• Education

  • • Swarthmore College (BA)

    • Yale University (MPH)

    • Princeton University (PhD)

• Scientific career

  • • Fields : Biosecurity / International affairs

    • Institutions Georgetown University Medical Center

    • Thesis : Yellow Rain Revisited: Lessons Learned for the Investigation of Chemical and Biological Weapons Allegations (2005)

    • Doctoral advisor : Burton Singer

Rebecca Katz is a professor and director of the Center for Global Health Science and Security at Georgetown University Medical Center. She is an expert in global health and international diplomacy, specializing in emerging infectious diseases. From 2004 to 2019, she was a consultant for the United States Department of State on matters related to the Biological Weapons Convention and emerging infectious disease threats. Katz currently serves on the Joe Biden presidential campaign's public health panel to advise on the novel coronavirus.

Education

Inspired by her parents' work to address HIV/AIDS epidemic in the 1980s, Katz initially aspired to be a health economist.^[1] She pursued an undergraduate degree in political science and economics at Swarthmore College, receiving her Bachelor of Arts degree in 1995. After graduating, she volunteered to work in maternal health in southern India, where she contracted Brucella melitensis and began to become interested in public health.^[2] She then chose to pursue a Master of Public Health degree at Yale University between 1996 and 1998. There, she was introduced to the world of bioterrorism. She followed that interest in health security to Princeton University Woodrow Wilson School of Public and International Affairs, where she pursued a doctorate degree from 2000 to 2005 at the intersection of public health and national security.^{[citation needed]}

The September 11th attacks and the 2001 anthrax attacks occurred while Katz was studying at Princeton.^[1] In response to the anthrax attacks, Katz authored a working paper outlining the threat of biological weapons over time, as well as the public health infrastructure necessary to effectively detect and respond to an attack.^[3]

• [ Link to 2004 Paper : 2004 (Research paper while at Princeton) - "Biological Weapons: A National Security Problem that Requires a Public Health Response / Working Paper 2001-04 / Rebecca Katz of Princeton's Office of Population Research" .... PDF : [HE005E][GDrive] / Some of content is shown later on in this page ]

The attacks also led to increased interest and funding support for biosecurity, which enabled her to do an internship at the Defense Intelligence Agency in Washington, DC. There, she was given access to documentation on an agent of Soviet-backed toxin warfare known as "yellow rain", which ultimately became the subject of her doctoral dissertation carried out under the mentorship of Burton Singer.^[1] Her thesis, entitled Yellow rain revisited: Lessons learned for the investigation of chemical and biological weapons allegations evaluated yellow rain as a case study in chemical and biological weapons allegations, as well as for evaluating the protocols used to mitigate proliferation of such warfare.

• [ Link to 2005 (May) : Rebecca Katz Dissertation for Princeton - "YELLOW RAIN REVISITED: LESSONS LEARNED FOR THE INVESTIGATION OF CHEMICAL AND BIOLOGICAL WEAPONS ALLEGATION" ... SOURCE PDF download : [HE0058][GDrive] / Some of content is shown later on in this page ]

• [ Link to Research paper (2006) built with content form her dissertation : ]

^{2005-05-princeton-dissertation-yellow-rain-revisited-rebecca-lynn-katz.pdf}

[ Research paper downloaded - https://www.jstor.org/stable/40072925?read-now=1&refreqid=excelsior%3Af0e9cf8402d1482904f7ab31466ea769&seq=17#page_scan_tab_contents

]katz-research-40072925.pdf

Can an Attribution Assessment Be Made for Yellow Rain? Systematic Reanalysis in a Chemical-and-Biological-Weapons Use Investigation Author(s): Rebecca Katz and Burton Singer Source: Politics and the Life Sciences, Vol. 26, No. 1 (Mar., 2007), pp. 24-42 Published by: Association for Politics and the Life Sciences Stable URL: http://www.jstor.org/stable/40072925 Accessed: 16-03-2016 10:30 UTC

Career

Katz began consulting for the United States Department of State in September 2004, working there until 2019.^[1] She specialized in issues related to the Biological Weapons Convention, a disarmament treaty signed 1975 to ban biological warfare.^[5] Since 2007, Katz has also worked on implementing the International Health Regulations (IHR), which are a legally binding instrument of international law to promote international cooperation and help countries prepare for and respond to public-health emergencies.^[6]

During her tenure at the State Department, Katz also became an associate professor at George Washington University from 2006 to 2016. In July 2016, she began an appointment associate professor position at Georgetown University and was promoted to professor in July 2019. There, she also became the director for the newly formed Center for Global Health Science and Security and has overseen the launch of the Center's Masters program.^[7]

In the wake of the 2019 Ebola virus disease outbreak in Tanzania, Katz also advocated to address gaps in the IHR and convene regular review conferences to discuss the potential for outbreaks, thus bolstering the ability of the World Health Organization to address emerging epidemics proactively.^[5][8] In light of the emerging COVID-19 pandemic, Katz has again advocated for stronger international regulations to more effectively address outbreaks.^[9][10] In late January 2020, she advocated that the WHO should declare the novel coronavirus a Public Health Emergency of International Concern (PHEIC) as a signal to the international community to launch a coordinated public health response.^[11] She and megacity expert Robert Muggah also co-authored recommendations for how to evaluate the preparedness of cities to address and mitigate infectious disease outbreaks.^[12][13]

Katz has contributed her expertise to advising a number of groups on strategies to strengthen health security. She is a member of the Center for Strategic and International Studies (CSIS) Commission on Strengthening America's Health Security, which conducts policy studies and strategic analyses to advance the United States leadership in global health security.^[14] In 2020, she was also appointed by the Council on Foreign Relations to serve on its Independent Task Force on Improving Pandemic Preparedness, co-chaired by Sylvia Mathews Burwell and Frances Fragos Townsend.^[15] On March 11, 2020, the Joe Biden 2020 presidential campaign announced Katz would be joining his campaign's public health panel to advise on coronavirus, along with Ezekiel Emanuel, David Kessler, Lisa Monaco, Vivek Murthy, and Irwin Redlener.^[16]

In November 2020, Katz was named a volunteer member of the Joe Biden presidential transition Agency Review Team to support transition efforts related to the Executive Office of the President of the United States and the National Security Council.^[17]

Selected publications

• "The novel coronavirus originating in Wuhan, China: challenges for global health governance." JAMA 2020;323(8):709-710. doi:10.1001/jama.2020.1097

• "Defining Health Diplomacy: Changing Demands in the Era of Globalization." Milbank Quarterly Sep 2011; 89(3): 503–523. doi:10.1111/j.1468-0009.2011.00637.x

• Encyclopedia of bioterrorism defense. Jun 2011. ISBN 9780470508930

ABSTRACT (Pages iii and iv)

This dissertation evaluates Yellow Rain as a case study for the lessons learned in the investigation of chemical and biological weapons allegations. I use a new body of evidence on the Yellow Rain investigation to examine methodologies of weighing evidence, evaluate protocols for chemical and biological weapons investigations, and retell the story of Yellow Rain and its impact on alleged victims, international law and proliferation of chemical and biological weapons.

