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At least 12 groups are working to develop a vaccine.

European Medicines Agency (EMA), Europe's drugs regulator, said it established an expert task force to advise companies working on Zika vaccines and medicines, mirroring similar action during the two-year-long Ebola epidemic that started in December 2013 and the pandemic flu outbreak in 2009.

There are no vaccines or treatment for Zika and none even undergoing clinical studies. Most infected people either have no symptoms or develop mild ones like fever and skin rashes.

"The good news is this is not like Ebola; people don't die of Zika. A lot of people get it and don't even know that they have it," Obama told CBS News

Most of the money sought by Obama, who faces pressure from Republicans and some fellow Democrats to act decisively on Zika, would be spent in the United States on testing, surveillance and response in affected areas, including the creation of rapid-response teams to contain outbreak clusters.

Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, said she was not expecting "large-scale amounts of serious Zika infections" in the continental United States as warmer months bring larger and more active mosquito populations.

Obama's funding request to Congress includes $335 million for the U.S. Agency for International Development to support mosquito-control, maternal health and other Zika-related public health efforts in affected countries in the Americas.

Fauci said he anticipated beginning a so-called Phase 1 trial this summer for a Zika vaccine that would take about three months to test if it is safe and induces a good immune response before further studies can be conducted.

The CDC said its Zika emergency operations center, with a staff of 300, has been placed on its highest level of activation, reflecting a need for accelerated preparedness for possible local virus transmission by mosquitoes in the continental United States.

Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition marked by abnormally small head size that can result in developmental problems.Brazil is investigating the potential link between Zika infections and more than 4,000 suspected cases of microcephaly. Researchers have identified evidence of Zika infection in 17 of these cases, either in the baby or in the mother, but have not confirmed that Zika can cause microcephaly. 

Word that Zika can be spread by sexual transmission and blood transfusions and its discovery in saliva and urine of infected people have added to concern over the virus.

The World Health Organization declared the outbreak an international health emergency on Feb. 1, citing a "strongly suspected" relationship between Zika infection in pregnancy to microcephaly.

Brazil is grappling with the virus even as it prepares to host the Olympic Games in Rio de Janeiro in August, with tens of thousands of athletes and tourists anticipated.The U.S. Olympic Committee has told U.S. sports federations that athletes and staff concerned about their health due to Zika should consider not going to the Olympics.

Former Olympian Donald Anthony, president and board chairman of USA Fencing, said, "One of the things that they immediately said was, especially for women that may be pregnant or even thinking of getting pregnant, that whether you are scheduled to go to Rio or no, that you shouldn't go."

Chan, whose agency was assailed as too slow in reacting to West Africa's Ebola epidemic that killed more than 10,000 people in the past two years, cited "first and foremost the big concern about microcephaly," the birth defect that causes babies to be born with abnormally small heads and improperly developed brains.

U.S. Centers for Disease Control and Prevention (CDC) head Thomas Frieden said the WHO emergency declaration "calls the world to action" on Zika. The CDC added four more countries and territories to its list of locales that pose a risk for Zika infection, advising pregnant women to consider avoiding travel to those areas.

Brazil is due to host the Olympics in Rio de Janeiro in August, and President Dilma Rousseff's chief of staff said on Monday there is no risk of cancelling the games due to Zika.

The emergency designation, recommended by a committee of independent experts following criticism of a hesitant response to Zika so far, should help fast-track international action and research priorities. The move lends official urgency to research funding and other steps to stem the spread of the virus.

This marks the fourth time the WHO has declared a global health emergency since such procedures were put in place in 2007, with the others arising from influenza, Ebola and polio.

The Zika virus has raised questions worldwide about whether pregnant women should avoid infected countries. Chan said delaying travel was something pregnant women "can consider" but added that if they needed to travel they should take protective measures by covering up and using mosquito repellent.

Brazil has reported some 3,700 suspected cases of microcephaly. Brazilian Health Minister Marcelo Castro told Reuters the epidemic was worse than believed because in 80 percent of cases the infected people had no symptoms.

As the virus spreads from Brazil, other countries in the Americas are also likely to see cases of babies with Zika-linked birth defects, experts believe. The clinical symptoms of Zika are usually mild and often similar to dengue, which is transmitted by the same mosquito, leading to fears that Zika will spread into all parts of the world where dengue is commonplace.

More than a third of the world’s population lives in areas at risk of dengue infection, in a band stretching through Africa, India, Southeast Asia and Latin America.Zika's rapid spread in Latin America is attributed to the prevalence of Aedes aegypti and a lack of immunity among the population.

A senior Obama administration official, speaking on condition of anonymity, said, "This is not an Ebola-type situation where you have to stop people at the border."

New York State Governor Andrew Cuomo said the state's health department would offer free tests for individuals with symptoms of infection who have traveled to countries impacted by Zika.

The announcement may increase pressure on Congress to allocate more than $1.8 billion in emergency funding that President Obama requested for prevention and treatment of the outbreak

About 700 people in the United States have been infected with the Zika virus as of last week, including 69 pregnant women, Dr. Anne Schucat, the deputy director of the C.D.C., said on Monday at a White House briefing. About half of the cases are in Puerto Rico, where the virus is circulating locally.

C.D.C. officials said they were not ready to confirm that Zika can cause neurological conditions in adults, including Guillain-Barre syndrome, cases of which have increased in some countries in the Zika outbreak.

Beyond microcephaly, Dr. Rasmussen said, the authors concluded that Zika causes some other fetal brain problems, such as calcifications inside the skull.

