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Kim Jong Il paid no attention to the public aspect of ruling, whereas his son's visibility and embrace of popular culture appears to be aimed at convincing North Koreans that changes may actually occur under him

Authoritarian rulers don't long survive if they're truly out of touch with reality. They need to read palace politics, reward friends and punish enemies, and manage competing interests that are vying for power. Kim Jong Il lasted from 1994 until his death in December 2011 without any obvious internal challenge to his rule, a mark of his political acumen and mastery of factional politics. Although Kim Jong Un is inexperienced, he has held power for over a year and appears to have the acquiescence -- for now -- of the most powerful actors in Pyongyang.

Kim faces just as many risks if he meaningfully reforms domestic, economic, or social policy. Even within a totalitarian dictatorship, there are different factions, coalitions, and bureaucratic interests that will be injured by any change in the status quo. Economic reforms, for example, may ultimately help the country but will risk chaos in the markets, weaken powerful stakeholders within the vast bureaucracy, and potentially unleash rising expectations from the general public.

five bad decisions North Korea has made in the management of its economy. First, in the aftermath of the Korean War, Kim Jong Un's grandfather -- President Kim Il Sung -- focused exclusively on heavy industry development and the military while expecting the country to be self-sufficient in agriculture. In a country that only has 20 percent arable land, that was a huge mistake. Second, rather than seek technologies and innovations like the Green Revolution that helped nations like India make enormous gains in agricultural productivity in the 1960s and 1970s, the North tried to substitute longer work hours and revolutionary zeal. Given the broken infrastructure, this was like squeezing blood from a stone. Third, rather than trade with the outside world, the North went deeply into debt in the 1970s, borrowing and then defaulting on hundreds of millions of dollars in loans from European countries, which forever lost them lines of credit with any country or international financial institution. Fourth, in the 1980s and 1990s, the North undertook extremely wasteful mega-projects, building stadiums, hydropower projects, and tideland reclamation projects -- most of which failed or were never completed. Finally, after the Chinese and Soviets stopping giving aid to the North at the end of the Cold War, Pyongyang relied on humanitarian assistance as a form of income, instead of trying to fix their economy.

North Korea is one of the only countries in the world to have suffered a famine after industrialization

China has more influence over North Korea than any other country, but less influence than outsiders think. Beijing-Pyongyang relations haven't been warm ever since China normalized relations with South Korea over 20 years ago, and both sides resent the other. But Beijing has few options. Completely isolating Pyongyang and withdrawing economic and political support could lead to regime collapse, sending a flood of North Korean refugees across the border, and potentially drawing all the surrounding countries into conflict with each other -- which could see the devastating use of nuclear weapons. And China fears that any conflict, or a collapse, could put South Korean or even U.S. troops on its eastern border. As a result, Beijing -- much like Washington -- is faced with the choices of rhetorical pressure, quiet diplomacy, and mild sanctions. As long as China continues to value stability on the peninsula more than it worries about a few nuclear weapons, it will not fundamentally change its policy towards its unruly neighbor.

Traditional attempts at peacemaking have created complex bureaucracies, circuses of diplomats, frequent flyers around the global terrain with insufficient evidence of success in the resolution of conflict. Indeed, current structures have proved to be cumbersome and ill-attuned to the skills of mediation. A new form of mediation is now required that recognises the competing narratives of the parties involved in the conflict.

polls show Britons are cooling to Brexit and are coming to realize that the ultimate irony of the slogan Johnson and other Leavers deployed during the Brexit campaign—“Take Back Control”—is that Britain has relinquished even more control to Brussels. 

Just as Trump pretended he was giving the American people a better NAFTA deal (which now has little chance of congressional passage) and pulled out of the Trans-Pacific Partnership—which had been the single most effective means of forcing China to behave better on trade and intellectual property rights—to show that he could do it better alone (he hasn’t), Johnson will take his nation through a similar charade. Egged on by Nigel Farage’s Brexit Party—which will threaten him with more Tory defections if he doesn’t keep his word—Johnson will continue to pretend to the British people that they can get better trade deals on their own, when most of the evidence is that instead he will bequeath to them international isolation, ever-rising prices, and permanent economic eclipse. And perhaps the eclipse of the Conservative Party as well.

“Trump will use his relationship to try to get the U.K. to change its views on the Iran nuclear deal,” said Heather Conley of the Center for Strategic and International Studies. Until now, the U.K. has stood with France and Germany in seeking to rescue the 2015 nuclear pact that Trump rejected last year; if it sides with the United States now, that in turn could create more fissures in the trans-Atlantic alliance. 