Yellow Rain is the name commonly given to alleged chemical and toxin weapons attacks in Southeast Asia and Afghanistan in the late 1970s and early 1980s. Allegedly, the Soviets provided Trichothecene Mycotoxin to communist Vietnamese and Pathet Lao forces for use against the Hmong (an ethnic minority group) in Laos and the Khmer Rouge coalition resistance groups in Cambodia. It was also allegedly used by the Soviets themselves against the Mujahidin in Afghanistan.

To evaluate the Yellow Rain investigation, I used a new body of United States government documents not previously released to the public, open source data and interviews conducted with people associated with the investigation. I analyze these data through a methodology I developed and present in Chapter Four for weighing evidence in a chemical and biological weapons investigation. Through this analysis I find that there appears to be sufficient information from a variety of sources to make a confident assessment that a chemical or toxin agent was used against the Hmong, Khmer Rouge and Mujahidin.

Yellow Rain exemplifies not only how difficult it is to prove or disprove the use of chemical or biological weapons, but also the problems inherent in the domestic and international system for entering into an investigation to verify allegations of use. This case study illuminates the shortcomings intrinsic to investigations of CBW use, and demonstrates the need for the creation of standards for verification.

ACKNOWLEDGEMENTS (Pages v and vi)

This dissertation would not have been possible without the gracious help of many people and institutions. First, I need to thank my advisor, Burt Singer, who took a chance on me at a time when issues related to biological warfare were not often being studied in academia. He forced me to think broadly and challenged me to do interesting work. His continued guidance and support has made this project possible. Betsy Armstrong has also been a great support and mentor. I am also thankful to Michael Meese and Frank von Hippel for their careful readings of my work and helpful suggestions.

Russ Swenson at the Joint Military Intelligence College, Jim Claxton at the Defense Intelligence Agency and my internship mentor from the Defense Intelligence Agency were all immensely helpful in making this project feasible and ensuring that the Yellow Rain documents became declassified. Chuck Hoing of DIA and Michelle Christy of Princeton helped smooth administrative hurdles.

Emily Katz of Massachusetts General Hospital (and my sister) utilized a differential diagnosis software program to help me analyze reported symptomology. Wingfield Rehmus of Stanford University Medical Center, Department of Dermatology provided expert opinion and reviewed pictures of alleged victims. Bill Guthe, T. Wangyal Shawa and Marcia Castro of Princeton provided valuable assistance in helping me navigate ArcView. Wayne Appleton and Angel Martinez of the Princeton Office of Population Research made sure my computer continued to function.

Many people generously gave me their time and often their personal files so I could more fully appreciate the complexities of Yellow Rain. These individuals include Gary Crocker, Kit Green, Chester Mirocha, Joe Rosen, Bruno Schiefer, Rod Barton, Al Santoli, the office of Paul Nelson, Thao Xoua, Denny Lane, Ed McWilliams, Amos Townsend, Sterling Seagrave, Bill Anderson, Charlene Day, Bernard Wagner, Charles Stahl, Richard Harruff, Bill Kucewicz, Ed Lacey, and Andrea Crossland. Others were also very helpful, but asked that their names not be used.

I am also thankful for the suggestions and comments from Bob McCreight, [Dr. Joshua Lederberg (born 1925)], Seth Carus, Martin Hugh-Jones, Jon Wiant, John Bodner, Jonathan Tucker, Matthew Meselson, Aaron Friedberg, Dan Markey, Elisa Harris, and Jeanne Guillemin.

Financially, I have been supported by the Princeton Graduate School, The Woodrow Wilson School, an NIH training grant through the Office of Population Research, the Princeton Center for Health and Wellbeing, and the Fellowship of Wilson Scholars. I also received institutional support as a research fellow at the Joint Military Intelligence College and as a visiting scholar at the Cold War History Group at George Washington University.

Finally, I thank Nirit, Cari, Jen and Karsten who collectively kept me sane; my family for their love and support; and I thank Matt, who was there for me 24/7 throughout this entire journey.

The federal government has cast a wide net looking for Ebola-infected passengers flying into U.S. airports from West Africa, but the stepped-up testing so far has turned up few suspected cases of the deadly virus.

Of the 1,249 passengers who have undergone enhanced screening this month at five airports, eight had been taken to a medical facility for an evaluation as of Thursday, according to data from the U.S. Department of Homeland Security.

Despite the few cases, many people in the U.S. who don’t show symptoms remain under watch in case they develop signs of infection. There were at least 700 people undergoing monitoring such as regular temperature checks across 10 states, officials said. That includes 117 in New York City and about 100 in New Jersey.

Since the federal government instituted enhanced screening for passengers arriving from Sierra Leone, Liberia and Guinea on Oct. 11, New York, New Jersey and other states have gone further, declaring widely debated quarantines even for travelers who have tested negative for the virus and showed no symptoms.

Two of those eight passengers landed at an airport serving New York City—Newark Liberty International, according to the Homeland Security data. Four flew into Washington Dulles International, and two into Chicago O’Hare International.

Some health experts said the relatively few potential Ebola cases caught in the screenings showed the inadvisability of mandatory quarantines for health-care workers. Such measures by New York and New Jersey last week drew sharp criticism from health experts who feared they would dissuade medical workers from going to West Africa.

“The public anxiety is way out of proportion to the facts,” said Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University. “Screening people is essential. It’s just a question if we are imprisoning them or just screening them.”

Other experts said the low numbers of potential cases identified here showed that West African nations were doing a good job screening outbound travelers.

The U.S. Centers for Disease Control and Prevention is helping conduct those checks.

U.S. Customs and Border Protection officers screen passengers coming into John F. Kennedy International Airport from high-risk locations.

“It’s horrific that there have been so many cases, but in the scheme of a large population, it’s only a small segment who has been exposed,” said Rebecca Katz, an associate professor of health policy at the Milken Institute School of Public Health at the George Washington University. “The screening process is working.”

As of Thursday evening, New York City was monitoring 117 patients, largely those who traveled from Ebola-stricken countries since Oct. 11.

The list also includes members of Bellevue Hospital Center, Fire Department of New York staff and lab workers who have worked with Craig Spencer, a New York physician with Ebola who recently returned from work in West Africa.

The city said the number was likely to change daily. “None of these individuals are showing any symptoms, and it is highly unlikely any of these people have the Ebola virus,” the city said.

Dr. Spencer was listed Thursday in serious but stable condition.

New York Gov. Andrew Cuomo has softened the state’s stance on quarantines, announcing that quarantined travelers would be allowed to remain at home.

Mr. Cuomo and New York City Mayor Bill de Blasio on Thursday announced a program offering financial incentives and employment protections to encourage health-workers to travel overseas.

State officials have defended their quarantine protocols. A New Jersey health official said the state had expected the number of quarantined people would be small, but that wasn’t an indication of its effectiveness.

“It is important to remember that a single symptomatic person using public transportation…could potentially expose hundreds of others,” the official said.

The CDC says Ebola can only be contracted through direct contact with body fluids of an infected person.

Direct contact means the fluids must touch the eyes, nose, mouth or an open cut, wound or abrasion, the agency says.

For all of the attention to health-care workers, relatively few—34, or 3%—of 1,004 passengers returning from the West African countries Oct. 11-27 were health-care workers, according to the CDC.

