The United States’ preparedness and response capabilities have buckled under the stress of the ongoing COVID-19 pandemic and proactive work is needed to meet the next infectious disease before it strikes, said experts during the Bipartisan Commission on Biodefense May 8 virtual meeting.
“America continues struggling to catch up with the disease and get ahead of it,” said former U.S. Sen. Joseph Lieberman, co-chairman of the Bipartisan Commission on Biodefense. “We at the commission know with a certainty that this is not the last infectious disease pandemic we face and it may not be the biggest,” noting that COVID-19 could return in the fall “with equal, or — God forbid — greater ferocity.”
The six-member commission, established in 2014, released A National Blueprint for Biodefense: Leadership And Major Reform Needed To Optimize Efforts in October 2015. The report’s bottom line, said Lieberman, was that America was not prepared for an infectious disease pandemic, a biological attack, or the accidental release of a deadly pathogen because the country lacked the needed medical countermeasures, vaccines, treatments and the ability to rapidly develop them.
And still, America remains “much too much dependent on other countries” for many of the medicines and essential supplies that are needed now, Lieberman said, adding that the U.S. also needs improved surveillance and detection capabilities to help identify and contain the spread of COVID-19.
While several recommendations from the commission’s report were included in U.S. President Donald Trump’s National Biodefense Strategy issued in September 2018, Lieberman said that “sadly, one COVID-19 hit and very few of the ideas we’ve put forward and even those that were adopted in legislation … were adopted or funded.”
“The conclusion we reached in 2015 was that America was not prepared, which unfortunately is painfully true in 2020 when the infectious disease pandemic struck,” he said.
On Friday, the Bipartisan Commission on Biodefense premiered the pre-taped May 6 “COVID-19: Forewarned, But Not Forearmed,” a meeting to better understand the nation’s ongoing response to the pandemic, its readiness to address the spread of the disease, and implications for bolstering preparedness for a new biological threat.
“We thought six years ago that [a potential pandemic] demanded immediate attention,” said former Pennsylvania governor and former director of the U.S. Office of Homeland Security Tom Ridge, who also co-chairs the commission. “What we’ve seen has validated our work and we hope to play as constructive a role as we have in the past to help identify gaps.”
“We know that this battle — this war, if you will — is not over,” Lieberman added.
Speakers who shared their perspectives, experiences, challenges, and recommended solutions regarding the federal and non-federal responses to COVID-19 included U.S. Rep. Donna E. Shalala (D-FL), an original member of the Bipartisan Commission on Biodefense who helped craft its Holding the Line on Biodefense: State, Local, Tribal, And Territorial Reinforcements Needed released in October 2018.
“Boy we weren’t ready,” said Rep. Shalala, who previously served as the U.S. Secretary of Health and Human Services (HHS). “All the recommendations we made, building up the infrastructure and readiness strategy, we still were not ready for COVID-19 at any level.”
Shalala said that the most important recommendation in that report regards an integrated budget, which “could be the way to put together a readiness strategy for the future.”
“If we lead with budget reform to put the pieces together, I think we have a real chance of getting this readiness strategy in place,” she told the commission members.
In April, Shalala joined several colleagues, including bill sponsor U.S. Rep. Jamie Raskin (D-MD), in introducing the bipartisan Reopen America Act of 2020, H.R. 6525, which would establish a comprehensive and science-based national plan to re-open the U.S. economy through federal-state collaboration, while protecting the public health against recurring COVID-19 outbreaks. The measure currently has 66 other cosponsors.
“Although our present social distancing is a necessary public health measure, it is critical to the livelihood of hundreds of millions of Americans that we reopen our economy and social life as soon as we can,” Rep. Raskin said when introducing H.R. 6525. “To reopen America, we must ensure that expanded free testing, contact tracing and strict public health safeguards are firmly in place so that Americans will remain safe and re-spiking infection rates do not compel yet another sudden economy-shattering closure.”
Shalala said the legislation would guarantee that the U.S. takes a science-based approach to ensure that “the right plans, tools and resources” are in place to help citizens safely and permanently resume normal life.
Additionally, H.R. 6525 would invite the states, District of Columbia, and the territories to submit reopening plans to the HHS Secretary. Once approved, the federal government would reimburse the states for the costs of implementation, including more testing to screen for the infected, personal protective equipment (PPE), more personnel and improved information systems, and expanded contact tracing, said Shalala.
If enacted, H.R. 6525 also would create a federal Health Equipment Production Board to mobilize increased production of tests, PPE, ventilators, and effective medical treatments, and which would reimburse states that group together and collaborate with each other to spur industry scale up of necessary supplies.
Shalala told the Bipartisan Commission on Biodefense members that the commission’s reports have been invaluable to members in Congress, and for any forthcoming reports, she suggested that along with the proposed integrated budget, the commission recommend a budget that respects the federalism piece; advises what to fund and what to put in place; and includes initial multiple-year funding estimates.
During part two of the commission’s meeting, experts focused on COVID-19 leadership, supply chain and diagnostic topics, as well as how to better defend against future biological threats.
Tevi Troy, former HHS deputy secretary and former deputy assistant and acting assistant to President George W. Bush for domestic policy, pointed to several issues around the current pandemic that could help inform policy going forward, including “the hiccups” around international monitoring by the U.S. public health community and the World Health Organization that may have led to the spread of COVID-19.
Tracing and isolation also didn’t work well and while the Strategic National Stockpile had ample medical countermeasures for influenza, it didn’t have them for the coronavirus, which is why the U.S. resorted to social distancing, Troy said.
“We need to look at bolstering these three levels,” said Troy, suggesting that the nation treat them using a military strategy in which it “brings in the troops to where the problems are: New York City and nursing homes,” where federal resources should be directed.
Nicolette Louissaint, executive director of the nonprofit Healthcare Ready and former senior advisor to the special coordinator for Ebola at the U.S. State Department, said the supply chain is another important consideration.
The sector knew going into the pandemic that it wasn’t properly prepared, said Louissaint, who noted three ongoing challenges: an unclear sense of roles between the federal government and the private sector; a lack of sustained government investment; and not making the scientific and R&D communities part of the considerations for the entire supply chain pipeline.
For instance, federal traffic restrictions have impeded the medical and pharmaceuticals supply chain, Louissaint said, which will see continued demand for certain products.
“We’re less than a month away from hurricane season and reopening plans that are taking shape across the nation are very concerning,” she said, noting two related risks.
First, there will be increased demands for PPE across myriad sectors and rushed reopening plans that are undertaken without clear guidelines will further stress healthcare and press demand.
“The same surge in demand at the same time means planning has to be global,” said Louissant. “It’s not feasible to keep the medical supply chain in the U.S. Being reliant on domestic production can be part of the solution, but not the entire part.”
Second, the Strategic National Stockpile already is an under-resourced model for sufficient coverage of products that are critically needed for national security, she said, suggesting that other ways must be found to expand the stockpile’s capacity and to review and sustain its investment.
Brent Satterfield, founder, chief science officer and chief technology officer at Co-Diagnostics Inc., agreed that federal policies to shut down the borders and various industries have made response efforts difficult and he suggested that from a regulatory perspective, the Food and Drug Administration’s Emergency Use Authorization be updated to hasten testing and treatment options.
The role of the Centers for Disease Control and Protection also should be enhanced around information sharing and data collection regarding treatments, Satterfield said, noting that better organization across the government and private sector could help the nation meet its demands.
Additionally, COVID-19 testing is currently being interrupted by political in-fighting that hasn’t helped overall response efforts, according to Satterfield. “We need to remain focused on the end goal of saving lives by getting diagnostics and tests out there,” he said.