Trump is plainly eager to have Johnson as an ally in his great task of unmaking the international system

we will all be witnessing a bizarre backward version of the so-called special relationship, one premised on undoing a great deal of what the U.K. and the United States accomplished together after World War II, when both nations oversaw the creation of postwar institutions such as the United Nations and Bretton Woods; British Foreign Minister Ernest Bevin took the lead in creating NATO (even as an exhausted U.K. bequeathed to the United States the role of stabilizer of the West); and the United States and Britain were the primary progenitors of the global free-trading system

It is true that the rise of both Johnson and Trump was a response to a real need for redress in the U.S. and U.K.-conceived international system. Go-it-alone nationalism did not come out of nowhere; both countries staked everything on globalization and free trade—particularly in the financial sector—and the middle class in both the United States and Britain had suffered from it. Indeed, Britain did even worse than the United States after the 2008 crash, and the Brussels bureaucracy had grown irritatingly intrusive. It’s probably surprising that it took this long for a backlash like Brexit to occur. But pointing out serious flaws in the system is not an argument for junking it altogether. And that’s where the new special relationship may be headed for trouble.

the United States needs a dramatic overhaul to adapt to the global threats of the 21st century, which should include moving away from military engagement and toward international cooperation on issues from peacekeeping to greenhouse gas reduction to global health to banking reform. Such an overhaul should also include cutting the defense budget in half by 2035, and perhaps even getting rid of the Pentagon itself.

one big, underappreciated reason for declining interstate war is that it doesn’t pay. Through most of history, global power and wealth have been determined by control of people, land and resources. Wars were fought over bodies and territory in zero-sum conflicts in which the victor took the spoils. Caesar was considered a Roman hero because he brought as many as 1 million slaves back from his Gallic wars alone. And as late as World War II, physical resources were still a key concern—Japan’s need for oil, Germany’s desire for Lebensraum (“living space”).

The World Bank estimates that nearly two thirds of global wealth is intangible—inventions such as the internal combustion engine or the solar panel that allow people to produce more power with less resources than older technologies, institutions including systems of property rights and education—leaving only around a third to be accounted for by built infrastructure, land and natural resources combined. Only in poorer countries are natural resources a large proportion of total wealth

the technological underpinnings of high productivity, such as the engines and solar panels and property rights, are “non-rival”—we don’t have to fight for them. If I occupy land, you cannot. If I use the technology of the internal combustion engine or double-entry bookkeeping, you can use it at the same time. In fact, if we both use the same technologies, we both benefit even more.

land and resources simply aren’t worth the cost of the fight for successful economies. And that helps to explain why the conflict that remains is increasingly concentrated in poorer countries where natural resources are still relatively important, especially in sub-Saharan Africa

The low returns of war may also help to explain the limited military ambitions of China, which has the world’s second-largest defense budget—about 40 percent the size of America’s. While China clearly wants dominance in the South China Sea, the country has only two aircraft carriers—one of which is a secondhand boat left over from the days of the Soviet Union. It conducts bomber flights in international waters, but the two warships are limited to the same area. And it spends a smaller percentage of its gross domestic product on the military than does the United States: 1.9 percent compared with America’s 3.2 percent. China’s recent success has been built on global connections that have left it the world’s largest trading nation. A world war would tear apart those connections

the United States retains a massive global military advantage, responsible for one out of every three dollars spent on defense worldwide and outspending the countries with the next seven biggest military budgets combined. But while that ensures dominance at confrontation on the battlefield, it is not so useful for the kind of conflicts the world still fights, dominated by guerrilla warfare. That is demonstrated by America’s not-winning streak over the past seven decades in civil conflict: Korea, Vietnam, Afghanistan and Iraq. The “Global War on Terror” drags on; the two countries suffering the most terror attacks in the world are also the two countries the United States has invaded in the past 20 years.

This low efficacy of the Department of Defense is primarily because the military is limited in its ability to keep the peace in countries where much of the population doesn’t want it there at a cost in lives, finance and time that is acceptable to U.S. voters and lawmakers.

Rising productivity has increased carbon emissions and other pressures on global sustainability. Connectivity leaves people worldwide more exposed to threats from elsewhere including viruses real and virtual alongside financial contagion. These new national security challenges require a collective response: We can’t bomb our way out of climate change or financial crises—we have to cooperate through international organizations, agreements and the shared financial incentives for signing on to them.

