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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.

As rich countries have been allowed to maintain their level of agricultural subsidies – which are mostly handed out to large producers, not family farms – developing countries have not been allowed under WTO rules to subsidise food production for domestic consumption to guarantee food security, nor to protect their farmers from unfair dumping.

subsidies for the environmentally damaging production of oil and gas remain undisciplined, while countries have successfully sued each other in the WTO for directing subsidies towards greener fuels, especially if they try to create jobs at the same time.

The environment has suffered as countries use environmental exploitation as a comparative advantage, and trade is responsible for a growing percentage of the greenhouse gases that contribute to climate change.

supporters of the WTO were able to get developing countries to agree to a new round of trade talks only by claiming it would be a “development” round – ie, one that put the needs of developing countries at its heart.  Since then, unfortunately, developed countries have never delivered on their promises to address the constraints that bad WTO rules put on development

most developing countries that have gained from trade have done so by exporting to China, whose growth is usually attributed to its divergences from the WTO model. 

At a time when most conversations regarding Big Tech are around the need for stronger antitrust and tax enforcement, and how their model of surveillance capitalism should not be allowed to shape the contours of our media, democracy, human rights, education and social relationships – or even how to break them up – they are working through the WTO, without public debate, to gain a new constitution that will consolidate their power and profits.

the problem with the dispute system is that it adjudicates according to a set of rules guided by corporate interests

The crisis is that people around the world have suffered through nearly 25 years of a damaging pro-corporate trade model, encapsulated by the WTO, and the domestic policies of austerity that have led to uprisings on four continents, mass migrations, and the election of right-wing governments in many countries.

We all need a global economy that facilitates decent jobs, access to affordable medicines, healthy food, and a thriving environment. Nearly all governments agreed to this mandate through the Sustainable Development Goals (SDGs) and Agenda 2030 in 2015. The rules of the global economy should be shaped around ensuring that trade can help achieve these goals, but at the minimum, it should not constrain governments from doing so.

The solution to the current conflicts on trade policy is not a false nationalism that nonetheless expands corporate control, nor a defence of the current failed corporate system. We need a wholly different system than that embodied in the WTO, just as the protesters clamoured for in Seattle 20 years ago. That will require a multilateral vision of ecological stability, shared prosperity, and leadership committed to that vision. Until then, we can expect more crises. 

greater awareness of the potential impact of natural as well as man-made shocks will accelerate tendencies not toward deglobalization but rather toward reglobalization: a reshuffling of supply chains and at least a partial reduction in the concentration of capacity inside China

The disruption caused by the pandemic creates an opportunity for U.S. policymakers to reassess and recalibrate their generally laissez-faire approach to globalization.

Another reason for attempting to shift existing supply chains and, in particular, for trying to preserve and expand domestic manufacturing capacity is that doing so could help boost the overall productivity, international competitiveness, and long-term growth prospects of the U.S. economy. That, in turn, would generate more of the aggregate resources necessary to sustain a protracted strategic competition with China, while at the same time enhancing the well-being of many American workers.

Even if the value-added from the final assembly of consumer goods is relatively small, from a strategic standpoint it would be preferable if the resulting gains accrued to the economies of U.S. friends and allies rather than to China. The physical relocation of some portion of existing supply chains could also help slow China’s efforts to extract sensitive technology through industrial espionage or coerced joint ventures.

Even a largely market-driven dispersion of supply chains and a lesser degree of concentration in China should help to reduce risks and increase resilience.

To the extent feasible, the United States should seek to source imports of critical goods from a trusted production network of facilities in friendly or allied countries, at least some of them located far from China.

During World War II and the opening stages of the Cold War, the federal government used the tax code in a focused fashion, extending the so-called rapid tax amortization privilege to promote expansion in sectors where resource requirement calculations revealed gaps that could stall defense mobilization. In the 1950s, federal agencies also used procurement guarantees to encourage the maintenance of capacity above anticipated market demand for certain minerals and machine tools by promising to buy a portion of the resulting output. Some of these were then placed in stockpiles for possible future use.