Still, quarantines have rattled medical professionals. Kwan Kew Lai, a doctor who is working with a nongovernmental organization treating Ebola patients in Liberia, said she was considering altering her trip home to Boston for Thanksgiving. Dr. Lai said she already planned to isolate herself from patients for 21 days upon her return, but she didn’t want to be treated like Ms. Hickox.

“If at all possible I would prefer not entering the U.S. through JFK or Newark,” said Dr. Lai, who in the U.S. works as a physician at Beth Israel Deaconess Medical Center in Boston.

It is “pretty easy” to avoid the airports with enhanced screening, said Mark Duell, vice president of operations at FlightAware, a flight-tracking website. “For a few hundred bucks you can definitely avoid those five cities,” he said.

Died on Sunday, January 24, 2016 at his home in Rockville, MD. He is survived by his wife of 43 years, Deborah; daughters, Rebecca Katz (Matt Scharf) and Emily Katz (Laura Chapman); and four grandchildren, Olivia, Benjamin, Leo and Eli. He is also survived by his sister, Miriam Cohen and brother-in-law, Herb Cohen; sister-in-law, Joan Rosenbaum and John Gorham; nephew, Joshua Galper and niece, Satya Welch and their families. Born and raised in the Bronx, son of the late Charlotte and Sirol Katz, Dr. Katz was a graduate of the Bronx High School of Science, Swarthmore College, and the University of Pennsylvania Medical School. A Captain in the U.S. Army, he was stationed at Fort Sam Houston, treating burn victims returning from Vietnam. Dr. Katz was a Board certified pathologist/hematologist/blood banker who had a distinguished career at the American Red Cross for more than 30 years, starting as the Director of Connecticut Blood Services, then becoming Executive Director of Blood Services at National Headquarters, and concluding his career as Senior Director of Biomedical Development at the Jerome H. Holland Laboratory. He also maintained a position as Clinical Professor of Pathology at The George Washington University. Dr. Katz was an avid, top-seeded masters tennis player, a transplant from New York who remained passionate about the N.Y. Giants football team and the New York Yankees. He loved music and the arts, attending concerts, theater, and films. A man for all seasons, he enjoyed travel and hiking trips with his wife.Dr. Katz was a man of great intellect who cared deeply about his family and was concerned about the world around him. His life was guided by high moral and ethical standards. He will be deeply missed. The family is grateful to his caregivers, who have been loyal and devoted to his well-being for the past year and a half. The family asks that donations in his memory be made to The Michael J. Fox Foundation for Parkinson''s Research. Funeral services will be held on Thursday, January 28, 2016 at Temple Beth Ami, 14330 Travilah Road, Rockville, MD at 1 p.m.Interment immediately following at the Garden of Remembrance in Clarksburg, MD. [...]

A global coalition to create new vaccines for emerging infectious diseases launched Wednesday with the ambitious aim of protecting the world from future epidemics.

Announced at the World Economic Forum in Davos, Switzerland, the initiative has an initial investment of nearly $500 million from the Bill and Melinda Gates Foundation, Britain’s Wellcome Trust and the governments of Japan, Norway and Germany.

The partnership will be called the Coalition for Epidemic Preparedness Innovations, or CEPI. It grew out of the lessons from the world’s woeful lack of preparedness for the 2014 Ebola epidemic in West Africa, which killed more than 11,000 people and caused at least $2.2 billion in economic losses in the three hardest-hit countries.

As a result of that and the current Zika epidemic in the Americas, a global consensus has steadily grown among an array of governments, public health leaders, scientists and vaccine industry executives that a new system is needed to guard against future health threats.

Global health experts welcomed the initiative, saying it would complement efforts already underway by the World Health Organization and the U.S. Biomedical Advanced Research and Development Authority (BARDA), part of the Department of Health and Human Services, which are working on Ebola and Zika vaccines.

The United States is not providing funding for CEPI, but it is offering subject expertise. Officials took part in the planning discussions, and “while we are not a formal partner to CEPI, we foresee synergies between our approaches,” BARDA Director [Dr. Rick Arthur -Bright (born 1966)] said in a statement. One such area is development of the most efficient technology for biodefense and infectious disease response, he said.

[Dr. Rebecca Lynn Katz (born 1973)], director of Georgetown University’s Center for Global Health Science and Security, expects the new coalition “will just add much needed resources to a hard problem” and not detract from other efforts' funding and resources.

CEPI initially plans to target three viruses that have known potential to cause serious epidemics and can be transmitted from animals to humans: MERS, a deadly respiratory virus first identified in Saudi Arabia in 2012 that can be spread by camels and now is in 27 countries, including the United States; Lassa fever, an acute viral illness mainly found in West Africa and spread by rats; and [Nipah Virus], a newly emerging infection initially identified in 1999 in Malaysia and Singapore. During a Nipah outbreak there among pig farmers and people with close contact with pigs, nearly 300 people were infected and more than 100 died.

Each virus is among WHO's priority pathogens. Few or no medical countermeasures exist to combat them. The current system for vaccine development is in crisis, health experts say, because it’s a costly, complicated and labor-intensive development process that prioritizes therapeutics with the biggest possible market.

CEPI hopes to develop two vaccine candidates against each of the target diseases. Officials said they did not choose Ebola and Zika vaccine work because considerable research is already underway.

“The last thing we would like to do is duplicate efforts,” Trevor Mundel, president of the Gates Foundation’s global health division, told reporters during a briefing.

Officials said they have raised $460 million, almost half of their $1 billion target for the first five years. They’re now seeking proposals from researchers and companies and expect to announce which will be funded by mid-year. They're also calling for other governments and organizations to help complete fundraising by the end of the year.

The Indian government, one of the coalition founders, is finalizing a financial commitment, according to CEPI.

Several major pharmaceutical companies are providing support in the form of vaccine technology, expertise and guidance. Industry representatives are on the coalition’s board and scientific advisory committee.

Bill Gates has said his biggest worry is a pathogen, more infectious than Ebola, for which the world is totally unprepared. In a statement Wednesday, Gates said, “The ability to rapidly develop and deliver vaccines when new ‘unknown’ diseases emerge offers our best hope to outpace outbreaks, save lives and avert disastrous economic consequences.”

Wellcome Director Jeremy James Farrar (born 1961) was among those who first proposed a global vaccine development fund in mid-2015. CEPI’s initial $1 billion investment goal, he said, pales in comparison to the tens of billions of dollars in costs from epidemics, starting with the 2003 SARS outbreak.

“Vaccines can protect us, but we’ve done too little to develop them as an insurance policy,” Farrar said.

CEPI's financial contributions so far for its first five years include:

• Japan: $125 million

• Norway: about $120 million

• Germany: about $10.6 million in 2017 with more funding to come

• Wellcome Trust: $100 million

• Bill & Melinda Gates Foundation: $100 million

The Trump administration has failed to fill crucial public health positions across the government, leaving the nation ill-prepared to face one of its greatest potential threats: a pandemic outbreak of a deadly infectious disease, according to experts in health and national security.

No one knows where or when the next outbreak will occur, but health security experts say it is inevitable. Every president since Ronald Reagan has faced threats from infectious diseases, and the number of outbreaks is on the rise.

Over the past three years, the Centers for Disease Control and Prevention has monitored more than 300 outbreaks in 160 countries, tracking 37 dangerous pathogens in 2016 alone. Infectious diseases cause about 15 percent of all deaths worldwide.