The total number of people working in the Department of Defense itself (none of whom are in the field actually defending or deterring war) climbed from 140,000 in 2002 to just shy of 200,000 in 2012. Nearly three-quarters of a million civilian federal employees work for the Defense Department—add in the Department of Veterans Affairs and that’s about half of the total civilian federal workforce

an institution that was recently declared simply unauditable due to complexity, failed systems and missing records—this after a $400 million effort involving over 1,200 auditors

Retired Lieutenant General David Barno and colleagues from the Center for a New American Security have listed seven “deadly sins” of defense spending in a recent report, ranging from redundant overhead through inefficient procurement systems to excess infrastructure to a bloated retirement system that could generate annual savings of $49 billion if rectified. If that sounds too large to be plausible, in 2015, the Department of Defense itself reported administrative waste and excess bureaucracy cost the institution an annual $25 billion.

A budget cut to 1.5 times the military spending of our nearest competitor (China) would free up about $150 billion of the current $649 billion in U.S. spending (as reported by the World Bank). Taking $100 billion of that and adding it to the U.S. overseas development assistance budget would also bring the U.S. aid ratio up to 0.7 percent of gross national Income—the U.N. target.

over 10 years, the United States could move toward 2 percent of GDP going to defense, down from today’s 3.2 percent—that’s the target set for NATO as a whole back in 2006. And perhaps in 15 years, U.S. military spending could reach the current global median: 1.5 percent of GDP

Each American citizen—man, woman and child—currently pays an average of $1,983 a year to the Department of Defense. Over an average lifetime, that adds up to $156,000 per person. It is a simply incredible sum for a country at zero risk of invasion and with a reasonable aversion to violent territorial expansion

People across the national security spectrum said: You don’t have to like, respect, or agree with Cohen and Patel, but you underestimate their drive and Machiavellian prowess at your own peril.

“Kash had a meteoric rise,” a senior administration official explained. “He gets hired for the Russia collusion [investigation], and that put him at the president’s doorstep. For the past year Kash has swung the biggest dick in D.C. because he could just say, ‘Oh, I’m going to go to the president.’ And we were on emails with him where he’s telling four-star generals, ‘Hey, this is a White House priority. Don’t make me go talk to the president, because I will.’ And the generals always rolled over.”

The CIA gambit took place last year. In fact, when I had spoken with Cohen about the matter, he had told me, “The idea was to put Kash in as the deputy, which doesn’t require Senate approval, and then to fire Gina the next day, leaving Kash in charge…. Robert O’Brien, [Trump’s national security adviser], is the one who deep-sixed it.” When I pressed Patel further about these machinations, which had occurred in December, I saw him turn lawyerly: “That stuff is between me and the boss. That’s the only thing I don’t comment on. Ever. It’s executive privilege.”

On the leg back to D.C., Miller invited me up to his cabin. I asked him about the $1.5 trillion F-35 Joint Strike Fighter (a deeply flawed system I had covered at length for Vanity Fair)—a purportedly off-the-record conversation that someone in the Pentagon decided to simply post on the Defense Department’s website. What did this costly, badly flawed aircraft—27 years in the making—say about the Pentagon’s spending priorities? Miller started laughing before letting loose: “I cannot wait to leave this job, believe me. Talk about a wicked problem! I wanted to take that one on. F-35 is the case study…. [T]hat investment, for that capability that we’re never supposed to use…I’m like, ‘We have created a monster.’”

Sitting on his couch at the end of a surreal week, he finally took off the gloves. His target? The Defense Department itself, the largest organization in the world—and one he has served in various ways since he was 18. “This fucking place is rotten. It’s rotten.” Miller’s gravest concern, he said, involved a bedrock principle of American democracy: civilian control of the military. “When the system is weighted towards the Joint Staff and the geographic combatant commanders against civilian control, you know, we’ve got to rethink this.” He expressed a belief that by “idolizing and fetishizing” the top brass, members of Congress had ignored an erosion over time in the chain of command.

the Joint Chiefs were creating their own “security compartments” containing operational planning details “for the express purpose of hiding key information from career civilian and political leaders in the Pentagon”—up to and including the secretary of Defense. Talk about a deep state. “That means that policymakers were basing their decisions on partial information. It’s very dangerous and irresponsible, and that’s something I’ve actually highlighted in my conversations with [Biden’s] transition team.” I’ll admit it sounded loopy. To me it had all the elements of a Trump fever dream: The military and intelligence establishment was somehow scheming against the renegades. That is, until two other senior national security officials—with Miller and company—confirmed Cohen’s assertion.

