to handle – and the public is less willing to accept – certain measures to confront a large-scale biological emergency than it was in 2020. Tensions persist between what the future of American democracy is to be and what the future of health security for Americans is to be. Far too often they collide, when the challenge is to address both together.
America’s success in facing the next crisis, be it biological or something else, will depend not only on how prepared we are, but also on the mindset we have as a nation in the face of adversity.
Will we succumb to our worst impulses or summon the better angels of our nature? Will we fall apart or pull together?
At our Worst and at our Best
In many ways, the story of how America fared under the pandemic is actually two stories—and both are true.
On the one hand, things went colossally wrong, especially at the outset.
The federal government initially downplayed the threat and failed to mount a concerted federal response, effectively abandoning the battlefield to the states. The U.S. Centers for Disease Control and Prevention (CDC) stumbled badly, with no mechanism for rapid deployment of widespread screening, surveillance, or testing. The initial COVID-19 tests CDC sent out didn’t work, and guidance was often confusing. Decades of underinvestment in our public health infrastructure left policymakers flying blind. They lacked vital situational awareness of what the virus was doing and where it was going due to a patchwork of incompatible data systems and antiquated technology. And, despite years of pandemic planning and the United States’ reputation for scientific excellence, the national conversation was distorted from the start by misinformation and anti-science conspiracy theories. Trust declined, as partisanship and polarization rose.
At the same time, the pandemic showcased American prowess in research and development.
Building on years of research into the Middle East Respiratory Syndrome coronavirus, the federal government launched audacious plans to achieve vaccines at a pace never seen. In March 2020, the White House mobilized emergency Defense Production Act authorities bringing together military and civilian agencies and corporate partners, and unlocking the resources essential to concentrate the attention of all parties. Out of this emerged Operation Warp Speed, charged with accelerating the development, acquisition, and distribution of medical countermeasures for COVID-19. This trailblazing public-private partnership surpassed even the most hopeful expectations: By December 2020, two vaccines had received emergency use authorization from the Food and Drug Administration (FDA), with clinical trials showing 95 percent efficacy for each. In 2021, the federal government, working with private sector and community leaders, expedited the largest vaccination program in modern U.S. history.
At the local level, the impact of the pandemic—and the interventions intended to slow its spread —reverberated through every aspect of American life. Officials grappled with seemingly diametrical pressures to minimize the multiple tolls of the virus – in health, livelihoods, learning — and preserve life as we knew it. There was no established method for reaching decisions on interventions from masking to school closures to social distancing to business operations. Decisions to resolve one single issue often aggravated challenges elsewhere.
Every Governor and Mayor faced these and other flashpoint issues; none perfectly navigated the storm. But if their approaches and emphases differed, they were all wrestling with the same dilemma: how to simultaneously protect health, protect jobs, protect school populations, protect the old, protect the young, protect individual freedom, and promote collective responsibility, against a terrifying set of unknowns.
Alas, in an already polarized political environment, and at a time of great fear and stress, diverging perspectives too often morphed into demonization of the other side. Vaccine and mask mandates became political and social flashpoints, pitting – sometimes violently — proponents of individual freedom against advocates of collective responsibility. Public health professionals found themselves under attack, with some even receiving death threats.
Political rhetoric heightened divisions, giving rise to the appearance of a “your money or your life” divide, with some Governors emphasizing the economy and some Governors emphasizing public health, though all used restrictions to varying degrees. Federal and state public health officials implored the nation to “follow the science” but it was not always clear what that meant in practice. Scientific uncertainty and many pressing societal concerns – economic, educational – had to be factored into urgent political decisions. Too often, valid dissenting views were summarily dismissed and open debate dampened. Mis- and dis-information flourished and further complicated the landscape.
This was America at its worst.
But beneath the national divisiveness and dysfunction, something else was happening too, at the state and local levels.
Across the country, in diverse communities, there were people finding ways to pull together, innovating amid profound uncertainty, transcending divides, and saving lives.