But after 11 weeks in office, the Trump administration has filled few of the senior positions critical to responding to an outbreak. There is no permanent director at the CDC or at the U.S. Agency for International Development. At the Department of Health and Human Services, no one has been named to fill sub-Cabinet posts for health, global affairs, or preparedness and response. It’s also unclear whether the National Security Council will assume the same leadership on the issue as it did under President Barack Obama, according to public health experts.

“We need people in position to help steer the ship,” said Steve Davis, the chief executive of PATH, a Seattle-based international health technology nonprofit working with countries to improve their ability to detect disease. “We are actually very concerned.”

In addition to leaving key posts vacant, the Trump administration has displayed little interest in the issue, health and security experts say. The White House has made few public statements about the importance of preparing for outbreaks, and it has yet to build the international relationships that are crucial for responding to global health crises. Trump also has proposed sharp cuts to government agencies working to stop deadly outbreaks at their source.

The slow progress on senior-level appointments — even those, such as the CDC director, that do not require Senate confirmation — is hobbling Cabinet secretaries at agencies across the government. Temporary “beachhead” teams the White House installed are hitting the end of their appointments. The remaining civil servants have little authority to make major decisions or mobilize resources.

An HHS spokeswoman declined to comment on personnel decisions. An NSC official, who was not authorized to speak publicly, said the administration recognizes that global health security is a national security issue and that America’s health depends on the world’s ability to detect threats wherever they occur.

Trump’s NSC does not have a point person for global health security as Obama’s did, but global health security is part of the overall portfolio of Tom Bossert, Trump’s homeland security adviser, another NSC official said.

Global health experts warn that a pandemic threat could be as deadly as a nuclear attack — and is much more probable.

A global health crisis “will go from being on no one’s to-do list to being the only thing on their list,” said Bill Steiger, who headed the HHS office of global health affairs during the George W. Bush administration. He spoke at a panel on pandemic preparedness in early January. He is now part of Trump’s beachhead team at the State Department.

Next month, the G-20 governments, which traditionally focus on finance and economics, will convene their health ministers for the first time, in part to test coordination and preparedness for a pandemic, according to German officials, who are hosting the summit in Berlin. It’s not clear who will represent the United States.

In a speech to a security conference in Munich earlier this year, billionaire Bill Gates said a pandemic threat needs to be taken as seriously as other national security issues. “Imagine if I told you that somewhere in this world, there’s a weapon that exists — or that could emerge — capable of killing tens of thousands, or millions of people, bringing economies to a standstill and throwing nations into chaos,” said Gates, who has spent billions to improve health worldwide. "Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year.”

The projected annual cost of a pandemic could reach as high as $570 billion.

Last month, Trump met with Gates at the White House. After the meeting, press secretary Sean Spicer said the two had “a shared commitment to finding and stopping disease outbreaks around the world.”

Americans are at greater risk than ever from new infectious diseases, drug-resistant infections and potential bioterrorism organisms, despite advances in medicine and technology, experts say. Not only has the total number of outbreaks increased in the past three decades, but the scale, impact and methods of transmission also have expanded because of climate change, urbanization and globalization.

The outbreak of Ebola that erupted in West Africa eventually infected more than 28,000 people and killed more than 11,000. MERS has killed nearly 2,000 people in 27 countries. Health officials around the world are monitoring a strain of deadly bird flu, H7N9, that is causing China’s largest outbreak on record, killing 40 percent of people with confirmed infections.

Of all emerging infectious disease threats, a global influenza outbreak is everyone’s worst fear because it could be highly lethal and highly contagious. A particularly virulent influenza pandemic that started in 1918 killed an estimated 50 million people. Today’s H7N9 strain poses the greatest risk of a pandemic if it evolves to spread easily from human to human, according to U.S. officials.

Last month, several Democratic lawmakers wrote HHS Secretary Tom Price to raise concerns about the nation’s ability to respond to infectious disease threats. They also asked about the vacancies and the impact of proposed budget cuts in the event of a flu pandemic. They received no response.

“Our whole community is kind of ear to the ground trying to figure out any clues we can discern,” said Rebecca Katz, co-director of the Center for Global Health Science and Security at Georgetown University’s Medical Center.

Global health security “is clearly an issue that needs to be taken up by the heads of state,” said one European official who declined to be identified because her government does not want to appear critical of the United States. Diseases travel fast and don’t recognize borders. In today’s connected world, a disease can be transported from a rural village to any major city within 36 hours.

“It’s not just from travel of people, but birds, too,” she said. Referring to Trump’s proposal to build a wall along the border with Mexico, she added: “You can’t build walls to stop birds.”

Global health security was a top priority for the Obama administration, which launched a partnership in early 2014 to prevent deadly outbreaks from spreading. Experts say the collaboration, known as the Global Health Security Agenda, has raised the political profile of infectious disease threats and strengthened basic public health systems in the countries least equipped to fight epidemics.

In Cameroon, the government developed a new emergency operations center able to respond within 24 hours to an outbreak of a highly lethal bird flu last year, removing more than 67,000 birds that had the potential to spread the virus to humans. In 2015, it took the country eight weeks to respond to a cholera outbreak.

In Mali, personnel who received epidemiology training began vaccination campaigns the day after detecting a measles outbreak last year.

In addition, more than 30 countries have taken part in evaluations to assess their ability to detect and prevent outbreaks, and their “report cards” are made public to spur governments to take action. But the gains made so far are “still fragile and require continued funding until they are strong,” according to an internal CDC analysis.

The Obama administration committed $1 billion to the program, which is due to end in fiscal 2019. Although it has strong support among global health officials and some Republican lawmakers, the Trump administration has yet to say whether it plans to continue funding the initiative.

President Obama also brought up global health regularly in meetings with foreign leaders. Trump has said little since taking office, except for a reference in his inaugural speech about his desire to rid the earth of disease.

During the Ebola outbreak, Trump tweeted that health workers should be blocked from returning to the United States, despite advice from the CDC and other experts that doing so would not protect U.S. health and would harm efforts to stop the outbreak.

The administration’s proposed budget is also problematic, health experts say.

If approved by Congress, Trump’s request for the current fiscal year would slash the entire $72 million budget for global health security at USAID. And his request for fiscal 2018 calls for a nearly 18 percent cut at HHS, which includes the CDC.

The request does propose a new federal emergency fund intended to allow HHS to respond to emerging public health outbreaks. However, administration officials have provided few details.

Many Republican lawmakers have criticized the requests, saying Congress is unlikely to approve such deep cuts to health agencies.

“You can have the best people in the world, but if you’re slashing the NIH budget by 20 percent, and presumably the same thing to CDC, then I don’t care how good your people are, they’re not going to be nearly as effective as they need to be,” said Rep. Tom Cole, (R- Okla.), who chairs the House Appropriations subcommittee on labor, health and human services, education, and related agencies.

The health agencies are “the front lines of defense for the American people for some pretty awful things,” Cole said. “If the idea of a government is to protect the United States and its people, then these people contribute as much as another wing on an F-35 [fighter jet], and actually do more to save tens of thousands of lives.”

A man in Washington state has been sickened by the new coronavirus spreading through Asia, marking the first confirmed case in the United States, experts from the Centers for Disease Control and Prevention announced Tuesday.