The scientific link between Zika and infant brain damage has not yet been proven. But the rising reports of microcephaly in parts of Brazil stricken by Zika have caused enough alarm that the World Health Organization declared an international public health emergency on Monday, noting that its “experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected.”

“They come to my office and ask, ‘Is there a chance for my baby to have microcephaly?’”

Dr. Timerman said. “We need to inform them there is. They ask if the chance is big or small. I respond, ‘I don’t know.’ They ask what I would do in their position. I tell them it’s a personal decision, only that the chance is a real one.”

“Later,” Dr. Timerman said, “both patients told me they had abortions.”

“With microcephaly, the child is already very much formed and the parents are conscious of this

“Getting an abortion creates guilt that will stay with the woman for the rest of her life.”

I know this is very difficult because the subject is new, requires thorough discussion and a great deal of religious influences persists,” said Mr. Coelho de Alcântara, a judge in Goiás State. “But my position is that abortion for microcephaly should be allowed.”

“Some children with severe-appearing brain malformations seem to be relatively unaffected,” said Dr. Hannah M. Tully, a neurologist at Seattle Children’s Hospital who specializes in brain malformations. “Yet others with relatively minor structural problems may have profound disabilities.”

El Salvador’s Health Ministry is particularly concerned about the rise of cases of Guillain-Barré syndrome, which leads to paralysis, usually temporary; researchers are exploring a possible link between Guillain-Barré and Zika. Forty-six suspected cases of the syndrome had been reported as of last week, Violeta Menjívar, the health minister, said in a radio interview.

virus has appeared in only three Mexican states. The mosquitoes that carry the virus, he said, could not survive in the high altitudes of the central plateau, including Mexico City.“I think it’s good to have these warnings,” he said, “but these things should be explained to people.”

Their model for Zika’s possible spread, using worldwide temperature profiles and air travel routes, also determined that more than 60 percent of the population in the United States lives in areas conducive to seasonal Zika transmission. And about 23 million people in the United States live in places with climates like Florida and parts of Texas where Zika can be transmitted by mosquitoes year-round, the researchers said.The authorities in Brazil insist that they are taking steps to fight Zika, including vaccine research.

There is no vaccine against the Zika virus. Efforts to make one have just begun, and creating and testing a vaccine normally takes years and costs hundreds of millions of dollars.

The virus was first identified in 1947 in Uganda, and for years lived mostly in monkeys. But last May in Brazil, cases began increasing drastically. The W.H.O. has estimated that four million people could be infected by the end of the year.

A New York Times investigation in Brazil found that, time and again, videos promoted by the site have upended central elements of daily life

YouTube’s recommendation system is engineered to maximize watchtime, among other factors, the company says, but not to favor any political ideology.

Some parents look to “Dr. YouTube” for health advice but get dangerous misinformation instead, hampering the nation’s efforts to fight diseases like Zika. Viral videos have incited death threats against public health advocates.

And in politics, a wave of right-wing YouTube stars ran for office alongside Mr. Bolsonaro, some winning by historic margins. Most still use the platform, governing the world’s fourth-largest democracy through internet-honed trolling and provocation

Teachers describe classrooms made unruly by students who quote from YouTube conspiracy videos or who, encouraged by right-wing YouTube stars, secretly record their instructors

But the emotions that draw people in — like fear, doubt and anger — are often central features of conspiracy theories, and in particular, experts say, of right-wing extremism

As the system suggests more provocative videos to keep users watching, it can direct them toward extreme content they might otherwise never find. And it is designed to lead users to new topics to pique new interest

The system now drives 70 percent of total time on the platfor

Zeynep Tufekci, a social media scholar, has called it “one of the most powerful radicalizing instruments of the 21st century.”

Danah Boyd, founder of the think tank Data & Society, attributed the disruption in Brazil to YouTube’s unrelenting push for viewer engagement, and the revenues it generates.

Maurício Martins, the local vice president of Mr. Bolsonaro’s party in Niterói, credited “most” of the party’s recruitment to YouTube — including his own.

“Before that, I didn’t have an ideological political background,” Mr. Martins said. YouTube’s auto-playing recommendations, he declared, were “my political education.”

“It was like that with everyone,”

Sometimes I’m watching videos about a game, and all of a sudden it’s a Bolsonaro video,”

More and more, his fellow students are making extremist claims, often citing as evidence YouTube stars like Mr. Moura, the guitarist-turned-conspiracist.

“If social media didn’t exist, I wouldn’t be here,” he said. “Jair Bolsonaro wouldn’t be president.”

In the months after YouTube changed its algorithm, positive mentions of Mr. Bolsonaro ballooned. So did mentions of conspiracy theories that he had floated. This began as polls still showed him to be deeply unpopular, suggesting that the platform was doing more than merely reflecting political trends.

Jonas Kaiser and Yasodara Córdova, with Adrian Rauchfleisch of National Taiwan University, programmed a Brazil-based server to enter a popular channel or search term, then open YouTube’s top recommendations, then follow the recommendations on each of those, and so on.

By repeating this thousands of times, the researchers tracked how the platform moved users from one video to the next. They found that after users watched a video about politics or even entertainment, YouTube’s recommendations often favored right-wing, conspiracy-filled channels like Mr. Moura’s

Crucially, users who watched one far-right channel would often be shown many more.

The algorithm had united once-marginal channels — and then built an audience for them

One of those channels belonged to Mr. Bolsonaro, who had long used the platform to post hoaxes and conspiracies

The conspiracies were not limited to politics. Many Brazilians searching YouTube for health care information found videos that terrified them: some said Zika was being spread by vaccines, or by the insecticides meant to curb the spread of the mosquito-borne disease that has ravaged northeastern Brazi

The videos appeared to rise on the platform in much the same way as extremist political content: by making alarming claims and promising forbidden truths that kept users glued to their screens.

