Our Response to 9/11 Gave us Lessons for COVID-19

“America is no longer protected by vast oceans. We are protected from attack only by vigorous action abroad, and increased vigilance at home.”

– President George W. Bush, State of the Union Address, January 29, 2002.

The COVID-19 outbreak will likely prove to be the most consequential event since the Second World War and economically as destructive as any event since the Great Depression. Certainly, the global economic and social scale of the COVID-19 outbreak is far more extensive than the events of 9/11. Yet common features between the two crises exist.

The COVID-19 crisis and 9/11 attacks challenged policymakers to simultaneously respond to a long-expected attack while dramatically improving our response capacity in anticipation of a future wave of attacks.

The roll-out of COVID-19 destruction is occurring at a far slower pace than the violence of 9/11, which was conducted in a single terrible day. But in each case, U.S. government decision-makers have the same challenge:  To understand an ongoing attack while considering steps to mitigate further damage. During the months following the 9/11 attacks, U.S. security services remained concerned that a second al-Qaida attack – possibly one involving nuclear or biological weapons – would follow. The imperative to neutralize possible further al-Qaida attacks dramatically reshaped domestic and foreign policy priorities. Interagency groups focused U.S. policy efforts and energetically engaged counterparts throughout the world to drive a worldwide campaign against al-Qaida as well as its ideological and financial foundations.

Similarly, we should hope that international policymakers will prepare for a possible second wave of COVID-19 outbreaks in the U.S. and abroad.  The human and economic consequences of this pandemic and its successors are only beginning to be understood; the long-term political and social impact domestically and abroad will remain unclear for months.

The U.S. should begin steps to form a bipartisan group of current and former officials as well as private sector leaders to understand what we could have done better during this COVID-19 crisis (and the decades preceding the outbreak) and how to prepare for the next epidemic.  It is critical that this group be perceived as nonpartisan and capable of engaging counterpart entities abroad and within international organizations.

Like 9/11, we had sufficient warning to know that a global pandemic was likely inevitable. Only the timing was unknown.

Throughout the 1990s, U.S. law enforcement and intelligence closely followed – and often frustrated – al-Qaida and other militant operations around the world. But the drumbeat of high-profile terrorist incidents persisted with attacks including the 1992 Gold Mohur Hotel in Aden, Yemen; the 1993 bombing of the New York World Trade Center; the 1998 bombing of the U.S. embassies in Kenya and Tanzania; and the 2000 attack against the USS Cole. By 2001, it was no secret that al-Qaida was building an army of foreign operatives trained at facilities in Afghanistan.

In response, U.S. national security officials developed unified national strategies to deal with this threat. The White House and Department of Defense issued policies to improve interagency counterterrorism cooperation and effectiveness. President Clinton’s Presidential Decision Directives in 1995 (no. 39) and May 1998 (no. 62) reiterated that terrorism was a national security problem, not just a law enforcement issue. The Department of Defense responded with recommendations of its own. Congress allocated hundreds of millions of dollars to resource counterterrorism initiatives.

Policymakers, Congress, and Defense Department officials demanded and received routine briefings on the threat picture as well as the diplomatic, intelligence, and law enforcement architecture arrayed against it. The results were impressive. The State, Treasury, and Defense Departments made counterterrorism a priority. The Central Intelligence Agency and the Federal Bureau of Investigation developed robust domestic and global programs targeting al-Qaida and related groups. U.S. diplomats and intelligence personnel regularly engaged their foreign counterparts to improve information sharing, to silence pro-militant propaganda outlets, and to end recruiting hubs and finance streams that enabled al-Qaida operations.

Despite these efforts, conclusive progress against al-Qaida remained elusive, and the necessary access to its leadership planning never crystallized. But even an incomplete understanding allowed the U.S. Intelligence Community (IC) to alert policymakers in the months before 9/11 that al-Qaida appeared to be planning a “spectacular” attack against a high-profile target. Unfortunately, the IC could not identify the timing, location, or means of the attack.

Similarly, concerns over a potential global influenza pandemic are far from new. During the past 150 years, the world has endured significant epidemics at least twice per generation and with alarming frequency in the last two decades.

• The 1889 influenza (“Asiatic flu” or “Russian flu”) was the most lethal epidemic of the nineteenth century, spreading rapidly throughout Europe and the United States. Emerging from eastern Russia, the outbreak is estimated to have killed one million people worldwide.
• The 1918-1919 H1N1 influenza (“The Spanish Flu”) likely first appeared between 1900 and 1915 and had its origins in the oldest classical swine influenza strain. The 1918 outbreak may have begun in Haskell County, Kansas, before spreading to army bases whose soldiers carried the virus abroad.  In a world lacking vaccines and antibiotics, the only response involved a combination of hygiene and isolation. By the time the pandemic abated, it had killed between 20 and 100 million people worldwide, including an estimated 675,000 people in the United States.
• Psittacosis (“Parrot Fever”) was first identified in Germany in 1879 as a disease transmitted from exotic birds to humans. The lethality of the virus was dramatic, killing as many as 20 percent of those it infected throughout Europe and the United States. Psittacosis erupted in 1917 in New York, but its most dramatic international outbreak was in 1929 (shortly after the stock market crash) when it spiked throughout Europe, North Africa, as well as the United States. Alarm over the outbreak grew with news that it killed some of scientists at the U.S. Hygiene Laboratory (later the National Institutes of Health) who studied it an effort to develop a cure. The 1929 outbreak received extensive media coverage to include doubts by some (mainly bird dealers) as to its cause. Countries banned bird importation, many birds were destroyed, and the use of antibiotics reduced the mortality rate to near zero. The virus reappeared over the years, to include as recently as 2016.