The patient, a resident of Snohomish County, Wash., recently returned to the United States after visiting the region around Wuhan, China, the epicenter of the outbreak. Once inside the U.S., he began to experience pneumonia-like symptoms and notified his doctor about his travel history. Test results for the virus returned positive over the weekend.

The man, who is in his 30s, was transported to Providence Regional Medical Center in Everett, where he is being monitored and is good condition, officials said.

Chinese officials said that at least 440 cases had been reported as of early Wednesday, most of them in Wuhan and surrounding Hubei province, where nine have died. Officials have also identified 21 cases in Beijing, Shanghai and southern Guangdong province.

Additional cases of infected patients have been confirmed in South Korea, Japan and Thailand, according to the Chinese government. And Taiwan’s disease surveillance officials said Tuesday that one traveler to Wuhan has returned sickened with the virus.

The patient in Everett is the only known case outside of Asia, and he represents the farthest spread of the novel coronavirus.

“We do expect additional cases in the U.S. and globally,” said [Dr. Nancy Messonnier (born 1965)], director of the CDC’s National Center for Immunization and Respiratory Diseases.

At the same time, public heath officials emphasized that the virus poses a low risk to the American public, and that it’s unlikely to spread widely here.

Chinese health officials initially said that most patients infected with the virus in Wuhan were exposed to live animals in a large seafood market, suggesting that the virus jumped from another species into humans and may not spread directly from person to person. But the Washington state patient, along with several others, said he had not visited the market.

On Monday, Zhong Nanshan, a Chinese government scientist, announced on Chinese state television that the virus can be transmitted between humans.

Even before that development, public health officials were concerned that the virus would spread more widely as travel picks up for the Lunar New Year.

Airline passengers arriving from the outbreak region are already being screened for the virus’ pneumonia-like symptoms at Los Angeles International Airport, San Francisco International Airport and John F. Kennedy International Airport in New York. The CDC said it would begin monitoring travelers at Chicago’s O’Hare International Airport and Hartsfield-Jackson Atlanta International Airport this week.

The Washington state patient entered the country before any of those screenings were implemented. But even if they had been in place, he would not have been detected because he was asymptomatic at the time, experts said.

“Leave no doubt: Entry screening is just one part of a multilayered system,” said [Dr. Martin Stuart Cetron (born 1959)], the head of the CDC’s Division of Global Migration and Quarantine. “Individuals are empowered to make good decisions if they’re informed.”

Outside experts cautioned that the increased airport screenings will be expensive, and that it will take some time to get answers to basic questions like what animal was the source of this virus and what makes some people more susceptible to infection than others.

“Basic epidemiology questions remain unanswered,” said [Dr. Rebecca Lynn Katz (born 1973)], the director of the Center for Global Health Science and Security at Georgetown University. “The CDC is the best of the best, and we should have faith in their leadership.”

Officials have begun to trace the Washington man’s contacts from China to his home in the United States in order to identify other people who may be infected, said Dr. Scott Lindquist, a communicable disease epidemiologist at the Washington State Department of Health.

On December 31, 2019, China reported to the World Health Organization (WHO) cases of pneumonia in Wuhan, Hubei Province, China, caused by a novel coronavirus, currently designated 2019-nCoV. Mounting cases and deaths pose major public health and governance challenges. China’s imposition of an unprecedented cordon sanitaire (a guarded area preventing anyone from leaving) in Hubei Province has also sparked controversy concerning its implementation and effectiveness. Cases have now spread to at least 4 continents. As of January 28, there are more than 4500 confirmed cases (98% in China) and more than 100 deaths.1 In this Viewpoint, we describe the current status of 2019- nCoV, assess the response, and offer proposals for strategies to bring the outbreak under control.

Current Status

China rapidly isolated the novel coronavirus on January 7 and shared viral genome data with the international community 3 days later. Since that time, China has reported increasing numbers of cases and deaths, partly attributable to wider diagnostic testing as awareness of the outbreak grows. Health officials have identified evidence of transmission along a chain of 4 “generations” (a person who originally contracted the virus from a nonhuman source infected someone else, who infected another individual, who then infected another individual),suggesting sustained human-to-human transmission. Current estimates are that2019-nCoV has an incubation period of 2 to 14 days, with potential asymptomatic transmission.1,2

Multiple countries have confirmed travel-associated cases, including Australia, Cambodia, Canada, France, Germany, Japan, Nepal, Singapore, SouthKorea,Taiwan, Thailand, United Arab Emirates, United States, and Vietnam. Vietnam identified the first human-to-human transmission outside China. Yet fundamental knowledge gaps exist on how to accurately characterize the risk, including confirmation of the zoonotic source, efficiency of transmission, precise clinical symptoms, and the range of disease severity and case fatalities.

Control Measures in China

The Chinese Lunar New Year is the largest annual mass travel event worldwide, risking amplification of the spread of 2019-nCoV. In response, China severely restricted movement across Hubei Province in 16 cities, affecting more than 50 million people.3 Authorities have closed public transit and canceled outbound transportation (air, train, and long-haul buses). Vehicular traffic in Wuhan was banned. China also imposed a ban on overseas travel with tour groups and suspended sale of flight and hotel packages. Authorities canceledLunarNewYear gatherings in Beijing as well as intra-province bus service into the nation’s capital. China's Finance Ministry announced ¥1 billion (US $145 million) to fund the response as well as the rapid construction of 2 hospitals inWuhan to treat those affected.

The Hong Kong Special Administrative Region declared its highest-tier emergency, curtailed public events, and barred travelers from Hubei Province. Travelers from mainland China must complete health declarations. Hong Kong has also closed schools and universities at least until mid-February.4

Control Measures by Governments Worldwide

As travel-associated cases of 2019-nCoV escalate, countries have implemented border screening. China itself sharply curtailed travel to and from Hubei Province. Consequently, governments have not yet felt the need to ban travel from China, with2exceptions:NorthKorea has prohibited entry of all Chinese travelers and Kyrgyzstan has closed its border with China. During previous outbreaks like SARS (severe acute respiratory syndrome) and Ebola, governments curtailed travel and trade, so future directives seem reasonably foreseeable.

Multiple countries (eg, Australia, Thailand, South Korea, Japan, India, Italy, Singapore, Malaysia, and Nigeria) have commenced temperature screening, symptom screening, and/or questionnaires for arriving passengers from China. The US Centers for Disease Control and Prevention launched enhanced, noninvasive screening of travelers from Wuhan at 20 major airports, while theUSState Department issued its highest-level travel advisory for Hubei Province: level 4, “do not travel.” The State Department now advises that people should “reconsider travel” for all of mainland China.

Non-pharmaceutical Interventions

The sheer scale of China’s cordon sanitaire across Hubei Province is unprecedented. Health authorities quarantined major cities during the 1918-1919 influenza pandemic, but with little lasting effect on the epidemic’s spread.5 The Ebola epidemic inWest Africa (2013-2016) spurred quarantines, such as the Liberian government’s unsuccessful and heavily criticized cordon sanitaire of 60000 to 120000 people inWest Point, Monrovia. The order led to violence and public mistrust that risked amplifying the spread of Ebola.

