Our Biggest Mistakes During the COVID-19 Pandemic

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University's Grossman School of Medicine.

We're starting to see some fading in the number of hospitalizations associated with COVID-19, the beginning of the end of mask mandates, and generally, people saying they're going back out to events, going back to restaurants, going to go visit friends, or going back to various sports venues or theater. They want normalcy.

It may not be a bad time to take a little bit of a grumpy attitude and ask what we've learned so far about the response to COVID-19 — what were our 10 biggest mistakes? I think there are probably more than 10, but let's see what that list might look like just so we can not only begin to debate how to correct what I think were errors and mistakes, but also see whether we're ready for the next wave of whatever it is that might show up as a pandemic, such as future COVID-19 variants, flu variants, Ebola, Zika, or some other horrible thing that might put American society and the world at risk.

Language Matters

The first thing I think we learned is that language matters. In this whole debate about COVID-19 and what to do, we heard terms like "warp speed" and "booster." Both of those terms, I think, were inaccurate. The suggestion that our vaccines were made at warp speed led some people to think they're not safe or they're cutting corners, or the evidence isn't good. Politicians, from Trump to Biden, wanted to take credit for getting vaccines out there very quickly in response to the appearance of COVID-19.

It's understandable, but you can't go around describing medicines or vaccines as "warp speed" or something that has never before been done at this rate. You scare people, and there's no reason to scare people. The evidence for COVID-19 vaccines was solid, impressive, and something that had been worked on in terms of basic science for many, many years. If there was a warp speed, it was because the manufacturers were given money to make the vaccines and have them ready to go as soon as approval came. The public often didn't understand that.

Similarly with boosters. They kept talking about the third shot as a booster. Many people hear the term booster and think, Well, that's not something I need or That's more voluntary. Look, the COVID-19 vaccine is a three-shot vaccine. It takes three shots to keep all the variants at bay, keep you out of the hospital, and keep you from dying. By talking about boosters all the time, the CDC and many other government agencies, I think, gave the impression that something really important was not.

There was even a hint that we were giving out boosters while the rest of the world didn't get any shots. That's inaccurate. It's a three-shot vaccine. The rest of the world needs three shots too. Everybody does. By misdescribing things and calling them boosters when they weren't, rather than saying you've got a vaccine that requires three shots to be complete, I think we undermined both Americans' willingness to get that third shot and set up a false scenario where the rest of the world was criticizing us, if you will, for indulging ourselves with boosters when they didn't have any vaccine. They certainly merit vaccine, but everybody merits the complete sequence of vaccination with the three shots. Every vaccinologist I've talked to says it's a three-shot vaccine, so this language of boosters really undercut what we could do.

The Ethics of Values vs Science

Another lesson we learned is that the pandemic is as much about values as it is about science. It's really important to understand that some of our biggest failures in responding to COVID-19 had nothing to do with a lack of vaccines, an inability to prove that masks helped, that testing was valuable in terms of trying to quarantine and isolate infected people, or that ventilation was important. I mean, the science, I think, was done very well and held up well, but what we never messaged very well was the ethics and the values.

When people said things like, "I want to be free to go where I want and do what I want, even if it's a pandemic," that is not an acceptable interpretation of liberty. You don't get to go where you want, do what you want, and show up where you want if you're going to pose a danger to somebody else. It's very simple. Liberty gets restricted when the possibility is there that you could harm somebody else.

If you're going out infected or you don't know your COVID-19 status, which was true for many people throughout the COVID-19 epidemic, then you have a duty not to put them at risk. We never sold that message effectively about the obligations to let liberty be tamped down or temporarily restrained to protect us. That's a fundamental goal of society, and by the way, a principle we follow when we say you have to have rules governing how you drive your car and putting kids in child seats.

There are many parts of our lives where we restrict liberty so that we can have less mayhem and more, if you will, social activity permitted. More freedom by restricting things that people do. We don't say you go out and pick which side of the road you want to drive on tomorrow morning, that it's up to you, it's a liberty choice.

The Mess of Medical Messaging

Another major failure I think we learned about is that we're not very good at communication within the medical and science communities to the public. I think there were many people who tried very valiantly to communicate messages to the public on mainstream media and social media, and they did their best. The battle about COVID-19 and getting messages across to fight misinformation about phony cures or the dangers of masks — that they're going to suffocate your children if they wear them — and many other powerful misinformation messages took place at the grassroots level.

