Each year, to mark the anniversary of DA Henderson's death, I write a blog post posing infectious disease and epidemiology questions that I wish he were around to answer. There usually are myriad public health threats that we have to face each year, but this year is a little different. The COVID-19 pandemic is the insoluble problem I wish he were here to fix. There are so many aspects of this response that have gone wrong and I have to think that part of it is because his voice is no longer part of the dialogue. I could never imagine DA deferring or subordinating his judgment in a situation like this. If DA were around, I believe his booming voice — infused with the confidence, moral authority and scientific certitude from being the man who rid this planet of smallpox — would have been sounding the alarm in January. DA’s would be an eminent voice that could not be ignored, could not be spun, and could not be misunderstood. He — as I witnessed countless times — had no problem or reservation about upsetting political leaders, describing them with choice (and accurate) adjectives, and would never be one who would express fealty. Just imagine what the world would be like if we acted in January instead of pursuing the non-strategy of evasion.
There are so many questions I would want to ask him about this pandemic. Here’s just a sampling.
What would have been the optimal strategy for the US in January, February, and March? Would it have been, as I have advocated, aggressive testing of all compatible syndromes, hospital preparedness, and targeted public health interventions? Would that have prevented the events in NYC from spiraling out of control and the cascading chaos?
What is the way forward now with an uncontrolled pandemic and a vaccine months away (in the best case scenario)? What is the most important thing we must do now? Is it a harm reduction approach that recognizes we will never go the way of Taiwan?
What is the best way to counteract the attacks on expertise? How does the CDC get restored to its prior position ?
What does this mismanagement portend for a more severe pandemic caused by an avian influenza virus? Which, of the myriad missteps, is the one most critical to fix?
Are paper-based cheap quick “contagiousness” tests a pathbreaking solution?
How should the vaccine be ultimately allocated? How should priority groups be decided?
What happens to polio eradication, guinea worm eradication, and measles control?
I suspect all of of us who were fortunate enough to be mentored by DA like to imagine he would agree with our own positions on the pandemic. While that is obviously impossible to know, I do think what is more likely (and more valuable) is that his mentees are likely thinking about the pandemic using a method he bequeathed us with. That method, as I practice it, involves thinking long-range, looking for historical clues, integrating every piece of new knowledge, keeping the full context, providing actionable guidance, and prioritizing the most important tasks in multifaceted complex problems.
Many of us who knew DA always ask ourselves and each other “What Would DA Do?” I think we ask this because we know if we could do just that, it would make all the difference.