As we saw with the Ebola outbreak — and the disastrous early handling of the COVID-19 coronavirus pandemic — a lack of preparedness, delays, and system-wide problems with the distribution of critical medical supplies can have deadly consequences. Yet after every outbreak, the systems put in place to coordinate emergency responses are generally dismantled.

One of America’s top biomedical researchers, Dr. Pardis Sabeti, and her Pulitzer Prize–winning collaborator, Lara Salahi, argue that these problems are built into the ecosystem of our emergency responses. With an understanding of the path of disease and insight into political psychology, they show how secrecy, competition, and poor coordination plague nearly every major public health crisis and reveal how much more could be done to safeguard the well-being of caregivers, patients, and vulnerable communities. A work of fearless integrity and unassailable authority, Outbreak Culture: The Ebola Crisis and the Next Epidemic seeks to ensure that we make some urgently needed changes before the next pandemic. Here is a brief excerpt:

Outbreak culture during the pandemic represented a collective experience larger than any one country’s response. Global agencies working to launch an effective global response through collaboration and coordination were instead met with unprecedented challenges. Amidst political posturing and national chauvinism, the WHO, which again found itself underfunded, under-resourced, and underpowered, was unable to effectively take up its role as a major connector in global outbreak response. In May 2020, the agency was dealt another major blow when the United States announced it would sever ties with the agency and redirect its funds to its national response. Though some collaborations continued and information was shared, the public gesture set a dangerous precedent by undermining global health agencies. Following through would have jeopardized the country’s own national security, since most infectious diseases originate outside of the United States. Although the decision was reversed, US disengagement from critical partnerships undermined early efforts at a collaborative global response.

The toxic political culture in the United States and elsewhere in the world overshadowed any forward momentum. Ironically, countries considered to have the most money, means, and expertise fared the worst in containing the virus’s spread. The United Kingdom experienced the second-worst “excess death” per capita compared to its neighboring countries in Europe. India’s politically driven mitigation strategies and delayed investment in health measures exploited the country’s longstanding health disparities and placed poor and migrant workers at highest risk for death. By February 2021, continued high circulation in some areas in India allowed for a new variant to emerge and cases to resurge. The same was true of many other countries, though a few showed impressive leadership, where governments partnered with scientists and quickly implemented provisions for testing, quarantining, and contract tracing. Promotion of health equity in Jordan, for example, led to citizens, refugees, and foreign residents receiving vaccinations free of charge. Tanzania’s inclusion of indigenous groups created a self-sustainable environment, limiting the need for outside support in their response. When the European vaccines promised under COVAX failed to reach the Balkans in a timely fashion, Serbia intentionally bypassed the geopolitical and bureaucratic hurdles hampering vaccine distribution elsewhere and began negotiations with China and Russia to obtain other options for their people. They then launched a vaccination strategy for the entire Balkans region, vaccinating populations in Bosnia and Herzegovina, North Macedonia, and — without the permission of the Kosovo government — the Kosovo Serbs as well. Actions by these countries countered many other in-country vaccination efforts such as Colombia and Israel that initially denied or significantly delayed vaccines to vulnerable territories or parts of their populations.

Just as the Ebola outbreak had in West Africa, the COVID-19 outbreak served as an opportunity for perverse incentives to take hold. The early shortages in diagnostic testing, masks, and hand sanitizers allowed for instances of price gouging by clinics and commercial entities, with the most extreme examples charging thou- sands of dollars per test, with insurance companies punting the bill to patients. Self-centered desires to reopen further fueled the capitalistic markets. In the United States, government agencies, professional sports teams, businesses, and many private colleges used vast clinical diagnostic resources to test thousands of asymptomatic individuals — sometimes daily — often while surrounding communities suffered testing delays and shortages, and struggled to meet basic clinical needs.

A lack of transparency made it hard to follow the money. For example, of the $1 billion allotted by the US Coronavirus Aid, Relief, and Economic Security (CARES) Act for the production of personal protective equipment and testing materials, $688 million was redirected to the Department of Defense, some for projects unrelated to pandemic response. Many research and response-based contracts were given to political contacts, and, as in Iraq, as sole-source or limited competition bids with no accessible Justification and Approval. States, given large funds to spend quickly but minimal assistance, were left to bid against the federal government for personal protective equipment and diagnostic supplies. While the opaque nature of the process makes it difficult to identify the specific instances of corruption, it is clear that the COVID- 19 pandemic has seen many individuals and organizations profit at the expense of livelihoods and lives.

Medical centers in every hard-hit country felt the effects of the fractured response. Equipment and resource shortages put health care workers at risk. Hospitals that reached capacity were forced to turn away COVID-19 patients, and those who could accept patients prioritized giving critical care to those who were in a better position to survive. Emergency departments saw higher rates of child abuse, drug overdoses, and attempted suicides compared to the year before the pandemic began. Fear of contracting COVID-19 kept many from seeking medical care, and we are already seeing an uptick in critical cancers. Skepticism and misinformation made physicians’ jobs harder.

Viruses expose and exploit the cracks in trust in our society, as SARS-CoV-2 made abundantly clear. In America we saw a rise in tensions, disinformation campaigns, and striking inequalities that allowed the virus to thrive. The more we fought one another, the more opportunities the virus had to tighten its grip.