Gaining the public’s trust is critical to any public health strategy.The health system should facilitate and encourage individuals to promptly seek testing and treatment, as well as to cooperate with containment measures such as isolation and contact investigations. According to Wuhan officials, by the time China implemented the cordon sanitaire, up to 5 million individuals had already traveled fromWuhan for Lunar New Year.6 While social distancing measures can delay viral spread, involuntary restrictions of movement within Hubei are likely to erode community trust and undermine cooperation with health authorities. Within the cordon sanitaire, logistical issues are evident, already resulting in shortages of pharmaceuticals and medical equipment. With hospitals and clinics overcrowded and public transport limited, symptomatic individuals may delay access to treatment. There is also the possibility that congregating people in congested cities may still lead to infection, albeit in divergent ways.

Beyond the public health effects, enforcing cordons sanitaires can violate human rights, including the rights to dignity, privacy, and freedom of movement. The International Health Regulations (IHR) proscribe unnecessary interference with international travel and trade, while also requiring respect for the human rights of travelers. States must impose the “least restrictive” measures necessary to safeguard public health.7 While border screening has had questionable efficacy for detecting cases in past disease outbreaks, the enhanced noninvasive screening implemented by US officials appears consistent with IHR requirements, provided it is conducted in a manner that treats travelers with respect for their dignity, human rights, and fundamental freedoms.7

Role of the WHO

The IHR grants the WHO director-general power to declare a public health emergency of international concern (PHEIC) for an extraordinary event that poses a public health risk to other states through international spread and requires a coordinated international response. It is clear that the 2019-nCoV outbreak fully meets these legal criteria for a PHEIC. The director-general announced that on January 30 the Emergency Committee will reconvene to consider if the coronavirus outbreak constitutes a global health emergency. The escalating 2019-nCoV outbreak poses a significant risk to human health, international spread, and interference with international traffic.

WHO has declared 5 PHEICs: H1N1 (2009), polio (2014), Ebola in West Africa (2014), Zika (2016), and Ebola in the Democratic Republic of Congo (2019). The IHR does not grant WHO special powers or financing in the event of a PHEIC, suggesting an imperative to reform the regulations to give traction to an emergency declaration.8 Still, declaring a PHEIC is a powerful signal to the international community to launch a surge public health response, galvanizing political action and mobilizing funding. When declaring a PHEIC, the director-general can make influential, albeit legally non-binding, recommendations. Declaring a health emergency would be a critical opportunity for WHO leadership to set norms, devise a global strategy, and uphold principles meticulously articulated by 196states party to the IHR.

Bringing 2019-nCoV Under Control

The 2019-nCoV outbreak is currently not under control, with a high risk of spread in China and globally. Managing the outbreak requires international cooperation using traditional public health strategies that ultimately succeeded with SARS. The scientific community must fully characterize 2019-nCoV; epidemiologists must conduct intensive contact investigations; researchers should move rapidly toward development of medical countermeasures; and supply chains must mobilize to meet human needs for food, water, and medicine.

While China has considerable resources and technical competence, containment of 2019-nCoV requires a coordinated international response. WHO should exercise leadership, urgently convening a multidisciplinary committee to devise a global action plan for novel outbreaks, including surveillance, contact investigations, testing, and treatment; fostering public trust and cooperation; transparently sharing scientific information; and incentivizing academia and industry to develop vaccines and antiviral medications.

It is too early to predict how widespread and pathogenic 2019-nCov will become. It is better to act decisively now rather than wait to see how the outbreak unfolds globally. Beyond all, this global health threat teaches, once again, that it is far better to invest in preparedness to prevent, rapidly identify, and contain outbreaks at their source. Reacting after a novel infection has spread widely (perhaps overreacting with travel bans and quarantines) costs lives, economic resources, and the well-being of millions of people currently cordoned off in a zone of contagion.

• ARTICLE INFORMATION :Published Online: January 30, 2020. doi:10.1001/jama.2020.1097
• Conflict of Interest Disclosures: Mr Gostin is the director of theWorld Health Organization Collaborating Center on National and Global Health Law. No other disclosures were reported.
• REFERENCES
  • 1. World Health Organization. Novel coronavirus (2019-nCoV) situation report-8. https://www.who.int/docs/default-source/coronaviruse/situationreports/20200128-sitrep-8-ncov-cleared.pdf?sfvrsn=8b671ce5_2. January 28, 2020.
    2. US Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China: symptoms. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html . Published January 26, 2020. Accessed January 27, 2020.
    3. Shih G, Lynch DJ, Denyer S, Shammas B. Chinese coronavirus infections, death toll soar as fifth case is confirmed in U.S. https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-latestupdates/2020/01/26/4603266c-3fa8-11ea-afe2-090eb37b60b1_story.html . Published January 26, 2020. Accessed January 27, 2020.
    4. Hong Kong declaresWuhan virus outbreak “emergency”—the highest warning tier. Hong Kong Free Press. https://www.hongkongfp.com/2020/01/25/breaking-hong-kong-declares-wuhan-virusoutbreak-emergency-highest-warning-tier . January 25, 2020.
    5. 5. Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA. 2007;298(6):644-654.
    6. Shih G, Denyer S.Wuhan mayor says 5 million people left city in recent days.Washington Post. https://www.washingtonpost.com/world/coronavirus-china-latest-updates/2020/01/27/3634db9a-40a7-11ea-aa6a-083d01b3ed18_story.html. January 27, 2020.
    7. World Health Organization. International Health Regulations. 2nd ed. https://www.who.int/ihr/publications/9789241596664/en/ . Published 2008. Accessed January 27, 2020.
    8. Gostin LO, DeBartolo MC, Katz R. The global health law trilogy: towards a safer, healthier, and fairer world. Lancet. 2017;390(10105):1918-1926.

Joe Biden has created a war-cabinet-in-waiting on the coronavirus pandemic, with major figures from the Obama, Clinton and George H.W. Bush administrations drafting plans for distributing vaccines and personal protective gear, dramatically ramping up testing, reopening schools and addressing health-care disparities.

The effort began six months ago when the campaign consulted David Kessler, a former Food and Drug Administration commissioner under Presidents Bush and Bill Clinton, and Vivek H. Murthy, surgeon general under President Barack Obama, on how to run a presidential campaign during a pandemic.

The pair, along with a growing cadre of volunteer health experts, has been working behind the scenes to craft plans that could take effect Jan. 20, when the next president will take the oath of office, said Jake Sullivan, a senior policy adviser on the Biden campaign.

Biden has laid out a far more muscular federal approach than has President Trump, whose “failures of judgment” and “repeated rejection of science” the Democrat first pilloried in a Jan. 27 op-ed about the crisis. Biden has said that he would urge state and local leaders to implement mask mandates if they are still needed, create a panel on the model of President Franklin D. Roosevelt’s War Production Board to boost testing, and lay out detailed plans to distribute vaccines to 330 million people after they are greenlighted as safe and effective.

The Democratic presidential nominee’s “public pronouncements are not just about laying out an agenda for voters, but giving shape to an operational plan that he’s already starting to think about now for what Day One is going to look like,” Sullivan said.

Yet experts caution that even the best-laid plans will be challenged in a politically fractured nation where rampant disinformation about the novel coronavirus — often exacerbated by Trump himself — has complicated efforts to have people follow safety protocols like wearing masks and practicing social distancing.