‘Well, who are these people that have the complete picture?’ I felt like I finally did as acting SECDEF—to a point. I’m sure there’s still some stuff that was being compartmented. But I don’t know that for a fact.”

What interests Hill is how the three such different countries end up in the same boat, run by populists and significantly less able to cope with a pandemic than their neighbours. She believes the critical common factor is the heady rise, and then the catastrophic collapse, of heavy industry and the failure of their governments to manage the fall and cushion the impact on their people.

when you’re coming from the north of England, you are completely network-poor – you have no idea of how to go about it. It’s all about mentorship and connections

In all three countries, the government did little to mitigate the pain, leaving afflicted families to move to where the jobs were. In practice, the barriers to mobility – vast distances and bureaucracy in Russia, house prices in the UK – kept them anchored. Even in the US, the bursting of the housing bubble in 2008 made movement harder. And in all three countries, the ties of family obligations and social networks kept people rooted in place without prospects, and educational opportunities to change your destiny have withered away.

“If you’re in the north of England it’s probably easier to move to Australia, Canada or America and start again, like some of my family did, rather than trying to find a job in the south,” Hill said. “House prices in the north-east were so ridiculously low vis-a-vis in London or the south.”

In both the UK and Russia, the planners had built new towns as part of the great industrialisation drive, which suddenly had their economic lifelines cut off and were left to wither. Hill felt another echo when she visited the American midwest, where her in-laws lived. The great cities built on steel and automobiles had died, leaving hollowed-out communities.

At the interview in London, only she and another northern girl, a farmer’s daughter from Sunderland, took the time to chat to the secretary. It turned out that the secretary was part of the selection panel, and it was the two northerners who won the fellowships.

“Populism provides a narrative for people who have lost their identities that were tied to meaningful work,” she said. “When people lose that then they’re looking for something. There’s a feeling they’ve been robbed and deprived of a golden age, and they want that back and populist politics feeds upon that, and provides scapegoats for losing it.”

“Liberal democracy hasn’t been delivering,” she argued. “If I go back to my home town, it’s still no better than it was when I was growing up in terms of opportunity. The shops are boarded up in the main street. Nothing new is coming in. There’s just no kind of sense of optimism. And when I visit my relatives here in the US in Wisconsin and other places, there’s a lot of sense of: the rest of the world is kind of moving on and leaving us behind. People see that as being closely associated with liberal democracy.”

“Trump didn’t look up when I came in and I don’t think he looked up the whole time I was giving my spiel about the terrorist attack,”

Trump had decided he wanted a press release and assumed Hill, one of the few women in the room, was there to type it up.

“It’s not like the first time I’ve been mistaken for a secretary. I’ve been mistaken for many things, believe me,”

“A lot of this stuff which is described as policy is really all about personal fighting … And it’s kind of a comedy of errors, with all this intriguing. It’s very reminiscent of Kremlin intrigue and the kind of intrigue around No 10 in the UK – people always trying to do each other in.”

She argues Trump’s desire to forge a personal relationship with Putin is no different from his approach to the North Korean leader, Kim Jong-un, or the Chinese president, Xi Jinping, or Israel’s prime minister, Benjamin Netanyahu. “He wants to be like he was as a CEO, he has all these discussions with people in private … He has a very informal style with everyone. Putin is similar. He just tries to engage with people in the way that he thinks kind of fits them best,” she said. “Boris is the same. It’s like the guy in the pub. It’s less getting into the weeds of the substance in some sort of formal way, and more two guys talking.

“He wanted to treat Putin the same way he treated Xi or Netanyahu. He wanted to be able to pick up the phone and talk to them.” But Putin could not be treated like the others. The Trump campaign had dozens of contacts with Russian officials or Kremlin intermediaries, and the candidate had appealed to Moscow to interfere in the election by hacking Hillary Clinton’s emails. Furthermore, as Hill made clear in her biography of him, Putin has taken all the skills of his long KGB career with him to the Russian presidency. And the Kremlin was constantly outmanoeuvring the White House, arranging events so that Trump would be alone with Putin with only the Russian president’s translator in the room. The state department, which stuck to rigid protocol rules on whose translator should be where and when, was being played.

