During the period when I was secretary of the U.S. Department of Health and Human Services from 2005 to 2009, leaders around the world became concerned about the emergence of an influenza virus with pandemic potential known as the H5N1.

As I assessed our nation’s level of preparation, it became clear that we simply were not prepared for a pandemic.

With President George W. Bush’s support, Congress appropriated nearly $7 billion and I spent much of the next three years leading a focused effort to enhance our nation’s readiness.


In the course of those years, I often heard the question, “Is our nation prepared for a pandemic?” The answer then was that we were not.

Over time, I came to understand that national preparedness is the wrong measure. The right questions to ask all Americans are: Are you prepared? Is your family, your company, your school, your hospital prepared? A nation is only as prepared as the aggregate of its people.

It’s important to recognize that pandemics are difficult to talk about. Anything said in advance of a pandemic seems alarmist. After a pandemic begins, anything one has said or done is inadequate.

But pandemics happen. They are a fact of biology and a testament of history. Viruses are constantly mutating, adapting, and attacking.

Pandemics aren’t new

The first major pandemic in recorded history struck Athens at the height of its glory. In 430 B.C., a pestilence – now thought to have been typhoid – killed about a quarter of Athens’ army and its population.

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Beginning in the 6th century, Europe was ravaged by the plague of Justinian – the first outbreak of the bubonic plague. Amazingly, this plague lasted for about 150 years and during that time Europe’s population was cut roughly in half.

Six centuries later, history’s best-known pandemic hit: The Black Death of the mid-1300s. This was the return of the bubonic plague. And it killed about 25 million people – about a third of Europe’s population – in just six years.

Pandemics have struck 10 times in the last 300 years. We have had three in the past 100 years. The most serious of these is known as the Great Influenza of 1918. Its effects were mind-boggling. It was as deadly as the deadliest war in human history. Like World War II, the Great Influenza killed about 50 million people worldwide.

The 1918 flu cruelly seemed to target those in the prime of life, killing people in their 20s and 30s at an even greater rate than others – and leaving behind 21,000 orphans in New York City alone. It was a vicious killer.

John Barry, author of “The Great Influenza,” a history of the 1918 pandemic, described what happened when the pandemic hit. “In one week in October of that year, 4,500 people died from influenza or pneumonia in Philadelphia alone. Let me put that into perspective. In a single week, in a single city, the flu caused almost twice as many deaths as were sustained by all Allied forces combined on D-Day.”

Today many people mistakenly think pandemics are a thing of the past. And it’s true that we no longer fear the bubonic plague. We now have a cure for that. The same is true for smallpox. We do not, however, have a cure for emerging viruses.

As I traveled from state to state meeting with public officials about pandemic preparedness in my role as secretary of health and human services, I made a habit of Googling “pandemic of 1918” and then the name of the town where I was speaking. With few exceptions, my simple query would produce story after story of how the impacts this virus had reshaped lives and communities.

The history of pandemics is not so much the history of health as it is the history of humanity. When pandemics strike, they cause massive sickness and terrible loss of life. They even reshape nations, affecting politics, economics, culture and individual lives. However, here’s the dilemma: pandemics happen far enough apart that future generations forget.

Preparing for tomorrow

Now coronavirus – or as it is scientifically called, COVID-19 – is spreading around the world. I need not repeat the statistics. We are all following this daily. This looks like the real deal.

There is much we do not yet know. Public health officials will tell us what they know about how it spreads and update us when they learn more. We don’t know how virulent the virus is. We do know that lives are being lost, and pandemic viruses can be vicious killers.

The situation creates uneasiness, and a question of what action we should take. At this time, it is important to be informed and to plan.

Wouldn’t it be nice if this flames out like many of these viruses do? However, if it doesn’t, we must be ready. We have one great advantage in this realm over those who lived in the past: we have a far greater capacity to prepare.

Never have we possessed such a wealth of knowledge about the problem and such a strong ability to prepare. The ultimate weapon in preparing for a pandemic is a vaccine. The goal of developing and stockpiling vaccines is simply stated, but not easily achieved.