The U.S. government could use similar tools today if, for example, it wanted to expand the nation’s ability to manufacture personal protective equipment and ventilators, items that might be needed to combat the next pandemic.

Globalization is not an unstoppable natural force, propelled solely by technological progress and autonomous market forces; instead it is a man-made phenomenon with contours shaped by the choices of states as well as firms.

China’s emergence as an irresistibly attractive manufacturing platform was partly due to the sheer size of its working-age population and the falling costs of communication and transportation, but also due to deliberate government policies designed to aid in the acquisition of foreign intellectual property while keeping the cost of land, labor, and capital low and exchange rates favorable.

the migration of manufacturing capacity from the advanced industrial countries reflected not only the profit and loss calculations of individual companies but also the permissive policies of Western governments that concluded in effect (in the U.S. case) that what was good for Apple or 3M was good for the United States.

if it results in excessive dependence, an addiction to low costs can create serious commercial and strategic risks

There are obvious dangers here. Sharpened tools of trade and industrial policy can be abused by irresponsible leaders seeking to pander to voters and pay off supporters, or they may be captured and exploited by special interests.

the planet could see a greater temperature increase in the next 50 years than it did in the last 6,000 years combined. By 2070, the kind of extremely hot zones, like in the Sahara, that now cover less than 1% of the earth’s land surface could cover nearly a fifth of the land, potentially placing 1 of every 3 people alive outside the climate niche where humans have thrived for thousands of years. Many will dig in, suffering through heat, hunger and political chaos, but others will be forced to move on

In Southeast Asia, where increasingly unpredictable monsoon rainfall and drought have made farming more difficult, the World Bank points to more than 8 million people who have moved toward the Middle East, Europe and North America. In the African Sahel, millions of rural people have been streaming toward the coasts and the cities amid drought and widespread crop failures. Should the flight away from hot climates reach the scale that current research suggests is likely, it will amount to a vast remapping of the world’s populations.

Drought helped push many Syrians into cities before the war, worsening tensions and leading to rising discontent; crop losses led to unemployment that stoked Arab Spring uprisings in Egypt and Libya; Brexit, even, was arguably a ripple effect of the influx of migrants brought to Europe by the wars that followed. And all those effects were bound up with the movement of just 2 million people. As the mechanisms of climate migration have come into sharper focus — food scarcity, water scarcity and heat — the latent potential for large-scale movement comes to seem astronomically larger.

Northern nations can relieve pressures on the fastest-warming countries by allowing more migrants to move north across their borders, or they can seal themselves off, trapping hundreds of millions of people in places that are increasingly unlivable. The best outcome requires not only goodwill and the careful management of turbulent political forces; without preparation and planning, the sweeping scale of change could prove wildly destabilizing. The United Nations and others warn that in the worst case, the governments of the nations most affected by climate change could topple as whole regions devolve into war

To better understand the forces and scale of climate migration over a broader area, The New York Times Magazine and ProPublica joined with the Pulitzer Center in an effort to model, for the first time, how people will move across borders

Our model projects that migration will rise every year regardless of climate, but that the amount of migration increases substantially as the climate changes. In the most extreme climate scenarios, more than 30 million migrants would head toward the U.S. border over the course of the next 30 years

If governments take modest action to reduce climate emissions, about 680,000 climate migrants might move from Central America and Mexico to the United States between now and 2050. If emissions continue unabated, leading to more extreme warming, that number jumps to more than a million people. (None of these figures include undocumented immigrants, whose numbers could be twice as high.)