The people who were peddling bunk showed up at the school board, the church, the synagogue, the high school, and at public meetings and public forums. It's great to have messaging top-down and to be on the national media, send out messaging there, get things into major print outlets and social media outlets, but the battle in public health communication is grassroots-up, too.

We need more people who are showing up at local forums and local activities to really get messages across to the local community, to answer questions, and also to serve as trusted sources. Throughout the whole COVID-19 pandemic, I think some of the most trusted people remain doctors and nurses — the personable people who had relationships with patients or that people knew.

That's where we've got to get more effective communication going and get those people out a little bit more locally. It isn't just top-down, as much as everybody wants to pay attention to what Biden says or what Tony Fauci says, or what pundits are saying on various TV networks. That's half of the messaging battle. When you don't fill in the other half, misinformation and bad information take off, and it really hurt during the COVID-19 pandemic.

Pandemic Exposed Problems With Vaccine Distribution

I think there was another myth that grew, saying we were betraying the rest of the world when the richer countries vaccinated themselves. It would be useful to get vaccine out as fast as possible around the world. It's prudent because we know that new variants can occur in unvaccinated places, and it's obviously important for humanitarian reasons to help save lives in places that have dangerous outbreaks of COVID-19 or something else.

The world needs a better system to disseminate vaccines. It isn't enough just to send them on a boat to a dock. If the country where they arrived is corrupt and the leader is going to sell those vaccines to the highest bidder or some other country, if there are no refrigerators, if there are no roads, if there's no one trained to give the shots, if there's not even messaging that goes out to fight anti-vaccine misinformation in those countries, then vaccination isn't going to happen. It isn't as simple as just saying, "Give us the patents or give us the vaccine supply."

We've got an infrastructure challenge in much of the world that has to be overcome in order to vaccinate. Let me add that there are plenty of places in the world now where no one is getting in to vaccinate. Think about Ukraine, think about Ethiopia, think about Yemen, think about Somalia, North Korea. There's a big list of war-torn states and failed states where no one's going to be launching a vaccine campaign. We've got to come up with other tools in order to battle COVID-19 or any other outbreaks in those places.

Testing Took a Backseat, Supply Issues Caused Harm

My last item on the top 10 list, although it's not really 10, is that we didn't use all our tools. It was a big push trying to vaccinate our way out of COVID-19. Vaccines helped, but they're not enough. We never really pushed hard for testing. We wound up doing things like shutting down cities, shutting down entire schools if they had one case. The right way to go is to get testing out there that is cheap, available, and regular, every day, so that you could keep your child home if they were infected rather than closing the whole school. Similarly with the workplace.

The idea of quarantining and isolation — they're valuable. They're all public health tools, but in modern economies and modern society, they're not practical. Even the Chinese trying to shut down Shanghai and other huge cities are learning the bitter truth — that it really is impractical to shut down 26 million people in a city. You've got to test your way through, and we didn't pursue that option, and we didn't pursue the option of antiviral medicines. They were the tools that we used to get past HIV, and we didn't use them effectively. We didn't develop them fast enough. We didn't have protective gear. It's inexcusable that we don't store it and maintain it. Ventilators as well.

The just-in-time system of supply might be useful for car manufacturers, but it isn't going to work in healthcare. We need a reservoir of backup so that if something breaks out, we can quickly disseminate the requisite protective gear — the requisite masks, gowns, and so on.

Last, this is an airborne disease. It took us a long time to admit it, but we need to make sure that not only are we paying attention to deep cleaning, which I think didn't do much of anything, but that we're really trying to get viruses out of the air by upgrading ventilation systems in schools and workplaces, in hospitals, in nursing homes. That's something that is a weakness in our system. We've got to fix it.

There were many lessons forthcoming from the COVID-19 experience that I think finger-pointing might be appropriate, but hopefully not only finger-pointing but also trying to learn, improve, and do better for the next pandemic. As the experts say, there will be a next pandemic, and hopefully what we did wrong or what we didn't do as well in this one, we can fix in time for the next one.

I'm Art Caplan at the Division of Medical Ethics at New York University's Grossman School of Medicine.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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