The COVID-19 pandemic highlighted, as well as disrupted, the drastic inequalities around the world, within and between countries’ healthcare, transportation, and agricultural sectors. It has helped provide a fresh perspective on how interconnected the world is, through the movement of people, food, and diseases. It has also shown the disparities between wealthier, middle income, and lower income countries. In contrast to a pre-COVID world, political and economic perspectives today have also become more accentuated, as many scientists and health experts point to the changing global climate as a major factor in the spread of diseases. There has been heightened attention put on travel and who is able, or not allowed, to enter or leave international borders. The transmission of viruses like COVID-19 and the re-emergence of infectious diseases has incited nations to augment pandemic readiness.
Outlook of COVID deaths (US and world)
In terms of the official COVID death figures provided by the World Health Organization, the United States has the largest count compared to other countries. The COVID mortality rate in the US was at 3.382. Other countries told a different story: Australia had a COVID mortality rate of 0.888; South Korea had 0.701; and India had 0.375. As K. Bruce Newbold illustrates in Population Geography, health indicators “within the United States are rather poor by Western standards” (Newbold 99), so assuming that poor health indicators are only found in the developing world should be taken at face-value.
But now, considering the effects of the pandemic, it is clear that is not the case. But what the pandemic also did highlight was the growing ignorance of preventative measures due to religious and political beliefs. Newbold even states that as the movements of populations have long been the cause of diseases spreading, there is an “increasing number of cases in which individuals or societies reject immunization” (Newbold 105-106) out of fear of alleged psychological effects or political takeovers. On the other hand, most of the countries reported on do not have similar official COVID death counts and excess deaths, except for the United States. The estimated number of excess deaths in the United States was about 1,330,000 (the difference between the official figures and excess deaths was 212,664).
National & global response to COVID
The pandemic has illustrated the faults within national governments and the influence of political affiliations on health policy. The US government’s response to the COVID-19 pandemic during the three years of its spread went through significant iterations. Slow and misinformed responses made under the previous administration caused many lives to be taken, in fact 1.13 million Americans died compared to 6.9 million deaths globally. Under the Biden administration, the national response was more streamlined, with more emphasis put on preventative measures. However, although a national mask mandate was brought forth, it was deemed unconstitutional by the Supreme Court in April 2023. On the other hand, the presidency of Trump can be illustrated as part of an emerging shift in political sentiment and motivations that may have implications for health policies and immigration policies.
In other regions such as Europe and South America, more conservative parties have also made inroads. Countries such as Italy, Spain, Germany, Sweden, Argentina, Switzerland, and the Netherlands have seen gains in seats in governments by parties such as The Brothers of Italy, Alternative for Germany, Vox, the Sweden Democrats, and Freedom Advances. Many of these political parties have called for smaller governments and cuts to programs and policies designed to address climate change impacts. Climate policies have also been deemed expensive, with many becoming disillusioned and “weaponizing climate change.” The rise of more populist parties and leadership can potentially lead to harassment, discrimination, and violence against those individuals they see as “dangerous.” These changes will ultimately impact how health and health policies are addressed or even considered.
Published in 2021, authors Craig Albert, Amado Baez, and Joshua Rutland discuss the orientation of disease outbreaks as threats to national, global, and human security.
Impacts of COVID on biosecurity (surveillance programs in airports) and national security
The COVID-19 pandemic has streamlined a simultaneous commitment to disease prevention, national security, and surveillance. The Center for Disease Control and Prevention (CDC) has begun to expand testing and tracking infectious diseases at several major airports around the country. Out of the 19,699 airports in the United States, those who are participating include: Seattle-Tacoma (SEA), San Francisco (SFA), Los Angeles (LAX), New York’s John F. Kennedy (JFK), Boston’s Logan (BOS), Newark’s Liberty (EWR), and Washington, D.C.’s Dulles (IAD) international airports. Created during the pandemic in 2021, the Traveler-Based Genomic Surveillance Program (TGP) detects and tracks SARS-CoV-2 variants through nasal swabs from international travelers. A public-private partnership, the program illustrates a new step towards biosecurity and seeks to fill gaps in biosurveillance.
