When COVID-19 exploded onto the world stage, neither the United States nor the rest of the world was ready. Thanks to extraordinary research and development efforts, multiple vaccines are now available. Experts warn, however, that COVID-19 is far from the last pandemic. “World populations, including Americans, will remain vulnerable to new outbreaks of infectious diseases” states the recent Annual Threat Assessment of the U.S. Intelligence Community. But we can, however, defeat the next pandemic — in advance — by taking four critical steps.
First, the federal government needs to lead “moonshot” research and development efforts directed to countering future pandemics. Federal investment in ambitious science, from space exploration to the internet, has long been a driving force of U.S. leadership. While much of the underlying research for the novel mRNA vaccines was undertaken by Dr. Katalin Karikó and Dr. Drew Weissman, developmental efforts research were further funded nearly a decade ago by the Defense Advanced Research Projects Agency (DARPA), in a 2013 contract with Moderna Therapeutics. Seven years later, Moderna scientists partnered with the National Institute of Allergy and Infectious Diseases (NIAID) to co-develop a safe, effective, and novel COVID-19 vaccine — one of two currently authorized mRNA COVID-19 vaccines in the US (the other being from BioNTech where Dr. Kariko is now a senior vice-president).
The Biden administration has commendably included funding focused on pandemics in both its “American Jobs Plan” legislation and the FY2022 discretionary budget request (the “skinny budget”), each now before Congress. The proposed legislation includes provisions for increased spending for the Centers for Disease Control and Prevention (CDC), the national stockpile for drugs and medical materiel, and the establishment of an “Advanced Research Projects Agency — Health.” As Congress reviews the budget, it equally needs to include high levels of funding required for R&D efforts to combat future outbreaks of infectious diseases including for the necessary diagnostics, therapeutics, and vaccines. Funding directed toward seeking a universal flu vaccine is an example of the kind of effort needed to stay ahead of the next pandemic.
Second, a dedicated effort to combat “antimicrobial resistance” is required. Effective treatments — along with vaccines — are key to containing disease spread and limiting harm. Unfortunately, our most stalwart sentinels against infection — antibiotics — are rapidly losing their efficacy. The consequences during a pandemic are substantial. As COVID-19 has illustrated, serious respiratory infections can be complicated by secondary infections that are increasingly difficult to treat due to antimicrobial resistance.
The current antibiotics market has not been structured for breakthrough research in part because of poor return on investment (ROI) to companies. One bright spot has been recent joint efforts by leading pharmaceutical companies, medical societies, Congress, and other experts to support the development of new antibiotics and promote appropriate use of existing ones. A group of pharmaceutical companies has recently pledged $1 billion for a fund to support antimicrobial R&D. Congress should enhance this private R&D effort with complementary and sustained funding.
Additionally, in 2020 the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, was introduced in Congress that would provide significant government payments to developers of a “critical need antimicrobial” so long as they would ensure a reliable supply chain generating reasonable volume and availability as well as undertaking tracking and reporting drug resistance data. Passage of the bipartisan PASTEUR Act would be a major step toward supporting innovation for the development of urgently needed new antibiotics by ensuring that a desirable market will exist for new products. These types of innovative models may also be able to incentivize the development of diagnostics and other therapeutic countermeasures.
Third, “global scientific partnerships” are critical. Defeating future pandemics will require the best minds working together with multidisciplinary responses rooted in team science and novel partnerships.
There are significant capabilities in countries that are close allies and partners of the United States, and substantial benefits can be expected from appropriate international collaboration. President BidenJoe BidenSunday shows preview: Coronavirus dominates as country struggles with delta variant Did President Biden institute a vaccine mandate for only half the nation's teachers? Democrats lean into vaccine mandates ahead of midterms MORE’s recent “skinny budget” requests $1 billion for global health security programs, an increase of about $800 million over current levels. These funds would support efforts to prevent, detect, and respond to disease outbreaks around the world, including the development of a new multilateral health security financing mechanism to catalyze investment in pandemic prevention and preparedness activities. Congress should appropriate the requested funding and enable the capacity for such international collaboration.
Additionally, since the bulk of existing and future biological threats are likely to stem from zoonotic diseases (i.e., those spread from animals to people), developing and improving worldwide disease surveillance systems with the ability to collect both animal and human data is essential.
Finally, “enhanced surveillance” capabilities are a key requirement for dealing with the pathogens that cause pandemics. Congress has taken the first step toward ensuring this surveillance capacity with its recent allocation of $1.7 billion (a nearly 6-fold funding increase) to the CDC Advanced Molecular Detection program. $300 million of CDC’s increased surveillance funding will be dedicated to the formation of a National Bioinformatics Infrastructure to integrate modeling, laboratory, and surveillance data in an effort to create a centralized repository for public health information.
It will be important for Congress to maintain similarly high levels of funding in future years.
The emergence of the more virulent COVID-19 variants has underscored the need for expanded capabilities for “pathogen genomics,” that is, understanding the genetic structure of disease-causing entities, which in turn will lead to better understanding of key issues such as methods of disease transmission, disease virulence, and antimicrobial resistance. Effective investigations of outbreaks through more timely and granular surveillance will be crucial to informing the prompt development of therapeutics and vaccines. Likewise, having the capacity to analyze data quickly and develop assessments for public health and other government officials will be critical to effective decision making.
In January 2021, as the first authorized COVID-19 vaccines rolled out across the globe, the Gates Foundation proclaimed that “to prevent the hardship of this last year from happening again, pandemic preparedness must be taken as seriously as we take the threat of war… The world needs to spend billions to save trillions.”
We must capitalize on this once-in-a-generation opportunity — to undertake moonshot R&D for infectious diseases; to ensure sustained focus on antimicrobials; to establish enhanced surveillance capabilities; and to utilize global partnerships. With ambitious investments in good science, the U.S. can lead on pandemic preparedness and successfully combat the urgent challenges ahead. Now is the time to invest in a strategic and operational framework that will establish the capabilities for effective resilience as a foundation of U.S. public health strategy. Defining these efforts as a national objective — and investing in them accordingly — is critical to addressing vulnerabilities and maintaining long-term progress.
Jaclyn Levy is the Director of Public Policy for the Infectious Diseases Society of America and an Atlantic Council Millennium Fellow. Franklin D. Kramer is a distinguished fellow and on the board of the Atlantic Council, and the author of “Effective Resilience: Lessons from the Pandemic and Requirements for Critical Infrastructure.”