As with much modeling work, the point here is not to provide concrete numerical predictions so much as it is to provide glimpses into possible futures. Human movement is notoriously hard to model, and as many climate researchers have noted, it is important not to add a false precision to the political battles that inevitably surround any discussion of migration. But our model offers something far more potentially valuable to policymakers: a detailed look at the staggering human suffering that will be inflicted if countries shut their doors.

the coronavirus pandemic has offered a test run on whether humanity has the capacity to avert a predictable — and predicted — catastrophe. Some countries have fared better. But the United States has failed. The climate crisis will test the developed world again, on a larger scale, with higher stakes

Climate is rarely the main cause of migration, the studies have generally found, but it is almost always an exacerbating one.

In the case of Addis Ababa, the World Bank suggests that in the second half of the century, many of the people who fled there will be forced to move again, leaving that city as local agriculture around it dries up.

North Africa’s Sahel provides an example. In the nine countries stretching across the continent from Mauritania to Sudan, extraordinary population growth and steep environmental decline are on a collision course. Past droughts, most likely caused by climate change, have already killed more than 100,000 people there. And the region — with more than 150 million people and growing — is threatened by rapid desertification, even more severe water shortages and deforestation. Today researchers at the United Nations estimate that some 65% of farmable lands have already been degraded. “My deep fear,” said Solomon Hsiang, a climate researcher and economist at the University of California, Berkeley, is that Africa’s transition into a post-climate-change civilization “leads to a constant outpouring of people.”

The story is similar in South Asia, where nearly one-fourth of the global population lives. The World Bank projects that the region will soon have the highest prevalence of food insecurity in the world. While some 8.5 million people have fled already — resettling mostly in the Persian Gulf — 17 million to 36 million more people may soon be uprooted, the World Bank found. If past patterns are a measure, many will settle in India’s Ganges Valley; by the end of the century, heat waves and humidity will become so extreme there that people without air conditioning will simply die.

We are now learning that climate scientists have been underestimating the future displacement from rising tides by a factor of three, with the likely toll being some 150 million globally. New projections show high tides subsuming much of Vietnam by 2050 — including most of the Mekong Delta, now home to 18 million people — as well as parts of China and Thailand, most of southern Iraq and nearly all of the Nile Delta, Egypt’s breadbasket. Many coastal regions of the United States are also at risk.

rough predictions have emerged about the scale of total global climate migration — they range from 50 million to 300 million people displaced — but the global data is limited, and uncertainty remained about how to apply patterns of behavior to specific people in specific places.

Once the model was built and layered with both approaches — econometric and gravity — we looked at how people moved as global carbon concentrations increased in five different scenarios, which imagine various combinations of growth, trade and border control, among other factors. (These scenarios have become standard among climate scientists and economists in modeling different pathways of global socioeconomic development.)

every one of the scenarios it produces points to a future in which climate change, currently a subtle disrupting influence, becomes a source of major disruption, increasingly driving the displacement of vast populations.

Around 2012, a coffee blight worsened by climate change virtually wiped out El Salvador’s crop, slashing harvests by 70%. Then drought and unpredictable storms led to what a U.N.-affiliated food-security organization describes as “a progressive deterioration” of Salvadorans’ livelihoods.

climate change can act as what Defense Department officials sometimes refer to as a “threat multiplier.”

For all the ways in which human migration is hard to predict, one trend is clear: Around the world, as people run short of food and abandon farms, they gravitate toward cities, which quickly grow overcrowded. It’s in these cities, where waves of new people stretch infrastructure, resources and services to their limits, that migration researchers warn that the most severe strains on society will unfold

the World Bank has raised concerns about the mind-boggling influx of people into East African cities like Addis Ababa, in Ethiopia, where the population has doubled since 2000 and is expected to nearly double again by 2035

now a little more than half of the planet’s population lives in urban areas, but by the middle of the century, the World Bank estimates, 67% will. In just a decade, 4 out of every 10 urban residents — 2 billion people around the world — will live in slums

Migration can bring great opportunity not just to migrants but also to the places they go

High emissions, with few global policy changes and relatively open borders, will drive rural El Salvador — just like rural Guatemala — to empty out, even as its cities grow. Should the United States and other wealthy countries change the trajectory of global policy, though — by, say, investing in climate mitigation efforts at home but also hardening their borders — they would trigger a complex cascade of repercussions farther south, according to the model. Central American and Mexican cities continue to grow, albeit less quickly, but their overall wealth and development slows drastically, most likely concentrating poverty further. Far more people also remain in the countryside for lack of opportunity, becoming trapped and more desperate than ever.