The efforts of these unsung heroes – lamplighters — reflected the spirit of community, ingenuity, and participatory decision making that are the hallmarks of American democracy at its best. They formed ad hoc collaborations, fusion cells, and networks that reached the corporate sector, the vulnerable and marginalized, the faith and school communities. These improvisations broke down silos, welcomed diverse inputs, demonstrated humility in the face of uncertainty, and prioritized listening that met people where they were. These leaders prized regular, quality communications and deft explanation of evolving data. They were driven by the will to move rapidly and creatively to create consensual and inclusive solutions. In so doing, they struggled – and often succeeded — to transform a limited set of blunt, binary tools – open or close, health or jobs – into more surgical instruments, better tailored to community needs, and better able to balance the science with the social, economic, and educational impacts of an effective battle plan to combat COVID.
In these efforts, state and local officials joined with willing, able, and collaborative partners. Businesses in sectors from technology to pharmaceuticals, manufacturing, retail, and more helped fill critical gaps, collect data, improve processes, and assist with communication, planning, and delivery. Hospitals and health systems rose to the challenge, proposing and implementing innovative ideas to remedy gaps in care. Universities brought to the table exceptional technological assets and expertise. Community organizations from faith-based institutions to parent groups stepped up to support local priorities, providing trusted messengers for public health.
This side of the American experience of COVID-19 may have gotten less publicity, but it is no less real. Harvesting the hard-won lessons of what worked must be a national priority. It will be critically important to understand what factors favored innovative solutions and won broad community support. No less important is enumerating the concrete gains achieved, and which of them can be replicated to meet new threats in the future.
At our Worst and at our Best
In many ways, the story of how America fared under the pandemic is actually two stories—and both are true.
On the one hand, things went colossally wrong, especially at the outset.
The federal government initially downplayed the threat and failed to mount a concerted federal response, effectively abandoning the battlefield to the states. The U.S. Centers for Disease Control and Prevention (CDC) stumbled badly, with no mechanism for rapid deployment of widespread screening, surveillance, or testing. The initial COVID-19 tests CDC sent out didn’t work, and guidance was often confusing. Decades of underinvestment in our public health infrastructure left policymakers flying blind. They lacked vital situational awareness of what the virus was doing and where it was going due to a patchwork of incompatible data systems and antiquated technology. And, despite years of pandemic planning and the United States’ reputation for scientific excellence, the national conversation was distorted from the start by misinformation and anti-science conspiracy theories. Trust declined, as partisanship and polarization rose.
At the same time, the pandemic showcased American prowess in research and development.
Building on years of research into the Middle East Respiratory Syndrome coronavirus, the federal government launched audacious plans to achieve vaccines at a pace never seen. In March 2020, the White House mobilized emergency Defense Production Act authorities bringing together military and civilian agencies and corporate partners, and unlocking the resources essential to concentrate the attention of all parties. Out of this emerged Operation Warp Speed, charged with accelerating the development, acquisition, and distribution of medical countermeasures for COVID-19. This trailblazing public-private partnership surpassed even the most hopeful expectations: By December 2020, two vaccines had received emergency use authorization from the Food and Drug Administration (FDA), with clinical trials showing 95 percent efficacy for each. In 2021, the federal government, working with private sector and community leaders, expedited the largest vaccination program in modern U.S. history.
At the local level, the impact of the pandemic—and the interventions intended to slow its spread —reverberated through every aspect of American life. Officials grappled with seemingly diametrical pressures to minimize the multiple tolls of the virus – in health, livelihoods, learning — and preserve life as we knew it. There was no established method for reaching decisions on interventions from masking to school closures to social distancing to business operations. Decisions to resolve one single issue often aggravated challenges elsewhere.
Every Governor and Mayor faced these and other flashpoint issues; none perfectly navigated the storm. But if their approaches and emphases differed, they were all wrestling with the same dilemma: how to simultaneously protect health, protect jobs, protect school populations, protect the old, protect the young, protect individual freedom, and promote collective responsibility, against a terrifying set of unknowns.