Doctors, social workers and former government officials said the videos had created the foundation of a public health crisis as frightened patients refused vaccines and even anti-Zika insecticides.

Not long after YouTube installed its new recommendation engine, Dr. Santana’s patients began telling him that they’d seen videos blaming Zika on vaccines — and, later, on larvicides. Many refused both.

Medical providers, she said, were competing “every single day” against “Dr. Google and Dr. YouTube” — and they were losing

Brazil’s medical community had reason to feel outmatched. The Harvard researchers found that YouTube’s systems frequently directed users who searched for information on Zika, or even those who watched a reputable video on health issues, toward conspiracy channels

As the far right rose, many of its leading voices had learned to weaponize the conspiracy videos, offering their vast audiences a target: people to blame

Eventually, the YouTube conspiracists turned their spotlight on Debora Diniz, a women’s rights activist whose abortion advocacy had long made her a target of the far right

Bernardo Küster, a YouTube star whose homemade rants had won him 750,000 subscribers and an endorsement from Mr. Bolsonaro, accused her of involvement in the supposed Zika plots.

As far-right and conspiracy channels began citing one another, YouTube’s recommendation system learned to string their videos together

However implausible any individual rumor might be on its own, joined together, they created the impression that dozens of disparate sources were revealing the same terrifying truth.

When the university where Ms. Diniz taught received a warning that a gunman would shoot her and her students, and the police said they could no longer guarantee her safety, she left Brazil.

“The YouTube system of recommending the next video and the next video,” she said, had created “an ecosystem of hate.

“‘I heard here that she’s an enemy of Brazil. I hear in the next one that feminists are changing family values. And the next one I hear that they receive money from abroad” she said. “That loop is what leads someone to say ‘I will do what has to be done.’

In Brazil, this is a growing online practice known as “linchamento” — lynching. Mr. Bolsonaro was an early pioneer, spreading videos in 2012 that falsely accused left-wing academics of plotting to force schools to distribute “gay kits” to convert children to homosexuality.

Mr. Jordy, his tattooed Niterói protégé, was untroubled to learn that his own YouTube campaign, accusing teachers of spreading communism, had turned their lives upside down.One of those teachers, Valeria Borges, said she and her colleagues had been overwhelmed with messages of hate, creating a climate of fear.

Mr. Jordy, far from disputing this, said it had been his goal. “I wanted her to feel fear,” he said

The group’s co-founder, a man-bunned former rock guitarist name Pedro D’Eyrot, said “we have something here that we call the dictatorship of the like.”

Reality, he said, is shaped by whatever message goes most viral.

Even as he spoke, a two-hour YouTube video was captivating the nation. Titled “1964” for the year of Brazil’s military coup, it argued that the takeover had been necessary to save Brazil from communism.Mr. Dominguez, the teenager learning to play guitar, said the video persuaded him that his teachers had fabricated the horrors of military rule.

. Its economy has not grown in over a decade, and there is a $28 billion gap in funding over the next five years alone.

Public hospitals and health-care facilities may close, exacerbating an ongoing crisis that already sees Puerto Rican patients receiving far worse health care than their mainland counterparts.

Puerto Rico has attempted to solve its debt issues by granting itself bankruptcy powers under rules that grant service providers in the states the ability to seek relief, but that decision remains under Supreme Court review and has been opposed in no uncertain terms by the federal government.

The plan also exempts Puerto Rican workers under 25 years old from the labor protections of a federally-mandated minimum wage and overtime regulation, with the goal of making Puerto Rico’s job market more competitive in comparison to its neighbors.

Representatives of those who hold the territory’s general obligation bonds oppose the bill as well, because it would allow Puerto Rico to restructure its debts and delay payment, as well as limit the ability of bondholders to sue if it defaults.

In 1984 Congress specifically carved Puerto Rico out from Chapter 9 municipal bankruptcy protections that it once had, offering no reason for singling out the territory.

Also in 1996, Congress passed legislation to phase out Section 936 of the federal tax code, a law that exempted U.S. industries from taxes on income in Puerto Rico. With no replacement plan to promote development or growth, Puerto Rico’s economy suffered.

The Medicaid underpayment deficit alone accounts for almost one-fifth of the current total deficit in the territory. A legislative medical-funding scheme could both help right the financial ship in Puerto Rico and help its crippled health-care system face the siege of Zika.

Granted, the government of Puerto Rico is not blameless in this saga. Its public-services monopolies are extraordinarily inefficient; the territorial government has not been good with spending, budgeting, or long-term fiscal planning; and the two major parties––for statehood and the status quo––have supported some congressional reforms with the goal of forcing the other side’s hand, instead of promoting good governance.

Congress’s dysfunctions might run so deep that they keep it from even addressing a humanitarian crisis in the country, a total failure of the body’s special duty towards Puerto Rico. Congress’s current plan might provide short-term relief, but it is a bit of a Hobson’s choice.

“Never before have so many opportunities existed for pathogens to pass from wild and domestic animals to people,” she told the Guardian, explaining that 75% of all emerging infectious diseases come from wildlife.“Our continued erosion of wild spaces has brought us uncomfortably close to animals and plants that harbour diseases that can jump to humans.”

“There are too many pressures at the same time on our natural systems and something has to give,” she added. “We are intimately interconnected with nature, whether we like it or not. If we don’t take care of nature, we can’t take care of ourselves. And as we hurtle towards a population of 10 billion people on this planet, we need to go into this future armed with nature as our strongest ally.”

