A panel of public health experts and U.S. senators agreed on several steps Congress should take to prevent or remediate the next pandemic, basing their proposals on lessons learned during the 14 months working to resolve the COVID-19 health crisis.
Among their recommendations, aired during a hearing Wednesday before the U.S. Senate Homeland Security and Governmental Affairs Committee, are: the need for permanent stockpiles of medical and healthcare supplies readily available; greater capacity for data collection, interpretation and sharing; clear delineation of federal agency authority; creation of a permanent rapid response team for everything from natural disasters to a pandemic, and policies to address the disparate effects on people of color and low income.
Dr. Julie Gerberding, former director of the Centers for Disease Control and Prevention at the Department of Health and Human Services (HHS), told the panel: “Perhaps the most important of the many lessons learned from this experience are: (1) the CDC, FDA, public health laboratories, private sector diagnostic companies, and academic institutions must collaborate in the development of rapid, reliable, and scalable diagnostic testing platforms, and also plan and exercise their deployment and updating; (2) existing regulatory policies made early collaborations challenging; (3) the state and local public health workforce is severely hampered by inadequate human and financial resources to provide testing, trace contacts, and implement immunization programs at the scale required for success.”
She made several recommendations to address these shortfalls in dealing with the COVID-19 pandemic. Among them: prioritize virus testing and vaccines for people in the most vulnerable communities; enhance access and linkages to primary care medical services, cancer screening, perinatal care, routine vaccinations, mental health services, substance use services, and dental care, especially among people in hard-to-reach communities and environments; conduct a thorough medical supply chain assessment; examine how to best strengthen the Strategic National Stockpile performance to be the most effective and efficient during a pandemic; augment supplies of antibiotics, intravenous fluids, and other medicines to sustain critical care; formalize augmented health care workforce contingency plans and update training; create an interoperable pandemic health data network (instead of local and state stand-alone networks); engage and incentivize the private sector in planning efforts; and exercise and improve planning with accountability from partners to follow through on lessons learned.
“We also must achieve greater operational capability to execute in disordered settings around the world. We need to invest directly and consistently, over the next decade, in the capacities of low-income countries,” Gerberding told the senators. “The best approach to protect the American people is to stop outbreaks at their source. The Global Health Security Agenda has a proven track record in building health systems and health security preparedness, and that investment must continue. The United States must establish permanent health security leadership as a central pillar of the National Security Council, by a credentialed and qualified expert. This is critical to guaranteeing effective oversight of global health security and biodefense policy and spending. As has been reinforced over the last year, public health is an essential component of national security.”
Sen. Gary Peters (D-MI), the chairman of the committee, said some of these issues, most of which appear to have bipartisan support, are already being addressed in legislation the committee is drafting.
Several experts and senators said some of these shortfalls had already been addressed and planned for but have been ignored by the Trump administration.
“We have long known that a pandemic was not a matter of if, but when. Over the past 30 years, our country has made substantial investments to develop robust authorities, plans, and systems to respond in the face of contagion rapidly and nimbly. Yet, ongoing preparedness program funding cuts, and failures of leadership along with active dismantling of preparedness infrastructure by the Trump administration thwarted our ability to build on the institutional knowledge gained during the 2009 H1N1 pandemic, and to rapidly and fully leverage these investments and lessons to protect the American people when confronted with COVID-19,” said Dr. Nicole Lurie, former Assistant Secretary of Preparedness and Response (ASPR) at HHS.
“Unfortunately, a series of actions over the period leading up to the pandemic left us less ready than we otherwise might have been,” Lurie said. “Among them were the dismantling of the pandemic office at the NSC, and the degradation of the PHEMCE process, which would have been critical to an early start on countermeasures. Another example is a contract for a high-speed mask production line that was terminated without an obvious replacement. Sustaining funding for preparedness has proved challenging across all administrations. For example, from its peak in 2002, the Hospital Preparedness Program alone experienced a 50 percent decline over a 16-year period. The public health preparedness system tenuously persists with repeated cycles of panic and neglect, hamstringing efforts to build durable capabilities, not least a high quality, sustainable workforce.”
“But even these actions cannot fully explain the failure of the Trump administration to act early in the pandemic. Our withdrawal from the world stage compromised important strategic global health relationships; nonetheless, there was sufficient warning of a potential pandemic by the last week in December 2019, to warrant attention, and by mid-January, when cases were detected outside of China, the threat was very clear.”
Sen. Peters agreed with Dr. Lurie, asserting the Trump administration’s delegation of critical policy-making authority early in the pandemic “contributed to the carnage of the past year,” as American lives lost to COVID-19 are approaching 560,000.
Sen. Rob Portman (R-OH), the ranking Republican on the committee, called for a balanced bipartisan approach to the panel’s review, calling COVID-19 an “unprecedented challenge, to, in many ways, an unprepared U.S. healthcare system.” He insisted in the initial stages of the pandemic leadership roles for federal agencies were not clearly defined. “They’re still not, in some cases.”
Sen. Peters asked the experts whether they agree with the assertion by Dr. Deborah Birx, the Trump administration’s Coronovirus Response Coordinator, that the first 100,000 deaths came from a critical surge while all of the rest could have been mitigated. “I absolutely agree,” said Lurie, who suggested at least 40 percent of the remaining COVID-19 deaths may have been avoidable. She said the nation is still grappling with the politization of the pandemic, with many Americans still at odds over remedial actions like wearing masks, social distancing or even getting vaccinated.
“With hindsight being 20/20, I am confident in saying that the United States was not prepared for COVID-19,” said Joseph Nimmich, former deputy administrator of the Federal Emergency Management Agency (FEMA). “But the challenges, missteps, and even some of the successes during the early days of the pandemic should not have been a surprise to anyone involved in emergency response at the federal level. HHS ASPR’s ‘Crimson Contagion’ pandemic exercise, run from January to August 2019, identified and predicted almost all of the problems encountered.”
Nimmich called for the development of rapid deployment teams, a Civilian Expertise Reserve (CER) program to recruit civilians with targeted skill sets that FEMA can deploy when required. “Individual CERs could activate for service in both state and federal crises,” said Nimmich. “Aspects of FEMA’s Disaster Reservist, Surge Capacity Force and Community Emergency Response Team programs may offer useful insights on how to streamline time commitment requirements, recognizing that CERs will need to take into account training and skills already resident within certain professions. The National Guard’s command and control structure could also present a model for designing the CER management and leadership systems. CERs would have state-based operations and a leadership hierarchy in each state, with national leadership based in Washington, D.C., which would assume command upon federalization.
Elizabeth Zimmerman, former associate administrator for the Office of Response and Recovery at FEMA, told the senators now is a good opportunity to determine what data being collected provides the best information for dealing with an outbreak and which people it should be shared with.
Sen. Ron Johnson (R-WI) said the U.S. needs to stop depending on foreign manufacturers, particularly China, to create critical medicines and their precursors and start manufacturing those materials in the U.S. “The vulnerabilities are clear now,” Johnson said.
Sen. Alex Padilla (D-CA) said any future pandemic response planning needs to consider the disparate effects of public health crisis on minorities.
Sen. Jacky Rosen (D-NV) said public health agencies need to enhance their data collection capabilities so that the need to get a full picture of a pandemic does not slow down a response to the next pandemic.
Peters asked whether the federal government should create a permanent accounting of medical supplies needed for a pandemic. Lurie answered yes, in order for the government to know what is available when an emergency arises. “We need to have the ability to monitor critical and healthcare supplies,” said Lurie. “This is an area where I think new authorities and funding are going to be really, really important.”