Alas, in an already polarized political environment, and at a time of great fear and stress, diverging perspectives too often morphed into demonization of the other side. Vaccine and mask mandates became political and social flashpoints, pitting – sometimes violently — proponents of individual freedom against advocates of collective responsibility. Public health professionals found themselves under attack, with some even receiving death threats.
Political rhetoric heightened divisions, giving rise to the appearance of a “your money or your life” divide, with some Governors emphasizing the economy and some Governors emphasizing public health, though all used restrictions to varying degrees. Federal and state public health officials implored the nation to “follow the science” but it was not always clear what that meant in practice. Scientific uncertainty and many pressing societal concerns – economic, educational – had to be factored into urgent political decisions. Too often, valid dissenting views were summarily dismissed and open debate dampened. Mis- and dis-information flourished and further complicated the landscape.
This was America at its worst.
But beneath the national divisiveness and dysfunction, something else was happening too, at the state and local levels.
Across the country, in diverse communities, there were people finding ways to pull together, innovating amid profound uncertainty, transcending divides, and saving lives.
The efforts of these unsung heroes – lamplighters — reflected the spirit of community, ingenuity, and participatory decision making that are the hallmarks of American democracy at its best. They formed ad hoc collaborations, fusion cells, and networks that reached the corporate sector, the vulnerable and marginalized, the faith and school communities. These improvisations broke down silos, welcomed diverse inputs, demonstrated humility in the face of uncertainty, and prioritized listening that met people where they were. These leaders prized regular, quality communications and deft explanation of evolving data. They were driven by the will to move rapidly and creatively to create consensual and inclusive solutions. In so doing, they struggled – and often succeeded — to transform a limited set of blunt, binary tools – open or close, health or jobs – into more surgical instruments, better tailored to community needs, and better able to balance the science with the social, economic, and educational impacts of an effective battle plan to combat COVID.
In these efforts, state and local officials joined with willing, able, and collaborative partners. Businesses in sectors from technology to pharmaceuticals, manufacturing, retail, and more helped fill critical gaps, collect data, improve processes, and assist with communication, planning, and delivery. Hospitals and health systems rose to the challenge, proposing and implementing innovative ideas to remedy gaps in care. Universities brought to the table exceptional technological assets and expertise. Community organizations from faith-based institutions to parent groups stepped up to support local priorities, providing trusted messengers for public health.
This side of the American experience of COVID-19 may have gotten less publicity, but it is no less real. Harvesting the hard-won lessons of what worked must be a national priority. It will be critically important to understand what factors favored innovative solutions and won broad community support. No less important is enumerating the concrete gains achieved, and which of them can be replicated to meet new threats in the future.
The American Democracy and Health Security Initiative:
Lighting a Path Amid Pandemic Polarization
In 2023-2024, our team—the Brown University School of Public Health Pandemic Center, the Center for Strategic and International Studies (CSIS) Bipartisan Alliance for Global Health Security, and the COVID Collaborative, with assistance from the National Academy for State Health Policy (NASHP)—interviewed current and former federal, state, and local leaders across the health, business, education, and community service sectors who led through the pandemic, seeking to identify replicable solutions, strategies, and systems to help our nation do better in the future.
We focused on a cross-section of states that represented wide geographic and socioeconomic diversity, as well as different political contexts and state and local structures. Each of these states improvised, generating a distinct set of compelling lessons.
We’ve called our endeavor the American Democracy and Health Security Initiative because, in our view, the two are inextricable: American health security depends on maximizing our options to live in a democracy and manage a public health emergency simultaneously. Likewise, the strength of our democracy depends on citizens’ faith in our institutions, from our government to our schools and workplaces, to protect them in a crisis.
Somehow, we must find a way forward that both respects the individual freedoms we hold dear and supports the collective good—and to do so now, before the next devastating health emergency strikes.