Likewise, Sunday, November 26, has been recorded as the busiest day ever at airports in the United States. The Transportation Security Administration (TSA) reports that it screened 2,907,378 passengers. This means that at least 51,000 flights operated, exceeding last year’s average of 45,000 flights. Flight Tracker 24 further illustrates that less than 0.5% of 51,322 flights were canceled. This day marks only the second time in this year that the Transportation Security Administration (TSA) broke its record. The first time was June 30, ahead of the Fourth of July weekend, when 2.883 million passengers were screened.
Other measures by the CDC include testing wastewater from airplanes and airport triturator drains. The first program, which began in August 2022, has been proven as an effective and cheaper method of tracking SARS-CoV-2 and other pathogens—before they spread into further cities and communities. A custom-made collective device first collects for pathogens in the wastewater, samples of which are then shipped to and tested at the laboratory. Finally, variants of the pathogens are determined once whole genome sequencing is conducted. The second program commenced in April 2023 and has been mainly conducted at SFO Airport in San Francisco. A sampler device is used to extract wastewater from airplanes collected at the triturator. It does not collect terminal waste.
Objectively, the Traveler-Based Genomic Surveillance Program has given myriad results and is still a work in progress. Among the six participating airports, none have all three programs in place. Whereas nasal swabs are used alongside triturators at SFO and airplane wastewater at JFK, only nasal swabs are used at SEA, LAX, IAD, EWR. BOS currently only uses the triturator. On the other hand, it has worked as an “early warning system” that catches infectious diseases before they spread. This is also a benefit given to authorities in public health, including federal laboratories, in which they are quick to act and be informed. The genomic sequencing of SARS-CoV-2 has been contributed to by this program. The program has not only prevented infectious, communicable diseases from spreading, but also interventions at borders and travel and trade disruptions. Despite annually enrolling more than 300,000 travelers from 135 countries in the six World Health Organization regions, this can risk jeopardizing ethics.
On the other hand, while the United States does not have a national vaccination registry, state health departments do have immunization information systems (IIS). These information systems are digital databases that store immunizations conducted by providers to individuals in that state. Specifically, immunization histories are provided in instances of “point of clinical care” and at “the population level.” At the “point of clinical care,” full immunization histories are provided by the IIS to be used by the vaccination provider to see the appropriate vaccinations for their clients. At the “population level,” vaccination data is given by the IIS to be used for surveillance and other programs. They are also used in augmenting rates of vaccination.
However, calls for a national vaccination registry in the United States have been made. According to The Hill, a national registry of vaccinations is a much-needed solution to the current inefficient distribution of vaccines. A national registry would keep records for individuals who have and have not received vaccines. Especially with administering vaccinations to a population of at least 330 million people, a standardized system can be put in place to see who has received it. Other countries with national vaccination registries such as Australia have demonstrated a streamlined and efficient system.
Efforts have emerged to replicate the initiatives being done in the United States’ TGP on a global scale. In a study published by authors at The Lancet writing for Global Health specified that a surveillance network can be established using the world’s busiest airports as nodes and other segments in flight routes can be used as vectors.
As Think Global Health illustrates, the COVID-19 pandemic has stressed countries to take a variety of border measures. Between national security and economic security, surveilling pathogens at nodes where international travelers interact—airports, border crossings—fall under both. Border measures have been implemented in response to outbreaks of diseases and are often a last resort taken by countries to prevent their spread. Most importantly, these border measures must be adhered to the guidelines specified in the World Health Organization’s International Health Regulations, published in 2005. Whereas the outbreaks of the H1N1 influenza and West African Ebola prompted travel restrictions that were based on a lack of evidence, the restrictions made in 2020 in response to COVID were implemented based on available evidence from other outbreaks.
But even the evidence from those outbreaks were not as sufficient. Regarding travel restrictions influenced by geopolitics under one presidential administration and risk-based restrictions under another, these responses had varying degrees of effectiveness. However, it should be emphasized that the same won’t be justified for future outbreaks. In terms of border management, risk-based approaches must be taken into account alongside addressing insufficient evidence. This also calls for standardized terminology and taxonomies to better address new diseases, and a consensus on safely collecting and sharing data. The lack of evidence puts countries at an unsure position in responding to new outbreaks and forces border restrictions to be implemented.