Interview. Andrew Lakoff is an American professor of sociology at the University of Southern California. After training in anthropology of science and medicine, he conducted research in the United States, Argentina and France. His work focuses on the globalization of health issues. His most recent work is called Unprepared: Global Health in a Time of Emergency (("Unprepared, global health in times of emergency", University of California Press, 2017, untranslated).
We have known for a long time that a pandemic like the one we are facing can happen. How has the United States prepared for such an eventuality?
The United States is a very decentralized federation. Each state, each county, each city can have its own autonomous health system. To prepare the country for an event of this magnitude, Washington therefore sought to strengthen coordination between the various actors in public health. For twenty years, the Center for Disease Control (cbetween disease control, CDC) led them to imagine together what would happen if a new disease spreads quickly.
The goal is to get government agencies, government officials to identify the gaps in their system and the measures to take to fill them. Preparatory games are organized for this purpose. They bring together for a day or two experts, representatives of the institutions concerned, elected officials, etc. They follow a predetermined scenario and, at different times in the game, participants must identify the choices available to them and make decisions. More elaborate exercises were also carried out with the personnel who would be directly involved in the management of the crisis (for example doctors).
In view of what is happening today, does this preparation seem to have worked?
In part. We are currently experiencing a real shock. Some states have a strong public health system and have been able to count on politicians who have shown themselves to be up to the task. I am thinking here of New York State and California which have taken social distancing measures before the others.
However, the disease spread so quickly that the authorities' reaction probably came late. A city like New York, because of its density, is particularly vulnerable. It is worrying that the federal state is not fully fulfilling its role. Washington is dragging its feet, because the administration does not believe it should rely on the advice of experts to define its choices.
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