• The 1949-1952 Poliomyelitis pandemic (Polio) involved a virus feared since ancient Egypt. Almost certainly present in the U.S. throughout the 18th and 19th centuries, the disease appeared frequently and spread rapidly. A summer 1916 outbreak resulted in 27,000 victims and 6,000 deaths. New York suffered 9,000 cases, of which 2,000 victims died. In 1921, the disease struck its most famous victim, Franklin Delano Roosevelt, and it continued to ravage thousands of victims throughout the 1930s and 1940s. In 1952, the virus struck 60,000 children in the U.S. alone, killing more than 3,000 and leaving thousands more paralyzed. Media attention was widespread, and the 1953 announcement of the Salk vaccine was considered a modern miracle. By 1979, the disease had been eradicated within the United States.  International cooperation through the Global Polio Eradication Initiative has reduced the disease’s presence to Afghanistan, Nigeria, and Pakistan.
• The 1956-1958 H2N2 virus (“The Asian Flu”) emerged in Guizhou province in China as a variant on an avian virus. By the time scientists developed a vaccine, the virus had killed between one and three million victims worldwide – 116,000 of which were in the U.S. The virus would reappear periodically as a global infection.
• The 1968 Influenza A subtype H3NS virus (“The Hong Kong Flu”) originated in China in July 1968 and lasted until 1970. The pandemic spread rapidly, reaching the United States and Europe by the autumn of 1968. Particularly lethal to those 65 years and older, the virus killed an estimated one million people worldwide, including 100,000 within the United States.
• The 1981-present Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic was recognized in the 1980s but the disease likely existed in Africa, Australia, Europe, North America, and South America since the 1920s.  The disease is believed to have transmitted to humans from African chimpanzees and sooty mangabeys.  By the 1990s, an international coalition of public and private sector officials resulted in policy focus and funding that produced dramatic improvements in testing and treatments although a cure remains unknown. The disease is believed to have infected 75 million people of which approximately 32 million died.
• The story of the 2002-2003 Severe Acute Respiratory Syndrome virus (SARS) foreshadowed the COVID-19 outbreak and deserves a more detailed review. In November 2002, the first known SARS case is believed to have appeared in the city of Foshan in central Guangdong Province, China. Beijing initially treated news of the pandemic as a state secret. The international community remained unaware of the disease until it had spread abroad. In February 2003, rumors of the pandemic forced Beijing to announce that a pneumonia-like virus had infected 305 people and killed five. Nonetheless, Chinese officials continued to downplay the outbreak’s severity and maintained a news blackout to avoid disruption of a National Party Congress gathering.

China’s decisions had lethal consequences. The absence of a coordinated domestic and international response enabled the virus to spread throughout China and neighboring regions. A Chinese professor who had treated patients in Guangdong traveled to a Hong Kong hotel on February 21. She died shortly after, but not before she and those with whom she came into contact infected 80 percent of Hong Kong’s cases. Infected tourists and businessmen then transmitted the disease to their home countries. By February 28, the World Health Organization (WHO) identified Vietnam’s first SARS victim. Within two weeks, SARS cases appeared in Asia, Canada, and the United States.

The WHO quickly alerted airlines to be vigilant for travelers with pneumonia-like symptoms. The U.S. Centers for Disease Control and Prevention (CDC) discouraged non-essential travel to countries with outbreaks of atypical pneumonia, expanding the advisory to China by the end of March. Schools and churches closed throughout in Asia.  Canadian officials ordered thousands of people, including health workers, to self-quarantine at home for ten days. The Department of State evacuated non-essential U.S. diplomats from China and Hong Kong.

Beijing’s cooperation remained limited despite growing international criticism. Chinese officials repeatedly declared the situation under control and denied WHO experts access to Guangdong until April 2.  Beijing was embarrassed by U.S. media reports showing that its officials attempted to conceal the number of victims treated at military hospitals. China eventually issued an apology for its slow handling of the epidemic and dismissed its health minister and the mayor of Beijing.

The SARS virus abated through syndromic surveillance, isolation of patients, and strict, state-mandated quarantine regimens. China declared the pandemic under control in late March, and the WHO lifted its travel advisory a month later. The epidemic infected more than 8,000 persons worldwide and killed 774. The actual number of persons infected and killed was likely higher.

• The 2009-2010 H1N1 novel influenza virus (Swine Flu) appeared in California in April 2009.  By the end of that month, the WHO declared the outbreak a pandemic. Infection quickly spread to all 50 states and Mexico with a second wave occurring in the fall.  In part due to the development of a vaccine, the WHO was able to declare an end to the pandemic in 2010. One estimate declared that the virus was responsible for as many as 575,000 deaths.
• The 2012 Middle East Respiratory Syndrome Coronavirus (MERS) has been traced to dromedary camels handlers in the Middle East as well as Egyptian tomb bats.  Outbreaks have been most frequently reported in Saudi Arabia, although it has appeared in 27 countries.  The infection carries a high mortality rate, killing approximately 35 per cent of its victims. The initial Saudi response to the outbreak drew international criticism as being insufficient, but the Kingdom’s efforts since 2014 are believed to have significantly reduced infections.  Since 2012, more than 2,400 persons have contracted the virus of which at least 842 died. Incidents of the disease have been reported as recently as 2019. There remains no vaccine for the disease.