Developing and stockpiling vaccines is not a job for any one government. It is not even a job for any one nation. It requires cooperation between nations, cooperation between different government entities within nations, and cooperation between governments and the private sector.

Pandemic preparedness requires that all these different elements work together. The better they do so, the better prepared we will be, as a species.

Realistically, a COVID-19 vaccine is six to nine months away in a best-case scenario. Pandemic viruses tend to come in waves. Typically, there is more than one wave. So a vaccine will help on subsequent waves, but not the first one. In this first wave, prevention and avoidance are our only options.

Local challenges and local solutions

People still ask if our nation is prepared. It’s an understandable question, but the wrong question. Local preparedness is the foundation of pandemic readiness. In addition to state governors, leadership must come from mayors, county commissioners, school principals, church leaders, college presidents, corporate planners and the entire medical community.

Any community that fails to prepare – with the expectation that the federal government can come to the rescue – will be tragically wrong.

Most disasters, like hurricanes or even terrorist attacks, happen within a defined area and during a confined time. A pandemic could be happening in communities across the country at the same time. A pandemic is a unique disaster. And so we must all prepare.

When it comes to a pandemic, there is a role for everyone to play. For the world to be prepared, every nation, every city, every business, every school, every hospital, every clinic, every church, and every household needs a plan.

Most of our public health functions are conducted at the county level. In our rural counties, a heavy load is carried by multi-county organizations. County commissions need to begin to game out how to assure they are properly resourced.

City and town officials may be called upon to make some complicated decisions on whether to recommend or compel public events be avoided. As residents of those cities and towns, we need to listen closely to public health officials and follow their guidance.

City and town officials should be thinking about how to keep emergency medical providers such as ambulance, paramedic and law enforcement officers safe and well resourced.

For school officials, the decision to close schools should be a local one. They should consider following the guidance of their public health officials. Closing schools has dramatic implications for families.

Communicating with families on a contingent basis is important. A valuable question school officials should consider asking the families they serve is: If your children need to be at home all day, do you have a plan for their care?

Health care providers are already thinking deeply about this. We know a pandemic situation puts providers in unique danger. We thank them for all that they do and will do. Now is the time for providers to be training, stockpiling and preparing.

Employers need a plan, and it is something they should be thinking about now. Next week, Leavitt Partners will have at least one day where everyone works remotely to test and validate what works well and learn what unanticipated limitations employees will encounter when all work remotely concurrently.

That isn’t an option for every business, but every business needs to ask itself: How do we operate under various scenarios?

Families may be the most important planning unit of all. I want to quote excerpts from an email I sent to my family members about a month ago:

“Family preparation isn’t just about pandemics. There are many natural and man-made disasters that could affect our families. One thing most of them have in common is that supply chains get disrupted. Manufacturing stops, goods don’t get transported, stores close. Hence, preparation for all of them is pretty much the same.

“Ask yourself the question: What would I need if my family needed to isolate itself for a month? Or, expressed another way: What do I need to have on hand if I couldn’t shop for a month? 

“It will cause you to think about things like food and medicine. There are members of almost every one of our family units who depend on prescription medicine, we need to factor that in.

“Finally, can I suggest we use this as parents to reinforce handwashing as a habit?”

I will conclude with just a reminder that pandemics are part of life. They come and they end. If coronavirus becomes the real threat it appears it may be, we will work our way through it.

This is a time for us inform, but not inflame. We have many assets that our ancestors and previous generations did not, but there is no reason to think we will be spared the challenge. So, let us prepare.

Coronavirus resources and tips

If you have concerns about coronavirus, the following are reputable sources of information:




In addition, the CDC advises us to take the following preventative steps:

  1. Cover nose and mouth when coughing and sneezing with a disposable tissue or flexed elbow. 
  2. Clean hands with soap and water or alcohol-based hand rub. 
  3. Avoid close contact with anyone who has cold or flu-like symptoms. Do not feel compelled to come to work if you have a cold or the flu.
  4. Avoid touching eyes, nose and mouth. 
  5. If you have a fever, cough or difficulty breathing, seek medical attention early. 
  6. At this time, it is recommended for health professionals, who are managing cases, to use an N95 respirator mask. The CDC will update its website should the needs change for the public.