By midcentury, the U.N. estimates that El Salvador — which has 6.4 million people and is the most densely populated country in Central America — will be 86% urban

Most would-be migrants don’t want to move away from home. Instead, they’ll make incremental adjustments to minimize change, first moving to a larger town or a city. It’s only when those places fail them that they tend to cross borders, taking on ever riskier journeys, in what researchers call “stepwise migration.” Leaving a village for the city is hard enough, but crossing into a foreign land — vulnerable to both its politics and its own social turmoil — is an entirely different trial.

I arrived in Tapachula five weeks after the breakout to find a city cracking in the crucible of migration. Just months earlier, passing migrants on Mexico’s southern border were offered rides and tortas and medicine from a sympathetic Mexican public. Now migrant families were being hunted down in the countryside by armed national-guard units, as if they were enemy soldiers.

Models can’t say much about the cultural strain that might result from a climate influx; there is no data on anger or prejudice. What they do say is that over the next two decades, if climate emissions continue as they are, the population in southern Mexico will grow sharply. At the same time, Mexico has its own serious climate concerns and will most likely see its own climate exodus. One in 6 Mexicans now rely on farming for their livelihood, and close to half the population lives in poverty. Studies estimate that with climate change, water availability per capita could decrease by as much as 88% in places, and crop yields in coastal regions may drop by a third. If that change does indeed push out a wave of Mexican migrants, many of them will most likely come from Chiapas.

even as 1 million or so climate migrants make it to the U.S. border, many more Central Americans will become trapped in protracted transit, unable to move forward or backward in their journey, remaining in southern Mexico and making its current stresses far worse.

Already, by late last year, the Mexican government’s ill-planned policies had begun to unravel into something more insidious: rising resentment and hate. Now that the coronavirus pandemic has effectively sealed borders, those sentiments risk bubbling over. Migrants, with nowhere to go and no shelters able to take them in, roam the streets, unable to socially distance and lacking even basic sanitation. It has angered many Mexican citizens, who have begun to describe the migrants as economic parasites and question foreign aid aimed at helping people cope with the drought in places where Jorge A. and Cortez come from.

a new Mexico-first movement, organizing thousands to march against immigrants

Trump had, as another senior government official told me, “held a gun to Mexico’s head,” demanding a crackdown at the Guatemalan border under threat of a 25% tariff on trade. Such a tax could break the back of Mexico’s economy overnight, and so López Obrador’s government immediately agreed to dispatch a new militarized force to the border.

laying blame at the feet of neoliberal economics, which he said had produced a “poverty factory” with no regional development policies to address it. It was the system — capitalism itself — that had abandoned human beings, not Mexico’s leaders. “We didn’t anticipate that the globalization of the economy, the globalization of the law … would have such a devastating effect,”

No policy, though, would be able to stop the forces — climate, increasingly, among them — that are pushing migrants from the south to breach Mexico’s borders, legally or illegally. So what happens when still more people — many millions more — float across the Suchiate River and land in Chiapas? Our model suggests that this is what is coming — that between now and 2050, nearly 9 million migrants will head for Mexico’s southern border, more than 300,000 of them because of climate change alone.

“If we are going to die anyway,” he said, “we might as well die trying to get to the United States.”

The world can now expect that with every degree of temperature increase, roughly a billion people will be pushed outside the zone in which humans have lived for thousands of years

Without a decent plan for housing, feeding and employing a growing number of climate refugees, cities on the receiving end of migration can never confidently pilot their own economic future.

