A leadership spot at the highest level in the United States government would be best positioned to harness and focus available resources and influence governors and the private sector on a common biodefense vision, a Texas A&M University (TAMU) international affairs expert said this week.
Likewise, two planks of preparedness must be financed to improve a collective prepare-and-response plan for fighting global pandemics, according to a World Health Organization (WHO) report.
“The growing threat of emerging infectious diseases with pandemic potential, as well as the real threat of bioterrorism demand more focused leadership attention to overcome barriers to real progress,” Andrew Natsios, executive professor and director of the Scowcroft Institute of International Affairs at TAMU’s Bush School of Government and Public Service, told Homeland Prep News on Thursday.
As discussed in the Scowcroft Institute white paper, “The Growing Threat of Pandemics: Enhancing Domestic and International Biosecurity,” Natsios said there are almost a dozen U.S. departments and/or agencies and approximately 50 Senate-confirmed officials with biodefense and global health security responsibilities.
“Despite the hard work of many in public health, emergency management and foreign assistance at all levels of government, industry and NGOs, the United States and the international community are not prepared and we remain vulnerable,” said Natsios, who authored the white paper along with Scowcroft’s Gerald Parker, senior fellow for pandemic and biosecurity policy programs, and researcher Christine Crudo Blackburn.
Stated even more urgently, WHO said in its report that the global pandemic response currently is in a phase of neglect, “leaving the world highly vulnerable to massive loss of life and economic shocks from natural or human-made epidemics and pandemics.”
Stateside strategy
Natsios advises that a strong centralized leadership, coupled with a new national biodefense strategy tied to a unified budget with accountability for outcomes, would “enable effective decentralized implementation and more effective utilization of available resources before an outbreak occurs.”
Specifically, the U.S. vice president should take on this leadership role, he said.
Comparatively, Natsios explained, a single cabinet-level secretary, such as the secretary of the U.S. Department of Health and Human Services (HHS), doesn’t have the necessary authorities or expertise, domestically or internationally, to lead such a national multi-disciplinary, all-of-government-and-community approach.
“The Commander in Chief is ultimately responsible and will be held accountable if we fail to prevent an outbreak from becoming a pandemic and potential black swan event,” Natsios said. “We believe the threat and our continued vulnerabilities are of such seriousness that the vice president should be vested with this responsibility on behalf of the president on a day-to-day basis, and that this responsibility should transcend administrations for preparedness to receive priority and continuity.”
Besides the president, he said, the vice president, national security advisor and director of the Office of Management and Budget (OMB) are effectively the only positions that can transcend administrations.
Additionally, legislative changes may be necessary to require the OMB director to consolidate individual department/agency biodefense and health security budgets to enable better transparency and accountability, said Natsios, the former administrator of the U.S. Agency for International Development from 2001 to 2006 where he managed reconstruction programs in Afghanistan, Iraq and Sudan.
Such a recommendation resembles the approach that former President George W. Bush implemented for the pandemic influenza emergency supplemental request of 2005 that was approved by Congress in 2006, said Natsios, a retired U.S. Army Reserves lieutenant colonel and Gulf War veteran.
“This multidisciplinary, cross department/agency budget was coupled to strong centralized leadership, a new pandemic influenza national strategy and a detailed implementation plan,” he said. “Day-to-day leadership was provided by the special assistant to the president for health security and biodefense and overseen by the homeland security advisor, the vice president and the president on a regular basis.
“Preparedness outcomes and real progress were made that otherwise would not have been possible,” he added.
In fact, Natsios said that the lack of centralized leadership at the federal level could lead to confusion during an epidemic or pandemic.
“Unfortunately, lessons observed whether intended or not reveal that the United States’ biodefense and emerging infectious disease preparedness strategy has evolved to a reactive approach that depends on emergency supplemental appropriations after an outbreak occurs,” he said. “This is very costly and does not prevent catastrophic impacts to the United States. And this was before [President Trump’s 2018] proposed budget cuts.”
Global plan
There are two global preparedness pieces to be strengthened, according to a WHO May 18 journal article summarizing the recommendations of a workshop held at the National Academy of Medicine in Washington, D.C., co-hosted by the Center for Policy Impact in Global Health at Duke University and Norway’s Coalition for Epidemic Preparedness Innovations.
The first should be public health capacity—including human and animal disease surveillance, according to the WHO report. This would be “a first line of defense,” particularly the animal surveillance part because “most emerging infectious diseases with outbreak potential originate in animals.”
The workgroup recommended that financing would come mainly from domestic resources, “but supplementary donor financing to low-income, high-risk countries is also needed.”
The second piece would entail financing global efforts to accelerate the R&D of vaccines, drugs and diagnostics for outbreak control, and to strengthen the global and regional outbreak preparedness and response system, the WHO report says.
“These two international collective action activities are underfunded. Medical countermeasures against many emerging infectious diseases are currently missing. We need greater investment in development of vaccines, therapeutics, and diagnostics to prevent potential outbreaks from becoming humanitarian crises,” according to the report.
Natsios said that the 2014-2015 Ebola outbreak exposed many response deficiencies and vulnerabilities in the United States, multilateral international organizations — such as the WHO — and WHO member states.
“The response to Zika has been better, both in the [U.S.] and internationally, perhaps due to the slower progression of Zika spread,” he said. “Nonetheless…the United States remains vulnerable to epidemics and a pandemic.”
Natsios said that reforms in the international response structures are required, along with a commitment to the Global Health Security Agenda.
“We believe that the United States, with our international partners, must do more to prevent outbreaks at their source. We can either choose to fight infectious diseases with pandemic potential overseas where they emerge through health systems institutional investments, or wait to fight a more costly and deadly battle at home,” Natsios said.
And while many may dismiss these threats, he added, “I believe we ignore the bioterror threat at our peril.”