Few people have trouble understanding the purpose of public education or public housing: they are tangible programs that, at least in theory, are designed to improve our lives. Public-health accomplishments, however, are measured in an entirely different way: success is defined by what is prevented, not by what is produced. This creates an odd psychological dynamic.

When public-health programs are successful, they are invisible, and what is invisible is almost always taken for granted. Nobody cheers when they remain untouched by a disease that they hardly knew existed. That makes it easy for shortsighted politicians to deny long-term realities. And that is what they almost always do.

Members of Congress hardly made a peep in 2018, when the Trump Administration disbanded the White House’s National Security Council Directorate for Global Health Security and Biodefense. The directorate was established after the Ebola epidemic in West Africa in 2014 with a simple mission. Beth Cameron, its former head, recently wrote in the Washington Post: “to do everything possible within the vast powers and resources of the U.S. government to prepare for the next disease outbreak and prevent it from becoming an epidemic or pandemic.’’

I have never met an epidemiologist or virologist who expressed even the slightest doubt that such an outbreak would occur. Nor would anyone have to look hard for evidence that it would. In just the past twenty years, we have seen a rolling cascade of dangerous viral epidemics, including SARS, MERS, avian influenza, Ebola, and the H1N1 influenza epidemic of 2009, which, alone, infected as many as 1.4 billion people. If it had been as lethal as current low-end mortality estimates of COVID-19—about one per cent—as many as fourteen million would have died.

But we lucked out in 2009, because viruses do not decide how deadly they will turn out to be, and H1N1 was relatively mild. Public-health defense systems are created to protect us in the future, not in the past. Yet, in a single stroke, the Trump Administration fired the people whose job it was to plan for—and attempt to blunt—inevitable epidemics, such as the one that is currently bringing much of the world to its knees.

The results of such acts of denialism are painful. And, although Donald Trump deserves condemnation for constantly understating and ignoring this threat, he is hardly the first American leader to gut or ignore the very system that protects the people.

In 2000, the Institute of Medicine issued a report titled “Public Health Systems and Emerging Infections: Assessing the Capabilities of the Public and Private Sectors.” One of the report’s findings was that the basic infrastructure of the American public-health system, particularly at the state and local levels, is eroding. With that deterioration comes a diminished capacity to predict, detect, and respond to an emerging infectious disease. There have been scores of similar reports issued in the past twenty years—nearly each of which, like this one, was essentially ignored. This report was edited by the late Nobel laureate Joshua Lederberg, whose insights into the role of viruses and bacteria in the life of this planet should be read by every elected official with the power to appropriate even a single dollar toward our health care.

We also ignore the threat of diseases that have killed people for thousands of years. By the nineteen-seventies, it looked as if the United States was on the verge of eliminating tuberculosis as a significant cause of illness. So the political leadership simply stopped funding research programs. Experts warned that this neglect would guarantee a new epidemic, but nobody listened. As the number of TB infections grew, specialists became increasingly alarmed. Yet, every year between 1981 and 1987, the Reagan Administration opposed the very existence of a federal TB program, calling for its repeal in every new budget.

By 1992, the United States had created its first preventable epidemic—with new TB strains that proved resistant to conventional antibiotics. I wrote about this needless resurgence at the time, noting that the last time New York City had four thousand cases of TB, in 1967, more than a thousand beds in municipal hospitals were specifically assigned for tuberculosis patients. By 1992, when there were four thousand cases that were even more virulent, the number of available beds was fewer than seventy-five.

What will it take to interrupt this endless cycle of purposeful ignorance? It is not hard to predict what will happen after this pandemic fades—as eventually it will. If more people die and become sick than we expect, groups such as the World Health Organization will be denounced for their inability to protect lives. If the death toll is far lower than what is envisioned in the worst-case scenarios, people will denounce the same groups, along with the Centers for Disease Control and Prevention, as needlessly alarmist and blame them for the collapse of the economy.

There have been deep, systemic, and horrifying failures—most notably our inability to mobilize a testing regime that would provide the data that health-policy leaders need to make every other decision. You cannot understand the cause of a disease, its natural history, or the best ways to prevent infection without the ability to test the population. We have long had that ability—there are hundreds of American universities and medical centers that could create a useful diagnostic for COVID-19—but we have never bothered to properly prepare.

At a White House briefing on Tuesday, the President attempted to suggest that the federal response had been adequate. That is far from true. Trump has also suggested that the Obama Administration acted badly during the 2009 H1N1 epidemic and stated, as proof, that seventeen thousand people died. He was right about the death toll; what he seems not to understand is that that number is far lower than the death rate in any average influenza season.

Epidemics are spread at least as much by ignorance as by a virus. The tragedy of COVID-19 is that, this time, we are not ignorant. The virus was characterized quickly and sequenced in less than a month. By the end of February, scientists had re-created the coronavirus in a lab setting, and the data have now been shared throughout the world with anyone wishing to work on a vaccine, or design a diagnostic or a drug.

We have accumulated a huge amount of knowledge about this virus, with unprecedented speed. But it would be hard to have squandered our advantages more completely. Finally, Americans have been promised that widespread testing—which already exists in China, South Korea, Italy, and other countries—will be introduced, this week. That may help us slow the spread of this disease and lessen its impact. The bigger question is whether we will learn from the fact that this pandemic will kill many more people than it had to. I’d like to think we would, but, if the past is any guide, this pandemic will end with a bunch of new commissions and ominous reports. As soon as they are printed, they will be forgotten.

A Guide to the Coronavirus