“A lot of it is going to be out of Biden’s hands,” Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health, said of renewing faith in federal health officials. “It’s going to take time, and he is going to have to demonstrate that he’s restoring these agencies to their prior reputations through actions.”

By all accounts, the man who wins the Nov. 3 election will face a public health and economic crisis with little precedent. As of early September, the United States accounted for 4 percent of the world’s population but 23 percent of all coronavirus cases and 21 percent of deaths — a toll closing in on 200,000 and forecast to worsen significantly. Epidemiologists project a rise in cases and fatalities in late fall and winter as cold weather sends people indoors, students return to schools and colleges, and the pandemic converges with flu season.

Lindsay M. Chervinsky, the author of “The Cabinet: George Washington and the Creation of an American Institution,” said only a handful of incoming presidents have faced challenges as complex and dire as the one Biden would inherit if elected.

“With Biden, because this has been going on for a while, he would almost have to treat it as though he were starting from scratch and come up with a full-scale government response,” she said.

Biden has sought to make the crisis a referendum on Trump’s competence as well as his character.

At a campaign event Wednesday in Warren, Mich., he noted Trump’s assertions in recorded interviews with writer Bob Woodward that the president had intentionally played down the lethality and rapid spread of the coronavirus last winter, calling them “beyond despicable. . . . He knew how deadly it was. He knew and purposely played it down. Worse, he lied.”

Biden has also hammered Trump’s failure to take decisive steps to stem the spread of the virus. If the administration had acted early on, he said last week, “America’s schools would be open, and they’d be open safely. Instead, American families all across this country are paying the price.”

The Democratic nominee would have the federal government take the lead on many aspects of the response, from scaling up testing and contact tracing to setting strong national standards, drawing a contrast with Trump, who has ceded many of those matters to the states, with the federal government serving as a “backup” and “supplier of last resort.”

Trump dismisses Biden’s criticisms, citing his decision to seal U.S. borders, suspending entry from China on Jan. 31. But with community transmission of the coronavirus already underway in the United States by then and difficulties in screening passengers, experts have said those restrictions were ineffective.

Amid an outcry about the unavailability of tests, Trump also appointed Vice President Pence to oversee a high-level task force to respond to the virus. But the president has often played down or contradicted the advice of health officials on that panel, whether on treatments such as hydroxychloroquine or on reopening the economy.

Above all else, he has insisted that the country’s economic crisis is as critical as its health woes and has urged Americans to return to school and work as the best way to salvage the faltering economy. (Most public health experts and economists argue that there cannot be a true economic recovery without first bringing the outbreak under control.) In recent months, Trump has also focused single-mindedly on the pursuit of a coronavirus vaccine, which he predicts will win approval by year’s end or sooner, as part of the expedited research, development and distribution of vaccines and treatments under Operation Warp Speed.

“Americans have seen President Trump out front and leading the nation in the fight against coronavirus . . . while Joe Biden has been behind the curve and fearmongering to discredit the president,” said Trump campaign spokeswoman Samantha Zager.

The Biden campaign said the virus’s toll speaks for itself.

“With nearly 200,000 dead, more than 6 million infected with the virus and nearly 30 million on unemployment, we desperately need action and new leadership now,” said Jamal Brown, the Biden campaign’s national press secretary.

As Biden and his aides piece together a national strategy, they are contemplating myriad questions: How many tests a day can the country conduct? Will states and health-care workers have needed protective equipment and supplies, or will they still be battling shortages and competing against one another? Might cases plateau at 40,000 a day or more, climb higher, or finally begin to taper off?

“There’s a huge amount of preparation that needs to be done given the complete absence of leadership from the current administration, and no time to waste,” Sullivan said.

Among the campaign’s top priorities are planning for the complex challenge of distributing one or more coronavirus vaccines to tens of millions of Americans; appointing a “supply commander” to coordinate the distribution of supplies to states and localities; and, perhaps most important, unifying the country and restoring public trust in the federal government’s message.

The last task may be the most difficult, aides acknowledge. To that end, immediately upon taking office, Biden would call Democratic and Republican governors and mayors across the country to ensure that not only does the federal government speak with one voice, but that Americans hear the same message from their state and local leaders, Sullivan said. He would urge state and local leaders to issue mandatory mask orders if necessary and to work together on a nationwide vaccination campaign.

Biden has also vowed to have public health experts and doctors hold regular news conferences on the pandemic.

With the situation rapidly evolving, Biden and his running mate, Sen. Kamala D. Harris (D-Calif.), continue to receive regular briefings on the state of the pandemic.

Beginning in March, Kessler and Murthy prepared briefing documents of 80-plus pages that set the agenda, Kessler said. Biden peppered them with questions, several campaign aides said. How do you keep essential services going? How do you keep people safe? What kind of equipment do we need to provide for front-line workers and their families?

The campaign put together a six-person advisory committee of health experts that, in addition to Kessler and Murthy, includes former Obama advisers Lisa Monaco and Ezekiel Emanuel; Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center; and Irwin Redlener, a professor at Columbia’s Mailman School of Public Health.

The roster of experts offering advice, guidance and policy ideas has continued to grow rapidly, said several people familiar with the campaign.

Among Biden’s first appointments would be a supply commander, who would evaluate persistent shortages in equipment and test supplies, including swabs and reagents, his aides said.

That person would have to be able to identify bottlenecks and shortages in the supply chain for every component of tests, protective equipment and other material — whether the fabric used in N95 masks or reagents for diagnostic tests, said Nicole Lurie, a former Obama assistant secretary for preparedness and response and another campaign adviser.

Biden’s advisers have also prioritized planning for vaccine distribution on the assumption that one or more vaccines would be authorized, or close to such approval, by early next year.

“We’ve talked mostly about what’s going to be necessary to get a vaccine up and running, not just have a vaccine but actually produce it, bottle it, ship it out and vaccinate others,” said Emanuel, chairman of medical ethics and health policy at the University of Pennsylvania. “The logistics behind getting a vaccine to people is much more daunting than what people have thought through. . . . I don’t think our current infrastructure is sufficient.”

The Trump administration has a detailed vaccine distribution plan underway that the Centers for Disease Control and Prevention is overseeing, with backup from the Defense Department. At a news briefing last month, Trump said the United States is on pace to have more than 100 million doses of coronavirus vaccines ready before year’s end, and would partner with health-care giant McKesson to rapidly distribute them and related supplies as soon as one or more vaccines are approved. The administration has awarded billions of dollars to companies to manufacture those vaccines even before they win approval and to insulate them from the financial risks. It is also working with states and local governments on distribution plans that include supplies of syringes, plastic bandages and vials.

Unifying a bitterly divided nation might be the most difficult challenge of all, said aides and outside experts.

The single most important thing a President Biden must do would be to get buy-in for a new strategy from governors and mayors, as well as from the American people, said Leana Wen, an emergency physician and public health professor at George Washington University who was previously Baltimore’s health commissioner and is not part of the campaign.

Biden needs to be “the communicator in chief to turn this around,” Wen said. “He needs to convince people that they need to do what’s needed, while the government does what it needs to do.”

Otherwise, “if he orders a shutdown and 80 percent of people don’t comply, what good will that be?” she said, adding that it would be “a monumental task to get everyone on board.”

Biden’s advisers acknowledge that frequent and frank conversations with the American public will be essential.

