The Lancet   |  October 1, 2020

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The COVID-19 pandemic has now had significant effects throughout the world, shutting down economies and leading to the deaths of hundreds of thousands of people. Beginning in China in the midst of a US election year, it has proven politically charged. The USA has been especially hard hit by COVID-19, with more than 6 million cases as of Sept 1, 2020, more than any other country. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has laid bare the limitations of US foreign policy in preventing and stopping pandemics, not only during the current Trump administration but also over the past decade. Isolationism has not enabled the USA to stop the spread of SARS-CoV-2. But global health programmes centred on sharing US expertise with low-income and middle-income countries (LMICs) have also not ensured the USA, or the world, can respond effectively in the face of a complex virus and global competition for the goods and technologies to stop it. The next US administration should shift foreign policy towards thinking and acting holistically about pandemics, strengthening multilateralism, and embracing solidarity. Learning lessons from what has worked, and what has not, the next US administration should launch a concrete, sufficiently funded global pandemics initiative with three focuses. First, to better link responses to HIV, tuberculosis, and malaria with those addressing emerging outbreaks. Second, to put climate change at the centre of global health and health into international climate policy. Third, to build multilateral capacity and power. In tackling pandemics as a central element of engaged foreign policy, the next US administration could lead an historic shift.

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