The American Democracy and Health Security Initiative:
Lighting a Path Amid Pandemic Polarization
In 2023-2024, our team—the Brown University School of Public Health Pandemic Center, the Center for Strategic and International Studies (CSIS) Bipartisan Alliance for Global Health Security, and the COVID Collaborative, with assistance from the National Academy for State Health Policy (NASHP)—interviewed current and former federal, state, and local leaders across the health, business, education, and community service sectors who led through the pandemic, seeking to identify replicable solutions, strategies, and systems to help our nation do better in the future.
We focused on a cross-section of states that represented wide geographic and socioeconomic diversity, as well as different political contexts and state and local structures. Each of these states improvised, generating a distinct set of compelling lessons.
We’ve called our endeavor the American Democracy and Health Security Initiative because, in our view, the two are inextricable: American health security depends on maximizing our options to live in a democracy and manage a public health emergency simultaneously. Likewise, the strength of our democracy depends on citizens’ faith in our institutions, from our government to our schools and workplaces, to protect them in a crisis.
Somehow, we must find a way forward that both respects the individual freedoms we hold dear and supports the collective good—and to do so now, before the next devastating health emergency strikes.
Grounds for Hope and Optimism
As the voices and stories we are privileged to share in this report make clear, we found genuine reasons for optimism—individual leaders from diverse institutions who were more collaborative, more pragmatic, and more inspiring than the divided, dysfunctional version of our country that dominates many Americans’ recollections. Our team came to think of these leaders as lamplighters—Americans who succeeded in uniting and serving their communities, and who rose above rhetoric to meet an impossible moment with humility, grit, grace, and strength.
Their stories revealed a host of practical, actionable steps to advance our health security for the future, from empowering trusted local messengers to building effective 24/7 leadership command structures; using data to drive decision making; building an equitable response; leveraging the private sector; bridging political divides; and overcoming silos among public health, healthcare systems, education, and business.
In this pivotal moment for our country and the world, these accounts of innovation and of resilient and effective American leadership from individuals who adeptly balanced personal freedoms with communal health measures offer vital lessons for rebuilding trust and charting a hopeful future.
Our task now is to implement these innovations and reclaim the narrative around what kind of nation America is and aspires to be.
Grounds for Hope and Optimism
As the voices and stories we are privileged to share in this report make clear, we found genuine reasons for optimism—individual leaders from diverse institutions who were more collaborative, more pragmatic, and more inspiring than the divided, dysfunctional version of our country that dominates many Americans’ recollections. Our team came to think of these leaders as lamplighters—Americans who succeeded in uniting and serving their communities, and who rose above rhetoric to meet an impossible moment with humility, grit, grace, and strength.
Their stories revealed a host of practical, actionable steps to advance our health security for the future, from empowering trusted local messengers to building effective 24/7 leadership command structures; using data to drive decision making; building an equitable response; leveraging the private sector; bridging political divides; and overcoming silos among public health, healthcare systems, education, and business.
In this pivotal moment for our country and the world, these accounts of innovation and of resilient and effective American leadership from individuals who adeptly balanced personal freedoms with communal health measures offer vital lessons for rebuilding trust and charting a hopeful future.
Our task now is to implement these innovations and reclaim the narrative around what kind of nation America is and aspires to be.
A Path Forward
We know it won’t be easy.
But if the COVID crisis exposed our nation’s worst failings, it also revealed Americans’ greatest strengths. Our country now has a chance to define a path forward, while memories and learning are fresh.
We believe people want a path from despair to hope. The stakes are not just health preparedness, but the health of our democracy itself.
Our conclusion—and the lamplighters’ conviction— is that such a path exists; and that, paradoxically, our nation’s experience during COVID-19 provides multiple beacons to guide the way.
A Path Forward
We know it won’t be easy.
But if the COVID crisis exposed our nation’s worst failings, it also revealed Americans’ greatest strengths. Our country now has a chance to define a path forward, while memories and learning are fresh.
We believe people want a path from despair to hope. The stakes are not just health preparedness, but the health of our democracy itself.
Our conclusion—and the lamplighters’ conviction— is that such a path exists; and that, paradoxically, our nation’s experience during COVID-19 provides multiple beacons to guide the way.