Human infectious disease outbreaks are rising and in recent years there have been Ebola, bird flu, Middle East respiratory syndrome (Mers), Rift Valley fever, sudden acute respiratory syndrome (Sars), West Nile virus and Zika virus all cross from animals to humans.

Cunningham said other diseases from wildlife had much higher fatality rates in people, such as 50% for Ebola and 60%-75% for Nipah virus, transmitted from bats in south Asia. “Although, you might not think it at the moment, we’ve probably got a bit lucky with [Covid-19],” he said. “So I think we should be taking this as a clear warning shot. It’s a throw of the dice.”

“The animals have been transported over large distances and are crammed together into cages. They are stressed and immunosuppressed and excreting whatever pathogens they have in them,” he said. “With people in large numbers in the market and in intimate contact with the body fluids of these animals, you have an ideal mixing bowl for [disease] emergence. If you wanted a scenario to maximise the chances of [transmission], I couldn’t think of a much better way of doing it.”

Aaron Bernstein, at the Harvard School of Public Health in the US, said the destruction of natural places drives wildlife to live close to people and that climate change was also forcing animals to move: “That creates an opportunity for pathogens to get into new hosts.”

The billion-dollar illegal wildlife trade is another part of the problem, said John Scanlon, the former secretary general of the Convention on International Trade of Endangered Species of Wild Fauna and Flora.

The Covid-19 crisis may provide an opportunity for change, but Cunningham is not convinced it will be taken: “I thought things would have changed after Sars, which was a massive wake up call – the biggest economic impact of any emerging disease to that date,” he said.

This narrative – that "others," often from far-flung places, are to blame for epidemics – is a dramatic example of a long tradition of hatred. In 14th-century Europe, Jewish communities were wrongfully accused of poisoning wells to spread the Black Death. In 1900, Chinese people were unfairly vilified for an outbreak of the plague in San Francisco's Chinatown. And in the '80s, Haitians were blamed for bringing HIV/AIDS to the U.S., a theory that's considered unsubstantiated by many global health experts.

Some public health practitioners say the global health system is partially responsible for perpetuating these ideas.According to Abraar Karan, a doctor at the Brigham and Women's Hospital and Harvard Medical School, the notion persists in global health that "the West is the best." This led to an assumption early on in the pandemic that COVID-19 spread to the rest of the world because China wasn't able to control it.

China's response was not without fault. The government's decision to silence doctors and not warn the public about a likely pandemic for six days in mid-January caused more than 3,000 people to become infected within a week, according to a report by the Associated Press, and created ripe conditions for global spread. Some of the aggressive measures China took to control the epidemic – confining people to their homes, for example — have been described as "draconian" and a violation of civil rights, even if they ultimately proved effective.

But it soon became clear that assumptions about the superiority of Western health systems were false when China and other Asian countries, along with many African countries, controlled outbreaks far more effectively and faster than Western countries did, says Karan.

Some politicians, including former President Donald Trump publicly blamed China for the pandemic, calling this novel coronavirus the "Chinese Virus" or the "Wuhan Virus." They consistently pushed that narrative even after the World Health Organization (WHO) warned as early as March 2020, when the pandemic was declared, that such language would encourage racial profiling and stigmatization against Asians. Trump has continued to use stigmatizing language in the wake of the Atlanta shooting, using the phrase "China virus" during a March 16 call to Fox News.

A report by researchers at the University of California at San Francisco (UCSF), released this month, directly linked Trump's first tweet about a "Chinese virus" to a significant increase in anti-Asian hashtags. According to a separate report by the Center for the Study of Hate and Extremism, anti-Asian hate crimes in 16 U.S. cities increased 149 percent in 2020, from 49 to 122.

Suspicion tends to manifest more during times of vulnerability, like in wartime or during a pandemic, says ElsaMarie D'Silva, an Aspen Institute New Voices fellow from India who studies violence and harassment issues. It just so happened that COVID-19 was originally identified in China, but, as NPR's Jason Beaubien has reported, some of the early clusters of cases elsewhere came from jet setters who traveled to Europe and ski destinations.

Karan says we also need to shift our approach to epidemics. In the case of COVID-19 and other outbreaks, Western countries often think of them as a national security issue, closing borders and blaming the countries where the disease was first reported. This approach encourages stigmatization, he says.

In the early days of COVID-19, skepticism by Western public health officials about the efficacy of Asian mask protocols hindered the U.S.'s ability to control the pandemic. Additionally, stereotypes about who was and wasn't at risk had significant consequences, says Nancy Kass, deputy director for public health at the Johns Hopkins Berman Institute of Bioethics.

According to Kass, doctors initially only considered a possible COVID-19 diagnosis among people who had recently flown back from China. That narrow focus caused the U.S. to misdiagnose patients who presented with what we now call classic COVID symptoms simply because they hadn't traveled from China.

It's reminiscent of the HIV/AIDS epidemic in the 1980s, Kass says. Because itwas so widely billed as a "gay disease," there are many documented cases of heterosexual women who presented with symptoms but weren't diagnosed until they were on their deathbeds.

That's not to say that we should ignore facts and patterns about new diseases. For example, Kass says it's appropriate to warn pregnant women about the risks of traveling to countries where the Zika virus, which is linked to birth and developmental defects, is present.

But there's a difference, she says, between making sure people have enough information to understand a disease and attaching a label, like "Chinese virus," that is inaccurate and that leads to stereotyping.

the West is usually regarded as the hub of expertise and knowledge, says Sriram Shamasunder, an associate professor of medicine at UCSF, and there's a sense among Western health workers that epidemics occur in impoverished contexts because the people there engage in primitive behaviors and just don't care as much about health.

