Biden urged to harden government for future pandemics

Public health experts are urging the Biden administration to harden the federal government for future crises, warning that the U.S. is not prepared for the next pandemic.

The White House says it is laser-focused on bolstering the government’s ability to respond to another coronavirus-like outbreak. But doing so will require ample funding from Congress to help agencies react as quickly and effectively as possible to prevent a loss of life similar to COVID-19, which has killed more than 4 million people globally and more than 600,000 Americans.

Experts have said the U.S. was caught flat-footed by the coronavirus pandemic due to years of inadequate investments in public health infrastructure. The rapid spread of cases along with pressure on hospitals and clinical laboratories exposed critical weaknesses.

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Emergency funding has helped public health agencies fight the coronavirus, but unless that level of spending can be sustained, the country is considered in danger of repeating the same mistakes.

"I just think it would be sort of foolhardy to not realize that this can happen again and take some action," said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. "So far, that's borne out. There's been huge, huge resources put out to public health. It's just, we need to stay the course for a few years to really see some of these improvements along."

Biden administration officials are in the midst of reviewing the nation’s biopreparedness policies, the result of an executive order the president issued on his first day in office.

The order also restored a global health security office that the Trump administration had consolidated.

Biden administration officials are frank about the need to act with urgency.

“We’ve been dealing with COVID since early 2020 and we know from experience that emerging infectious disease outbreaks don’t wait for one crisis to end for another to begin. And so this is long-term preparatory work and it’s urgent,” a senior administration official said.

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“We obviously need to make sure that while we’re rebuilding from the COVID-19 pandemic that we’re preparing for the next one because it could come at any time.”

Historically, U.S. funding for health security has been disease-based. Spikes in funding have almost entirely been driven by specific events — like Zika, Ebola and SARS — and funded by emergency appropriations that eventually dried up.

Experts and advocates are now hoping the Biden administration can change that.

“I think the biggest challenge is persistence. We underestimate the microbial world at our peril, and if we don’t increase and then continue the investment we are making, we will continue to be underprepared for lethal threats,” said Tom Frieden, who served as director of the Centers for Disease Control and Prevention (CDC) during the Obama administration.

“Even more important than the amount of money is keeping at it.”

The coronavirus pandemic has made an outsized impact on the U.S. So far, the funding has matched it.

Biden’s $1.9 trillion American Rescue Plan signed into law in March included half a billion dollars in funding for a new Center for Epidemic Forecasting and Outbreak Analytics at the CDC.

Biden has also proposed spending $30 billion over four years on manufacturing, research and development to guard against future pandemics as part of his American Jobs Plan.

The Biden administration has set a goal of manufacturing 100 million vaccines within the first 100 days of the next outbreak.

It also wants to be able to identify pathogens within a few days, manufacture personal protective equipment more rapidly, and shore up the Strategic National Stockpile, which was ill-equipped to handle the spike in demand for critical supplies when COVID-19 took hold.

Plescia said the U.S. should overhaul antiquated data systems, as well as shore up the public health workforce. That won't take a substantial funding commitment, he said, but the money needs to be consistent.

"What Congress needs to do is just put forward some recurring funding for public health. Sure, that could get cut in years to come, but that's different than sort of the one-time resources we're getting now," Plescia said. "A lot of state, local governments are going to be hesitant to really take actions ... unless they see some kind of recurring funding."

Yet former officials and experts said they are concerned that as public attention shifts away from COVID-19, there will be less of an appetite in Congress for that level of robust and sustained funding.

“If we look at what has happened in the past, it’s always what has happened. It’s out of sight out of mind for public health protection funding,” said Frieden, who argued that money for public health should not be constrained by discretionary budget caps.

The senior administration official said the White House is engaging with members of Congress to ensure that public health efforts are more robustly funded, and expressed hope that lawmakers would not lose sight of the need to shore up the nation’s health apparatus, noting that there has been bipartisan support for biodefense.

In addition to the White House’s own review, there has been a push on Capitol Hill for the formation of a bipartisan 9/11-style commission to analyze the nation’s pandemic preparedness and response.

The bipartisan leaders of the Senate Health Committee are working on a legislative package to consider lessons learned during the COVID-19 response and ensure the public health system is fully modernized and in better shape to handle the next pandemic.

Some outside groups have undertaken their own reviews, and have offered recommendations. The White House is analyzing recommendations from experts in addition to gathering input from those within the government in its review.

The Bipartisan Policy Center is calling for the creation of a new federal board to oversee U.S. preparedness for future public health threats, and the allocation of $4.5 billion in annual mandatory funding for a new public health infrastructure account to support state and local governments.

“There needs to be intergovernmental coordination and federal oversight, there needs to be a 21st century public health data infrastructure, and there needs to be adequate public health funding,” said Anand Parekh, the center’s chief medical adviser.