In her efforts to have US career officials included in Trump’s meetings with Putin, she found herself facing determined resistance from inside the president’s entourage, as they became more and more distrustful of career officials as disloyal potential whistleblowers.

It gave Russians unnecessary leverage

He has torn up one arms control agreement after another with the result that in less than a year’s time, there could be no limits left on the world’s major nuclear arsenals.

bloated, inefficient health-care system

Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable

decades-long process of shredding the nation’s social safety net

same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories

the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,”

The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us

Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

This year, the world’s coronavirus experts—and there still aren’t many—had to postpone their triennial conference in the Netherlands because SARS‑CoV‑2 made flying too risky.

In 2003, China covered up the early spread of SARS, allowing the new disease to gain a foothold, and in 2020, history repeated itself. The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans, and only confirmed as much on January 20, after millions had traveled around the country for the lunar new year. Doctors who tried to raise the alarm were censured and threatened. One, Li Wenliang, later died of COVID‑19. The World Health Organization initially parroted China’s line and did not declare a public-health emergency of international concern until January 30. By then, an estimated 10,000 people in 20 countries had been infected, and the virus was spreading fast.

it found a nation through which it could spread easily, without being detected

“By early February, we should have triggered a series of actions, precisely zero of which were taken.”

Even after warnings reached the U.S., they fell on the wrong ears. Since before his election, Trump has cavalierly dismissed expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was twice ignored.

countries “rely on bans to the exclusion of the things they actually need to do—testing, tracing, building up the health system,”

genetic evidence shows that the specific viruses that triggered the first big outbreaks, in Washington State, didn’t land until mid-February. The country could have used that time to prepare. Instead, Trump, who had spent his entire presidency learning that he could say whatever he wanted without consequence, assured Americans that “the coronavirus is very much under control,” and “like a miracle, it will disappear.” With impunity, Trump lied. With impunity, the virus spread.

A study showed that the U.S. could have averted 36,000 COVID‑19 deaths if leaders had enacted social-distancing measures just a week earlier. But better late than never: By collectively reducing the spread of the virus, America flattened the curve. Ventilators didn’t run out, as they had in parts of Italy. Hospitals had time to add extra beds.

Tests were in such short supply, and the criteria for getting them were so laughably stringent, that by the end of February, tens of thousands of Americans had likely been infected but only hundreds had been tested.

Sabeti’s lab developed a diagnostic test in mid-January and sent it to colleagues in Nigeria, Sierra Leone, and Senegal. “We had working diagnostics in those countries well before we did in any U.S. states,”

In response to the global energy crisis of the 1970s, architects made structures more energy-efficient by sealing them off from outdoor air, reducing ventilation rates. Pollutants and pathogens built up indoors, “ushering in the era of ‘sick buildings,’ ” says Joseph Allen, who studies environmental health at Harvard’s T. H. Chan School of Public Health. Energy efficiency is a pillar of modern climate policy, but there are ways to achieve it without sacrificing well-being. “We lost our way over the years and stopped designing buildings for people,”

The indoor spaces in which Americans spend 87 percent of their time became staging grounds for super-spreading events. One study showed that the odds of catching the virus from an infected person are roughly 19 times higher indoors than in open air. Shielded from the elements and among crowds clustered in prolonged proximity, the coronavirus ran rampant in the conference rooms of a Boston hotel, the cabins of the Diamond Princess cruise ship, and a church hall in Washington State where a choir practiced for just a few hours.

Between harsher punishments doled out in the War on Drugs and a tough-on-crime mindset that prizes retribution over rehabilitation, America’s incarcerated population has swelled sevenfold since the 1970s, to about 2.3 million. The U.S. imprisons five to 18 times more people per capita than other Western democracies. Many American prisons are packed beyond capacity, making social distancing impossible. Soap is often scarce. Inevitably, the coronavirus ran amok. By June, two American prisons each accounted for more cases than all of New Zealand. One, Marion Correctional Institution, in Ohio, had more than 2,000 cases among inmates despite having a capacity of 1,500.