Instead, Karan suggests reframing the discussion to focus on global solidarity, which promotes the idea that we are all in this together. One way for wealthy countries to demonstrate solidarity now, Karan says, is by supporting the equitable and speedy distribution of vaccines among countries globally as well as among communities within their own borders.Without such commitments in place, "it prompts the question, whose lives matter most?" says Shamasunder.

Ultimately, the global health community – and Western society as a whole – has to discard its deep-rooted mindset of coloniality and tendency to scapegoat others, says Hswen. The public health community can start by talking more about the historic racism and atrocities that have been tied to diseases.

Additionally, Karan says, leaders should reframe the pandemic for people: Instead of blaming Asians for the virus, blame the systems that weren't adequately prepared to respond to a pandemic.

Although WHO has had specific guidance since 2015 about not naming diseases after places, Hswen says the public health community at large should have spoken out earlier and stronger last year against racialized language and the ensuing violence. She says they should have anticipated the backlash against Asians and preempted it with public messaging and education about why neutral terms like "COVID-19" should be used instead of "Chinese virus."

The result was a perfect storm: A U.S. government not well prepared for a pandemic, run by a president who was slow to act after his intelligence community and public health advisers were warning about the dangers.

U.S. government over 20 years of successive administrations and Congresses failed to heed the warnings by taking basic steps that would have made it easier to quickly respond to a fast spreading and lethal pathogen. They didn't set up and fund a large volunteer medical reserve corps, for example, or build surplus hospital capacity, or create a system to quickly produce and deploy virus tests.

elected officials from both parties have never fully geared up for the biological threat, former officials and public health experts told NBC News. Each new White House deprioritized the issue, only to elevate it later after some defining event led to a presidential revelation. They then belatedly scrambled to respond with ambitious plans and initiatives, which faded after a few years.

"Here's the problem: In 10 years, if there's no pandemic, then everybody starts getting a bit relaxed," said Michael Leavitt, a former Utah governor who served as secretary of Health and Human Services in the Bush administration.

officials deserved "at least a B-plus," and Mount Sinai virologist Peter Palese called the overall response "excellent." Republicans in Congress praised the CDC for developing a vaccine in six months.

But after 9/11 and the subsequent anthrax attacks, the newly created Department of Homeland Security hired Bernard back, with added staff, to run a bio-preparedness unit.

After Bush read a book about the 1918 influenza pandemic in 2005, he forced his administration to double down on pandemic preparation, replenishing the stockpile and creating an early warning system.

When President George W. Bush took office in 2001, Bernard wrote a transition memo. He soon learned the Bush team had eliminated his job as White House biodefense czar.

When Ebola erupted in Africa in 2014, Obama brought in an outsider, Ron Klain, to run the federal response. The effort was widely praised, as was Obama's response to the 2016 Zika virus outbreak. But afterward, the Obama administration failed to fully replenish the federal stockpiles, according to research by ProPublica and USA Today.

Under Obama and a mostly Republican-controlled Congress, public health spending declined. Per capita public health spending, adjusted for inflation, rose from $39 in 1960 to $281 in 2008, and fell by 9.3 percent from 2008 to 2016, according to a 2016 study published in the American Journal of Public Health. It has fallen further under the Trump administration, records show.

During the transition from Obama to Trump, Obama officials conducted a tabletop exercise based on a pandemic with incoming Trump aides. But in his second year as president, Trump fired his top official in charge of pandemic response, Tom Bossert, and did not replace him. Trump then allowed his national security adviser to disband the NSC's global health unit. As a result, when alerts about coronavirus began to emanate from the intelligence and public health communities, there was no senior official in the White House to coordinate a response.

"Every administration has at some point in time gotten religion and realized there is a program and dusted it off and used it," Clarke told NBC News."Except this one."

"The disease-causing microbes of the planet," wrote Garrett, "far from having been defeated, [are] posing ever greater threats to humanity."

The exercise predicted many of the problems besetting the coronavirus response – confused lines of authority, shortages of medical gear, controversies over social distancing.

They failed to set up a system that would insure the rapid deployment of tests for a novel virus. And they failed to replenish a federal stockpile that hospital officials say is both insufficiently stocked and rife with defective gear.

Those failures — and the late start on gear purchases by the Trump administration — have severely hampered the U.S. response to coronavirus, said Scott Gottlieb, who ran the FDA from 2017 to 2019.

"In no way, shape or form can anyone say that we weren't warned, that the information wasn't available and shared with them," he said. "We've known about the risk of pandemics, and war gamed them literally going back some 30 years."

Alejandro Mayorkas, who was a deputy secretary in the Department of Homeland Security during the Obama administration, is the first Latino and immigrant nominated as DHS secretary

Mayorkas was born in Havana, Cuba, and his family fled as political refugees to Miami.

he worked on the development and implementation of the Deferred Action for Childhood Arrivals program and headed the department's response to the Ebola and Zika health crises.

Avril Haines is tapped to serve as director of national intelligence, and if confirmed, she would become the first woman to lead the intelligence community.

She previously was deputy national security adviser and deputy director of the CIA, the first woman to hold the position

Additionally, former Secretary of State John Kerry, who led the negotiations over the Paris climate accords, has been named as special presidential envoy for climate to sit on the National Security Council. It will be the first time the NSC has included a member solely devoted to the issue of climate change.

Jake Sullivan, another close Biden aide, has been announced for the position of national security adviser in the new administration.