“Lots of other countries have succeeded in controlling this, not because they have medicine we don’t, or a magic vaccine that we don’t,” Emanuel said. “They’ve been clear about the message, they’ve enforced it, and I think that’s what the future president is going to have to make clear to the American people — short-term pain for long-term gain.”

President-elect Joe Biden on Monday announced the members of his coronavirus task force, a group made up entirely of doctors and health experts, signaling his intent to seek a science-based approach to bring the raging pandemic under control.

Biden’s task force will have three co-chairs: Vivek H. Murthy, surgeon general during the Obama administration; David Kessler, Food and Drug Administration commissioner under Presidents George H.W. Bush and Bill Clinton; and Marcella Nunez-Smith, associate dean for health equity research at the Yale School of Medicine. Murthy and Kessler have briefed Biden for months on the pandemic.

Biden will inherit the worst crisis since the Great Depression, made more difficult by President Trump’s refusal to concede the election and commit to a peaceful transition of power. The Trump administration has not put forward national plans for testing, contact tracing and resolving shortages in personal protective equipment that hospitals and health-care facilities are experiencing again as the nation enters its third surge of the virus.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” Biden said in a statement. “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.”

The United States is recording more than 100,000 new coronavirus cases a day and, on many days, more than 1,000 deaths, a toll expected to worsen during the crucial 10-week stretch of the transition. It remains unclear whether Trump or his top aides will oversee and lead a robust response to the pandemic during the transition, which could further exacerbate the crisis Biden and Vice President-elect Kamala D. Harris inherit.

The 13-member task force also includes former Trump administration officials, including Rick Bright, former head of the Biomedical Advanced Research and Development Authority, who, after being demoted, spoke out against the administration’s approach to the pandemic. Luciana Borio, director for medical and biodefense preparedness on Trump’s National Security Council until 2019, is also on the panel.

The group includes several other prominent doctors:

• Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

• Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School who is a prolific author.

• Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

• Eric Goosby, global AIDS coordinator under President Barack Obama and professor of medicine at the University of California at San Francisco School of Medicine.

• Celine R. Gounder, clinical assistant professor of medicine and infectious diseases at New York University’s Grossman School of Medicine.

• Julie Morita, executive vice president of the Robert Wood Johnson Foundation, a philanthropy focused on health issues.

• Loyce Pace, president and executive director of the Global Health Council, a U.S.-based nonprofit organization dedicated to global health issues.

Robert Rodriguez, professor of emergency medicine at the UCSF School of Medicine.

Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center, and Beth Cameron, director for global health security and biodefense on the White House National Security Council during the Obama administration, are serving as advisers to the transition task force.

Task force members will work with state and local officials to craft public health and economic policies to address the virus and racial and ethnic disparities, while also working to reopen schools and businesses, the transition team said in a news release.

While the makeup of the task force garnered widespread praise, Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said the group needs more geographic diversity.

“They are all from the Acela corridor or the [San Francisco] Bay Area,” he said. “Who is going to be the field marshal or the supreme allied commander who goes into the middle of the country and gets this done? The coasts are doing okay, but the red states are being hammered and the deaths are going to be extraordinary. There needs to be a frank reckoning between leaders of the two parties, to say we cannot let this happen.”

Public health experts said Biden should use the transition to provide leadership as the pandemic continues through a deadly stretch and begin communicating a strong national message.

“Clearly from the election outcomes, half the country doesn’t believe we’re in a crisis,” said Kavita Patel, a fellow at the Brookings Institution who worked on health policy in the Obama administration. Biden and Harris “have an incredible platform that can be used for communication. The country needs clear daily briefings that we thought we’d get from the White House coronavirus task force. They have an incredible platform, if not an official platform.”

Biden plans to call Republican and Democratic governors to ask for their help in developing a consistent message from federal and state leaders, according to three Biden advisers who spoke on the condition of anonymity because they were not authorized to speak publicly about these matters. He will urge governors to adopt statewide mask mandates and to provide clear public health guidance to their constituents, including about social distancing and limiting large gatherings.

The task force will have subgroups that focus on issues related to the response, including testing, vaccine distribution and personal protective equipment, according to two people familiar with the plans who spoke on the condition of anonymity to reveal plans that were not yet public.

In his victory speech Saturday, Biden addressed challenges in bringing the pandemic under control.

“We cannot repair the economy, restore our vitality or relish life’s most precious moments — hugging a grandchild, birthdays, weddings, graduations, all the moments that matter most to us — until we get this virus under control,” Biden said. “That plan will be built on a bedrock of science. It will be constructed out of compassion, empathy and concern. I will spare no effort — or commitment — to turn this pandemic around.”

Yet the plans Biden laid out on the campaign trail are set to collide with political realities. That includes a deeply divided nation in which more than 71 million people voted for Trump and the possibility of having to navigate a Republican-controlled Senate disinclined to support a greater federal role in testing and contact tracing, among other responsibilities now left mostly to the states.

Biden’s most ambitious plans will require significant congressional funding. Senate Majority Leader Mitch McConnell (R-Ky.) has said he would like to pass new coronavirus relief measures during Congress’s lame-duck session, and Congress faces a Dec. 11 government funding deadline. Biden and his team are poised to begin engaging with congressional Democrats on their priorities.

Biden’s plans include dramatically expanding testing and building a U.S. public health jobs corps to have 100,000 Americans conduct contact tracing. They also include ramping up production of personal protective equipment and implementing a vaccine distribution plan.

Murthy, who served as the 19th U.S. surgeon general, is a physician whose nomination was stalled in the Senate for more than a year because of his view that gun violence is a public health issue. Three months into the Trump administration, he was replaced as “the nation’s doctor” with more than two years left on his four-year term.

In 2016, he wrote a landmark report on drug and alcohol addiction, which put that condition alongside smoking, AIDS and other public health crises that previous surgeons general addressed. The report called the addiction epidemic “a moral test for America.” Murthy’s office sent millions of letters to doctors asking for their help to combat the opioid crisis.

The son of immigrants from India, he earned medical and MBA degrees at Yale before joining the faculty at Harvard Medical School, where his research focused on vaccine development and the participation of women and minorities in clinical trials.

After leaving his post as surgeon general, he wrote a book on loneliness and social isolation, including their implications for health, that grew out of his conversations with people in clinical practice and as surgeon general.

Several public health officials celebrated Nunez-Smith’s leadership role on the task force. Her research focuses on promoting health and health-care equity in marginalized populations, according to her Yale biography. She has also studied discrimination that patients endure in the health-care system — expertise that many said was welcome in an epidemic that is disproportionately affecting people of color.

Kessler was FDA commissioner from 1990 to 1997, during the George H.W Bush and Clinton administrations. He is well-known for his attempts to regulate cigarettes — an effort that resulted in a loss in the Supreme Court, which ruled that the agency did not have the authority. That prompted Congress to pass a law, enacted in 2009, that explicitly gave the agency that power.

Kessler, a pediatrician and lawyer, worked at the FDA to accelerate AIDS treatments and on food and nutrition issues. He oversaw the FDA’s development of standardized nutrition labels and notably ordered the seizure of orange juice labeled “fresh” because it was made from concentrate. He has written several books on diet, mental illness and other topics, and has served as dean of the medical schools at Yale and UCSF.