America’s nursing homes and long-term-care facilities house less than 1 percent of its people, but as of mid-June, they accounted for 40 percent of its coronavirus deaths. More than 50,000 residents and staff have died. At least 250,000 more have been infected. These grim figures are a reflection not just of the greater harms that COVID‑19 inflicts upon elderly physiology, but also of the care the elderly receive. Before the pandemic, three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control. The Trump administration’s policies have exacerbated the problem by reducing the influx of immigrants, who make up a quarter of long-term caregivers.

the Department of Health and Human Services paused nursing-home inspections in March, passing the buck to the states. Some nursing homes avoided the virus because their owners immediately stopped visitations, or paid caregivers to live on-site. But in others, staff stopped working, scared about infecting their charges or becoming infected themselves. In some cases, residents had to be evacuated because no one showed up to care for them.

its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

“As public health did its job, it became a target” of budget cuts,

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

In May, Maryland Governor Larry Hogan asserted that his state would soon have enough people to trace 10,000 contacts every day. Last year, as Ebola tore through the Democratic Republic of Congo—a country with a quarter of Maryland’s wealth and an active war zone—local health workers and the WHO traced twice as many people.

Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.

“We’re designed for discrete disasters” like mass shootings, traffic pileups, and hurricanes, says Esther Choo, an emergency physician at Oregon Health and Science University. The COVID‑19 pandemic is not a discrete disaster. It is a 50-state catastrophe that will likely continue at least until a vaccine is ready.

American hospitals operate on a just-in-time economy. They acquire the goods they need in the moment through labyrinthine supply chains that wrap around the world in tangled lines, from countries with cheap labor to richer nations like the U.S. The lines are invisible until they snap. About half of the world’s face masks, for example, are made in China, some of them in Hubei province. When that region became the pandemic epicenter, the mask supply shriveled just as global demand spiked. The Trump administration turned to a larder of medical supplies called the Strategic National Stockpile, only to find that the 100 million respirators and masks that had been dispersed during the 2009 flu pandemic were never replaced. Just 13 million respirators were left.

The supply of nasopharyngeal swabs that are used in every diagnostic test also ran low, because one of the largest manufacturers is based in Lombardy, Italy—initially the COVID‑19 capital of Europe. About 40 percent of critical-care drugs, including antibiotics and painkillers, became scarce because they depend on manufacturing lines that begin in China and India. Once a vaccine is ready, there might not be enough vials to put it in, because of the long-running global shortage of medical-grade glass—literally, a bottle-neck bottleneck.

As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.

Travel bans make intuitive sense, because travel obviously enables the spread of a virus. But in practice, travel bans are woefully inefficient at restricting either travel or viruses. They prompt people to seek indirect routes via third-party countries, or to deliberately hide their symptoms. They are often porous: Trump’s included numerous exceptions, and allowed tens of thousands of people to enter from China. Ironically, they create travel: When Trump later announced a ban on flights from continental Europe, a surge of travelers packed America’s airports in a rush to beat the incoming restrictions. Travel bans may sometimes work for remote island nations, but in general they can only delay the spread of an epidemic—not stop it.

the indiscriminate lockdown was necessary only because America’s leaders wasted months of prep time. Deploying this blunt policy instrument came at enormous cost. Unemployment rose to 14.7 percent, the highest level since record-keeping began, in 1948. More than 26 million people lost their jobs, a catastrophe in a country that—uniquely and absurdly—ties health care to employment

In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves disconnected from medical care and impoverished. They join the millions who have always lived that way.

Elderly people, already pushed to the fringes of society, were treated as acceptable losses. Women were more likely to lose jobs than men, and also shouldered extra burdens of child care and domestic work, while facing rising rates of domestic violence. In half of the states, people with dementia and intellectual disabilities faced policies that threatened to deny them access to lifesaving ventilators. Thousands of people endured months of COVID‑19 symptoms that resembled those of chronic postviral illnesses, only to be told that their devastating symptoms were in their head. Latinos were three times as likely to be infected as white people. Asian Americans faced racist abuse. Far from being a “great equalizer,” the pandemic fell unevenly upon the U.S., taking advantage of injustices that had been brewing throughout the nation’s history.

Of the 3.1 million Americans who still cannot afford health insurance in states where Medicaid has not been expanded, more than half are people of color, and 30 percent are Black.* This is no accident. In the decades after the Civil War, the white leaders of former slave states deliberately withheld health care from Black Americans, apportioning medicine more according to the logic of Jim Crow than Hippocrates. They built hospitals away from Black communities, segregated Black patients into separate wings, and blocked Black students from medical school. In the 20th century, they helped construct America’s system of private, employer-based insurance, which has kept many Black people from receiving adequate medical treatment. They fought every attempt to improve Black people’s access to health care, from the creation of Medicare and Medicaid in the ’60s to the passage of the Affordable Care Act in 2010.