Sullivan previously was the former vice president's national security adviser and worked at the State Department under Hillary Clinton.

Linda Thomas-Greenfield for the position of U.S. ambassador to the United Nations. The role would mark Thomas-Greenfield's return to public service after retiring from her 35-year career with the Foreign Service in 2017.

Biden is elevating the ambassadorship to a Cabinet-level position. The announcement also puts a Black woman in a highly visible role.

The staffing announcements come after reporting that Biden had selected longtime adviser Antony Blinken for the coveted secretary of state post. Blinken was deputy secretary of state and deputy national security adviser under President Barack Obama.

Four of the six roles require Senate confirmation, with Sullivan's and Kerry's positions not needing such a vote.

"These individuals are equally as experienced and crisis-tested as they are innovative and imaginative," Biden said in a statement.

they also reflect the idea that we cannot meet the profound challenges of this new moment with old thinking and unchanged habits — or without diversity of background and perspective. It's why I've selected them."

And dozens of House Democrats are urging Biden to name their colleague, Rep. Deb Haaland, as interior secretary. She would be the first Native American Cabinet secretary in U.S. history.

Even before the pandemic struck, local public health agencies had lost almost a quarter of their overall workforce since 2008 — a reduction of almost 60,000 workers

The agencies’ main source of federal funding — the Centers for Disease Control and Prevention’s emergency preparedness budget — had been cut 30 percent since 2003. The Trump administration had proposed slicing even deeper.

According to David Himmelstein of the CUNY School of Public Health, global consensus is that, at minimum, 6 percent of a nation’s health spending should be devoted to public health efforts. The United States, he said, has never spent more than half that much.

the problems have been left to fester.

Delaware County, Pa., a heavily populated Philadelphia suburb, did not even have a public health department when the pandemic struck and had to rely on a neighbor to mount a response.

With plunging tax receipts straining local government budgets, public health agencies confront the possibility of further cuts in an economy gutted by the coronavirus. It is happening at a time when health departments are being asked to do more than ever.

While the country spends roughly $3.6 trillion every year on health, less than 3 percent of that spending goes to public health and prevention

“That’s the way we run much of our public health activity for local health departments. You apply to the CDC, which is the major conduit for federal funding to state and local health departments,” Himmelstein said. “You apply to them for funding for particular functions, and if you don’t get the grant, you don’t have the funding for that.”

Compared with Canada, the United Kingdom and northern European countries, the United States — with a less generous social safety net and no universal health care — is investing less in a system that its people rely on more.

Himmelstein said that the United States has never placed much emphasis on public health spending but that the investment began to decline even further in the early 2000s. The Great Recession fueled further cuts.

Plus, the U.S. public health system relies heavily on federal grants.

“Why an ongoing government function should depend on episodic grants rather than consistent funding, I don’t know,” he added. “That would be like seeing that the military is going to apply for a grant for its regular ongoing activities.”

Many public health officials say a lack of a national message and approach to the pandemic has undermined their credibility and opened them up to criticism.

Few places were less prepared for covid-19’s arrival than Delaware County, Pa., where Republican leaders had decided they did not need a public health department at all

“I think the general population didn’t really realize we didn’t have a health department. They just kind of assumed that was one of those government agencies we had,” Taylor said. “Then the pandemic hit, and everyone was like, ‘Wait, hold on — we don’t have a health department? Why don’t we have a health department?’ ”

Taylor and other elected officials worked out a deal with neighboring Chester County in which Delaware County paid affluent Chester County’s health department to handle coronavirus operations for both counties for now.

One reason health departments are so often neglected is their work focuses on prevention — of outbreaks, sexually transmitted diseases, smoking-related illnesses. Local health departments describe a frustrating cycle: The more successful they are, the less visible problems are and the less funding they receive. Often, that sets the stage for problems to explode again — as infectious diseases often do.

It has taken years for many agencies to rebuild budgets and staffing from deep cuts made during the last recessio

During the past decade, many local health departments have seen annual rounds of cuts, punctuated with one-time infusions of money following crises such as outbreaks of Zika, Ebola, measles and hepatitis. The problem with that cycle of feast or famine funding is that the short-term money quickly dries up and does nothing to address long-term preparedness.

“It’s a silly strategic approach when you think about what’s needed to protect us long term,”

She compared the country’s public health system to a house with deep cracks in the foundation. The emergency surges of funding are superficial repairs that leave those cracks unaddressed.

“We came into this pandemic at a severe deficit and are still without a strategic goal to build back that infrastructure. We need to learn from our mistakes,”

With the economy tanking, the tax bases for cities and counties have shrunken dramatically — payroll taxes, sales taxes, city taxes. Many departments have started cutting staff. Federal grants are no sure thing.

80 percent of counties have reported their budget was affected in the current fiscal year because of the crisis. Prospects are even more dire for future budget periods, when the full impact of reduced tax revenue will become evident.

Christine Hahn, medical director for Idaho’s division of public health and a 25-year public health veteran, has seen the state make progress in coronavirus testing and awareness. But like so many public health officials across the country taking local steps to deal with what has become a national problem, she is limited by how much government leaders say she can do and by what citizens are willing to do.

“I’ve been through SARS, the 2009 pandemic, the anthrax attacks, and of course I’m in rural Idaho, not New York City and California,” Hahn said. “But I will say this is way beyond anything I’ve ever experienced as far as stress, workload, complexity, frustration, media and public interest, individual citizens really feeling very strongly about what we’re doing and not doing.”

At the same time, many countries that invest more in public health infrastructure also provide universal medical coverage that enables them to provide many common public health services as part of their main health-care-delivery system.

