As Americans move toward a vaccinated future, there are two crucial pandemic tasks to accomplish, and both would fare better with robust U.S.-China cooperation. The first is to vaccinate the world. The second is to prevent the next pandemic. Neither is being furthered by the intense focus on lab leak allegations.
As the friendly and eminent virologists on This Week in Virology remind us episode after episode, the prevailing hypothesis is COVID-19 arose as a spillover from animals, similar to the original origins of diseases that have caused serious outbreaks, epidemics, or pandemics in the past. If we were setting up a standard scientific inquiry, that would be the obvious hypothesis to test first. As columnist Michael Hiltzik documented thoroughly in the Los Angeles Times, there is no actual evidence for the lab leak allegation, which makes it an unlikely primary hypothesis. In other words, the lab leak is a distraction. That would be relatively harmless if the only effect was to cause a large number of pundits to pontificate on two areas of study many know nothing about: virology and the nature of the Chinese state. But in fact, it is contributing to the failure to make rapid and successful progress on critical issues promoting global human health.
Americans have large, unfinished tasks ahead that could benefit from true U.S.-China cooperation, something that’s perfectly possible even as geopolitical tensions increase. During the Cold War, the United States and the Soviet Union cooperated to eradicate smallpox. That was part of a longer period of vaccine cooperation that led to the development of the Sabin polio vaccine (to replace the original Salk polio vaccine) in the United States and its testing in the Soviet Union. Even while the two countries were involved in a space and a nuclear arms race, they took a cooperative approach to disease prevention because both countries recognized that disease preparation is a global public good. We are all protected only when everyone is protected.
The United States and China need to take the same message. In contrast to the continuing antagonism and competitiveness between the two governments on health, the two countries have struck a much more cooperative stance on climate change. Both presidents appointed experienced negotiators who had worked with each other before, and they immediately began meeting to address both bilateral issues and how to support the international climate process together.
The massive task of vaccinating the world has only just begun, and the promise of 500 million doses from the United States over the next year and a half is not going to solve the problem. The New York Times’s vaccine tracker reported the world had administered 31 vaccine doses per 100 people—but remember, that’s single doses, and almost all vaccines require two doses. World Health Organization Director-General Tedros Adhanom Ghebreyesus told the G-7 that to vaccinate 70 percent of the global population, the world will need 11 billion doses.
China and India have the largest vaccine production capacity, and the United States continues to hope that teaming with India will supply the world. But India needs a lot of its production for itself. Global vaccination is only possible on a reasonable timescale with China’s manufacturing power on board.
China now has two vaccines that have received emergency use authorization from the World Health Organization—manufactured by Sinovac and Sinopharm. Not only is the WHO satisfied with China’s safety and efficacy data, but the U.S. Centers for Disease Control and Prevention appears to be as well, issuing guidance that those vaccinated overseas with any WHO-authorized vaccine do not need to be re-vaccinated in the United States. There are, however, lingering questions about these vaccines. Anecdotal reports suggest some less successful outcomes in real-world use, such as concerns in Bahrain that have led to additional mRNA boosters, but also some accounts where the Chinese-made vaccines have been highly effective, such as a vaccine experiment in a Brazilian town. They require better study and perhaps some efforts to improve efficacy, both of which are better accomplished through cooperation.
The second task is to prepare for the next pandemic—and it will come. That’s why former U.S. Presidents George W. Bush and Barack Obama devoted considerable energy to developing Emerging Infections Programs around the world and especially in cooperation with China. These were severely cut back during the Trump administration, including eliminating the pandemic preparedness office at the National Security Council as well as removing most of the health staff from the U.S. Embassy in China.
This infrastructure needs to be rebuilt, but both Washington and Beijing also need to do more. The United States and China cooperated for decades to build Chinese capacity to contribute to the World Health Organization’s global effort to identify which influenza strains will be active each year. The world needs a similar level of effort to detect emerging viruses and likely a specific look for new coronaviruses. Previous cooperation included collecting coronavirus specimens in animals to look for the next potential spillover. Instead of seeing this program as insufficient and putting more resources into it in the wake of the COVID-19 outbreak, the United States cut off funds to the EcoHealth Alliance. There are real policy debates about whether the priority should be human or animal testing or both, but it should be clear to everyone that they need to do more. None of this can be done by the United States alone. Scientists need to go to where the diseases originated, and in the case of the types of coronaviruses that caused severe acute respiratory syndrome (SARS) and COVID-19, that is China and Southeast Asia.
Working collaboratively internationally requires diplomacy. Each WHO member is sovereign. That’s why the WHO negotiates member country entry for all projects, whether they involve specimen collection or disease control. That is also why the U.S. government works under bilateral agreements and coordinates closely with the WHO. The United States can’t demand the Chinese work with the WHO on these questions, but there are reasons why China would want to if the United States approached Beijing in a diplomatic manner.
The Chinese government wants a robust economy with an active population and therefore has strong reasons, as the United States should too, to protect human health. Pandemics are harmful to everyone. The Chinese scientific community also wants to conduct cutting-edge work, and much of its capacity is now top notch. But no country (even the United States) holds a monopoly on expertise; and therefore, scientists value working collaboratively. There are strong reasons to believe, as in the period after SARS when international cooperation increased rapidly in China, the United States could build ties, especially if it works collaboratively, to support a WHO effort the way it did for influenza.
But instead, the United States is in the midst of name-calling. Many of those calling for an “investigation” are sincere in their desire to get more information. It would be ideal if China just threw open its doors, but that is not a likely outcome, and those in the international biomedical community are long-experienced in negotiating with countries anxious about protecting their sovereignty or revealing their mistakes—and as we have all learned from botched COVID-19 control efforts in most countries, mistakes are the rule rather than the exception with a new pathogen. To be sure, things would be better if the Chinese government was completely open and transparent, both on this issue and other issues critical to global health, but that simply isn’t going to happen just because of outside demands. Nevertheless, the WHO team gained access to considerable information during its first visit and, even more importantly, identified sources of additional information that had not yet been studied.
Critics will claim those arguing for the likelihood of a natural origin to COVID-19 are in denial. But they confuse two points: one scientific and one political. Arguing that natural origins appear more likely than a lab leak but that nothing can be ruled out is not denial. It is simply giving a best estimate of likely outcomes. Equally, arguing that approaching the Chinese in an accusatory manner is not likely to yield openness and bring new information is not denial either. It is a description of the political situation the United States finds itself in.
A sincere quest for the pandemic’s origins also needs patience. It took 14 years to identify the full path of SARS, and the beginnings of many other diseases are still mysteries, including Ebola.
Right now, that information won’t help control the virus—that’s the vaccines’ job. But it can help prevent a future pandemic. The next pandemic won’t necessarily come out of China, but given the size of the Chinese population and the number of people in close proximity to animals there, it has to be a key part of any prevention strategy.