A number of former slave states also have among the lowest investments in public health, the lowest quality of medical care, the highest proportions of Black citizens, and the greatest racial divides in health outcomes

As of early July, one in every 1,450 Black Americans had died from COVID‑19—a rate more than twice that of white Americans. That figure is both tragic and wholly expected given the mountain of medical disadvantages that Black people face

Native Americans were similarly vulnerable. A third of the people in the Navajo Nation can’t easily wash their hands, because they’ve been embroiled in long-running negotiations over the rights to the water on their own lands. Those with water must contend with runoff from uranium mines. Most live in cramped multigenerational homes, far from the few hospitals that service a 17-million-acre reservation. As of mid-May, the Navajo Nation had higher rates of COVID‑19 infections than any U.S. state.

Americans often misperceive historical inequities as personal failures

the largely unregulated, social-media-based communications infrastructure of the 21st century almost ensures that misinformation will proliferate fast. “In every outbreak throughout the existence of social media, from Zika to Ebola, conspiratorial communities immediately spread their content about how it’s all caused by some government or pharmaceutical company or Bill Gates,”

Rumors coursed through online platforms that are designed to keep users engaged, even if that means feeding them content that is polarizing or untrue. In a national crisis, when people need to act in concert, this is calamitous. “The social internet as a system is broken,” DiResta told me, and its faults are readily abused.

Like pandemics, infodemics quickly become uncontrollable unless caught early.

In 2016, when DiResta spoke with a CDC team about the threat of misinformation, “their response was: ‘ That’s interesting, but that’s just stuff that happens on the internet.’ ”

The WHO, the CDC, and the U.S. surgeon general urged people not to wear masks, hoping to preserve the limited stocks for health-care workers. These messages were offered without nuance or acknowledgement of uncertainty, so when they were reversed—the virus is worse than the flu; wear masks—the changes seemed like befuddling flip-flops.

the United States underperformed across the board, and its errors compounded. The dearth of tests allowed unconfirmed cases to create still more cases, which flooded the hospitals, which ran out of masks, which are necessary to limit the virus’s spread. Twitter amplified Trump’s misleading messages, which raised fear and anxiety among people, which led them to spend more time scouring for information on Twitter.

By tying career advancement to the publishing of papers, academia already creates incentives for scientists to do attention-grabbing but irreproducible work. The pandemic strengthened those incentives by prompting a rush of panicked research and promising ambitious scientists global attention.

In March, a small and severely flawed French study suggested that the antimalarial drug hydroxychloroquine could treat COVID‑19. Published in a minor journal, it likely would have been ignored a decade ago. But in 2020, it wended its way to Donald Trump via a chain of credulity that included Fox News, Elon Musk, and Dr. Oz. Trump spent months touting the drug as a miracle cure despite mounting evidence to the contrary, causing shortages for people who actually needed it to treat lupus and rheumatoid arthritis. The hydroxychloroquine story was muddied even further by a study published in a top medical journal, The Lancet, that claimed the drug was not effective and was potentially harmful. The paper relied on suspect data from a small analytics company called Surgisphere, and was retracted in June.**

Science famously self-corrects. But during the pandemic, the same urgent pace that has produced valuable knowledge at record speed has also sent sloppy claims around the world before anyone could even raise a skeptical eyebrow.

No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the U.S. had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his unqualified son-in-law; that an armchair polymath would claim to have a “natural ability” at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, “I don’t take any responsibility at all.”

Trump is a comorbidity of the COVID‑19 pandemic. He isn’t solely responsible for America’s fiasco, but he is central to it. A pandemic demands the coordinated efforts of dozens of agencies. “In the best circumstances, it’s hard to make the bureaucracy move quickly,” Ron Klain said. “It moves if the president stands on a table and says, ‘Move quickly.’ But it really doesn’t move if he’s sitting at his desk saying it’s not a big deal.”

everyday Americans did more than the White House. By voluntarily agreeing to months of social distancing, they bought the country time, at substantial cost to their financial and mental well-being. Their sacrifice came with an implicit social contract—that the government would use the valuable time to mobilize an extraordinary, energetic effort to suppress the virus, as did the likes of Germany and Singapore. But the government did not, to the bafflement of health experts. “There are instances in history where humanity has really moved mountains to defeat infectious diseases,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It’s appalling that we in the U.S. have not summoned that energy around COVID‑19.”