“People locally are looking to see what’s happening in other states, and we’re constantly having to talk about that and address that,”

“I’m mindful of the credibility of our messaging as people say, ‘What about what they’re doing in this place? Why are we not doing what they’re doing?’ ”

Many health experts worry the challenges will multiply in the fall with the arrival of flu season.

“The unfolding tragedy here is we need people to see local public health officials as heroes in the same way that we laud heart surgeons and emergency room doctors,” Westergaard, the Wisconsin epidemiologist, said. “The work keeps getting higher, and they’re falling behind — and not feeling appreciated by their communities.”

Dogged by skepticism and inconsistent funding, these coronavirus researchers were stymied from developing treatments and vaccines for SARS—many of which could have been helpful in the current crisis.

Another similarly affected researcher was Brenda Hogue, a virologist at Arizona State University in Tempe. Hogue had devoted her career to studying coronaviruses, focusing on the protein machinery that drives their assembly. After SARS, she and her colleagues turned part of their attention toward developing a vaccine. But when the funding dropped off in 2008, she said, the vaccine went into limbo “and we put our efforts into other directions.”

to some experts whose business it is to hunt potential pathogens before they spill over into human populations, the many years spent not girding for a serious coronavirus outbreak were tragically—and unnecessarily—wasted.

“We were out there on the ground after SARS, working on coronaviruses with Chinese colleagues in collaboration,” said Peter Daszak, president of the EcoHealth Alliance, a New York–based nonprofit group that took part in a large federally funded effort, called Predict, to hunt for new pandemic viruses in wildlife in 31 countries, including China. That program was famously defunded last fall, just before the SARS-CoV-2 outbreak began.

“But we were the only group of western scientists,” Daszak added. “How can we be the only people looking for these viruses when there was such a clear and present danger?”

when SARS emerged in late 2002, there was initially “general disbelief among medical people that a coronavirus could be the basis of such a huge outbreak.”

As that epidemic spread, an influx of new researchers crowded the field. More grants were awarded, and funding started to climb. “Everyone wanted to know where the virus had come from,” said Ralph Baric, a microbiologist at the University of North Carolina’s Gillings School of Global Public Health. Initial findings pointed to wild civets and raccoon dogs sold for meat and pelts, respectively, in Chinese markets. Later evidence began to implicate horseshoe bats as the original source of the infections. Some researchers whose pre-SARS careers had been grounded in basic coronavirus biology began working on therapies and vaccines—and they made steady progress for several years.

funding declines hobbled individual investigators who weren’t part of these larger consortia. Pharmaceutical companies that develop vaccines and therapies scaled back on coronavirus research, too. Within a few years after the SARS outbreak, public health funding agencies both in the United States and abroad “no longer regarded coronaviruses as a high public health threat compared to other diseases,” Saif wrote in an email.

Then on May 12, The Wall Street Journal reported that the Chinese government was responding in kind, “by stalling international efforts to find the source of the [SARS-CoV-2] virus amid an escalating U.S. push to blame China for the pandemic.”

To demonstrate that a particular virus is actually harmful to people, scientists need to isolate and culture the microbe and show it infects human cells in the lab

Led by virologist Zheng-Li Shi, the Wuhan team reported in 2013 that this particular virus, called WIV1, binds with ACE2 in civet and human cells, and then replicates efficiently inside them. “That was the red flag,” Saif said. Earlier evidence suggested that direct contact with these bats could lead to viral spillover in humans. “Now there was proof of that.”

hen cases of those diseases fell off, public-health responders shifted to other viral emergencies such as Ebola and Zika, and coronavirus research funding dropped sharply.

They created a hybrid microbe by attaching the spike protein from SHC014 to the genetic backbone of a SARS-like virus that was previously adapted to grow in mice. Called a chimera—an organism containing cells with more than one genotype—this lab-made microbe had no problem binding with ACE2 and infecting human cells. Baric’s research team concluded that like WIV1, any SARS-like viruses outfitted with the SHC014 spike could pose cross-species threats to people.

Baric acknowledged the risky nature of the research but emphasized the safety protocols. “In general, we don’t know the transmissibility or virulence potential of any bat viruses or chimeras,” Baric said in an email message. “Hence it’s best to keep and work with them under biosafety level 3 laboratory conditions to maximize safety.”

Baric also pointed out that a chimera would display a genetic signature “that says what it is.” The adjoining parts of a chimera segregate discreetly in a logical pattern.

A genetic analysis of the chimera produced in his lab, for instance, “would come out to be mouse-adapted SARS everywhere but the spike, which is SHC014.” Similar logical patterns are absent in SARS-CoV-2, indicating that the virus that causes COVID-19 evolved naturally.

ven as Baric and others were generating lab evidence that more SARS-like viruses were poised for human emergence, another outbreak—in pigs, not people—provided another strong and recent signal: Some 25,000 piglets were killed by a coronavirus in the Guangdong province of China, starting in 2016. That virus, too, was found in horseshoe bats, and Buchmeier described the outbreak as both a major cross-species spillover and a warning shot that was never really picked up by the broader public-health community.

The EcoHealth Alliance, which had been part of the Predict effort, maintained its own collaboration with the Wuhan Institute of Virology using funds supplied by the National Institutes of Health. But on April 24, the Trump administration—which is investigating whether SARS-CoV-2 escaped accidentally from the Wuhan Institute, an allegation that’s been broadly discredited—directed the NIH to cut off that support.

The bats had been trapped in a cave in Kunming, the capital of the Yunnan province. At least seven other SARS-like strains were present in that same colony, leading the researchers to speculate that bat coronaviruses remained “a substantial global threat to public health.”