The United States refused to join 164 other countries in signing a global migration treaty in 2018, the first such agreement to recognize climate as a cause of future displacement. At the same time, the U.S. is cutting off foreign aid — money for everything from water infrastructure to greenhouse agriculture — that has been proved to help starving families like Jorge A.’s in Guatemala produce food, and ultimately stay in their homes. Even those migrants who legally make their way into El Paso have been turned back, relegated to cramped and dangerous shelters in Juárez to wait for the hearings they are owed under law.

There is no more natural and fundamental adaptation to a changing climate than to migrate. It is the obvious progression the earliest Homo sapiens pursued out of Africa, and the same one the Mayans tried 1,200 years ago. As Lorenzo Guadagno at the U.N.’s International Organization for Migration told me recently, “Mobility is resilience.” Every policy choice that allows people the flexibility to decide for themselves where they live helps make them safer.

what may be the worst-case scenario: one in which America and the rest of the developed world refuse to welcome migrants but also fail to help them at home. As our model demonstrated, closing borders while stinting on development creates a somewhat counterintuitive population surge even as temperatures rise, trapping more and more people in places that are increasingly unsuited to human life

the global trend toward building walls could have a profound and lethal effect. Researchers suggest that the annual death toll, globally, from heat alone will eventually rise by 1.5 million. But in this scenario, untold more will also die from starvation, or in the conflicts that arise over tensions that food and water insecurity will bring

America’s demographic decline suggests that more immigrants would play a productive role here, but the nation would have to be willing to invest in preparing for that influx of people so that the population growth alone doesn’t overwhelm the places they move to, deepening divisions and exacerbating inequalities.

At the same time, the United States and other wealthy countries can help vulnerable people where they live, by funding development that modernizes agriculture and water infrastructure. A U.N. World Food Program effort to help farmers build irrigated greenhouses in El Salvador, for instance, has drastically reduced crop losses and improved farmers’ incomes. It can’t reverse climate change, but it can buy time.

Thus far, the United States has done very little at all. Even as the scientific consensus around climate change and climate migration builds, in some circles the topic has become taboo. This spring, after Proceedings of the National Academy of Sciences published the explosive study estimating that, barring migration, one-third of the planet’s population may eventually live outside the traditional ecological niche for civilization, Marten Scheffer, one of the study’s authors, told me that he was asked to tone down some of his conclusions through the peer-review process and that he felt pushed to “understate” the implications in order to get the research published. The result: Migration is only superficially explored in the paper.

Our modeling and the consensus of academics point to the same bottom line: If societies respond aggressively to climate change and migration and increase their resilience to it, food production will be shored up, poverty reduced and international migration slowed — factors that could help the world remain more stable and more peaceful. If leaders take fewer actions against climate change, or more punitive ones against migrants, food insecurity will deepen, as will poverty. Populations will surge, and cross-border movement will be restricted, leading to greater suffering. Whatever actions governments take next — and when they do it — makes a difference.

El Paso is also a place with oppressive heat and very little water, another front line in the climate crisis. Temperatures already top 90 degrees here for three months of the year, and by the end of the century it will be that hot one of every two days. The heat, according to researchers at the University of California, Berkeley, will drive deaths that soon outpace those from car crashes or opioid overdoses. Cooling costs — already a third of some residents’ budgets — will get pricier, and warming will drive down economic output by 8%, perhaps making El Paso just as unlivable as the places farther south.

“If we don’t develop a different attitude,” he said, “we’re going to be like people in the lifeboat, beating on those that are trying to climb in.”

By exploiting governance gaps, terrorists and insurgents gain valuable propaganda victories

by launching public health campaigns and dispensing information and advice on how to avoid being infected, terrorist and insurgent groups can position themselves as a trusted voice on these issues.

Good governance and competent public administration are the best medicine for pandemics and insurgencies alike.