People suffered all the debilitating effects of a lockdown with few of the benefits. Most states felt compelled to reopen without accruing enough tests or contact tracers. In April and May, the nation was stuck on a terrible plateau, averaging 20,000 to 30,000 new cases every day. In June, the plateau again became an upward slope, soaring to record-breaking heights.

It is no coincidence that other powerful nations that elected populist leaders—Brazil, Russia, India, and the United Kingdom—also fumbled their response to COVID‑19. “When you have people elected based on undermining trust in the government, what happens when trust is what you need the most?”

Drawn to novelty, journalists gave oxygen to fringe anti-lockdown protests while most Americans quietly stayed home. They wrote up every incremental scientific claim, even those that hadn’t been verified or peer-reviewed.

The virus was never beaten in the spring, but many people, including Trump, pretended that it was. Every state reopened to varying degrees, and many subsequently saw record numbers of cases. After Arizona’s cases started climbing sharply at the end of May, Cara Christ, the director of the state’s health-services department, said, “We are not going to be able to stop the spread. And so we can’t stop living as well.” The virus may beg to differ.

The long wait for a vaccine will likely culminate in a predictable way: Many Americans will refuse to get it, and among those who want it, the most vulnerable will be last in line.

It is almost unheard-of for a public-health measure to go from zero to majority acceptance in less than half a year. But pandemics are rare situations when “people are desperate for guidelines and rules,” says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. The closest analogy is pregnancy, she says, which is “a time when women’s lives are changing, and they can absorb a ton of information. A pandemic is similar: People are actually paying attention, and learning.”

As the economy nose-dived, the health-care system ailed, and the government fumbled, belief in American exceptionalism declined. “Times of big social disruption call into question things we thought were normal and standard,” Redbird told me. “If our institutions fail us here, in what ways are they failing elsewhere?” And whom are they failing the most?

It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

The flu vaccine that Americans receive at drugstores and doctors’ offices is based on work that the CDC and Food and Drug Administration conduct through the WHO

Since 2004, the U.S. has helped build a global network of WHO flu centers, buying lab equipment and training scientists. The centers in more than 100 countries collect samples from sick people, isolate the viruses and search for any new viruses that could cause an epidemic or pandemic. The CDC houses one of five WHO Collaborating Centers that collect these virus samples, sequence the viral RNA and analyze reams of data on flu cases around the world, while the FDA runs one of the four WHO regulatory labs that help vaccine makers determine the correct amount of antigen, which triggers the immune response, to include in vaccines.

The Trump administration’s plan to bypass the WHO and address global health problems directly with foreign governments will run into trouble in the Middle East, South Asia, Africa and other regions where Americans encounter hostility or have difficulty operating

The onslaught of the coronavirus has hurt immunization activities worldwide, causing a rise in measles and other diseases.

fear that the U.S. decision will endanger a WHO-led program that has come tantalizingly close to the eradication of polio

The uncertainty has caused concern in the pharmaceutical industry as well as the government, officials said. The CDC could lose access to the data and virus samples that protects Americans from potentially deadly strains of flu from around the world.

“People coming into countries in WHO shirts to work on polio or AIDS are less threatening,”

“No one is looking for U.S.-based alternatives to WHO,” he said. “Dead on arrival. There is no way they are going to be supported or even accepted.”

The WHO has a history of bringing together ideological rivals. William Foege, a CDC director under Presidents Ronald Reagan and Jimmy Carter, credits the global agency for uniting American scientists and their counterparts from the Soviet Union during the Cold War to eradicate smallpox in a little more than a decade.

“It’s not a failed bureaucracy,” said Foege, who worked on the international fight against smallpox. “If you go there and see all they do every year, and they have a budget for the entire world that’s smaller than many medical centers in this country.”

global health experts across the political spectrum admit that the WHO needs reform

“In general, the WHO is deferential to member states,” Kolker said. “Yes, it should have been more aggressive in response to Chinese obstruction. Tedros surely realizes the public statements were too deferential to China. But the organization is not dominated by China. Its weaknesses reflect the challenges we have long faced in international collaboration on public health.”

“There’s one country that’s desperate for the United States to leave the WHO, and that’s China,” Sen. Chris Murphy, a Connecticut Democrat, said at a hearing Thursday of the U.S. Senate Committee on Foreign Relations. “They are going to fill this vacuum. They are going to put in the money that we have withdrawn, and even if we try to rejoin in 2021, it’s going to be under fundamentally different terms because China will be much more influential because of our even temporary absence from it.”