To disease experts, the bickering is a worrying—perhaps even astonishing—indicator that at least some global leaders still aren’t hearing what they have to say about the threat of coronaviruses, and Baric asserted that the ongoing pandemic exposes the need for better communication between countries, not less. “That is absolutely key,” he said. “Critical information needs to be passed as quickly as possible.”

Many other warnings would follow.Indeed, evidence of a looming and more deadly coronavirus pandemic had been building for years. Yet experts who specialize in coronaviruses—a large family of pathogens, found especially in birds and mammals, that can cross over to humans from other mammals and cause varying degrees of illness—struggled to convince a broader audience of the risk

the number of coronavirus-research grants funded by the National Institutes of Health—which had increased from a low of 28 in 2002 to a peak of 103 in 2008—went into a tailspin.

Though support for coronavirus research spiked a bit with the MERS outbreak in 2012, the increase was short-lived. Since that outbreak was quickly contained, the disease didn’t raise wider concerns and grant opportunities declined further.

Ironically, just as funding for drugs and vaccines was drying up, evidence that other coronavirus threats lurked in wildlife was only getting stronger

Ten years would pass, however, before researchers could show there were other SARS-like viruses in nature that also bind with ACE2. The evidence came from a team based at the Wuhan Institute of Virology

Growing evidence points to a connection between destructive environmental practices and emerging diseases.

Of more than 330 diseases which emerged between 1940 and 2004, nearly two-thirds were zoonotic, meaning they were transmitted from animals to humans, as with, for example, HIV/AIDS and probably covid-19.

over 70% originated in wildlife,

Replacing old-growth forests with a single crop, such as oil palm, can also lead to the transmission of disease. If predators’ habitats are destroyed and their populations dwindle, other creatures such as rodents, mosquitoes, bats and some primates can proliferate.

scientists are increasingly turning their attention to how altering land interferes with a pathogen’s journey from animals to humans

felling trees increases contact between humans and disease-carrying animals

correlation between the loss of forests in west and central Africa and outbreaks of Ebola between 2004 and 2014

Cutting down trees may also increase the threat to humans posed by viral infections transmitted through mosquito bites, such as Zika, dengue and chikungunya.

link between changes in global forest cover between 1990 and 2016 and an increase in reported epidemics, even accounting for the fact that deforestation usually means more humans living nearby

Wildlife may also move towards human settlements in search of food. Mango trees planted on pig farms in Malaysia probably attracted fruit bats carrying nipah, a virus that infected local pig farmers in 1999 and still breaks out yearly in Bangladesh.

Beyond Crispr and Covid vaccines, there are countless potential applications of mRNA tools for other diseases; a new frontier for immunotherapy and next-generation cancer treatment; a whole new world of weight-loss drugs; new insights and drug-development pathways to chase with the help of machine learning; and vaccines heralded as game-changing for some of the world’s most intractable infectious diseases.

the vaccine innovations stretch beyond mRNA: A “world-changing” vaccine for malaria, which kills 600,000 globally each year, is being rolled out in Ghana and Nigeria, and early trials for next-generation dengue vaccines suggest they may reduce symptomatic infection by 80 percent or more.

the mRNA sequence of the first shot was designed in a weekend, and the finished vaccines arrived within months, an accelerated timeline that saved perhaps several million American lives and tens of millions worldwide — numbers that are probably larger than the cumulative global death toll of the disease.

As the first of their kind to be approved by the Food and Drug Administration, they brought with them a very long list of potential future mRNA applications: H.I.V., tuberculosis, Zika, respiratory syncytial virus (R.S.V.), cancers of various and brutal kinds.

A Nobel laureate, Doudna is known primarily for Crispr, the gene-editing Swiss Army knife that has been called “a word processor” for the human genome and that she herself describes as “a technology that literally enables the rewriting of the code of life.”

many of their back stories do rhyme, often stretching back several decades through the time of the Human Genome Project, which was completed in 2003, and the near-concurrent near-doubling of the National Institutes of Health’s budget, which helped unleash what Donna Shalala, President Bill Clinton’s secretary for health and human services, last year called “a golden age of biomedical research.”

A couple of decades later, it looks like a golden age for new treatments. New trials of breast-cancer drugs have led to survival rates hailed in The Times as “unheard-of,” and a new treatment for postoperative lung-cancer patients may cut mortality by more than half. Another new treatment, for rectal cancer, turned every single member of a small group of cases into cancer-free survivors.

Ozempic and Wegovy have already changed the landscape for obesity in America

although the very first person to receive Crispr gene therapy in the United States received it just four years ago, for sickle-cell disease, it has since been rolled out for testing on congenital blindness, heart disease, diabetes, cancer and H.I.V

all told, some 400 million people worldwide are afflicted by one or more diseases arising from single-gene mutations that would be theoretically simple for Crispr to fix.

in theory, inserting a kind of genetic prophylaxis against Alzheimer’s or dementia.

In January, a much-talked-about paper in Nature suggested that the rate of what the authors called disruptive scientific breakthroughs was steadily declining over time — that, partly as a result of dysfunctional academic pressures, researchers are more narrowly specialized than in the past and often tinkering around the margins of well-understood science.

when it comes to the arrival of new vaccines and treatments, the opposite story seems more true: whole branches of research, cultivated across decades, finally bearing real fruit

Does this mean we are riding an exponential curve upward toward radical life extension and the total elimination of cancer? No. The advances are more piecemeal and scattered than tha

“The biology and the science that we need is already in place,” he says. “The question now to me is: Can we actually do it?”

Sometimes these things just take a little time.