Leaders prepare for the next pandemic

 The COVID-19 pandemic has been an unprecedented global crisis that has exposed numerous flaws in healthcare systems, social structures, and governance worldwide.  

In the United States, federal public health agencies like the Administration for Strategic Preparedness and Response (ASPR) struggled to maintain supply and deploy the necessary supply of ventilators, masks, and public health equipment while the Center for Disease Control (CDC) had to make challenging decisions in the face of changing information, sometimes in direct conflict with the President. 

The crisis resulted in an increasingly divided nation, a loss of trust in our public health systems, and the loss of over 1.1 million lives in the U.S. 

On May 11, the House Energy and Commerce Committee’s Health Subcommittee, led by Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Health Subcommittee Chair Brett Guthrie (R-KY), held a hearing on to discuss how the U.S. can be better prepared for a future public health crisis.  

“We have a unique chance to look back and ask ourselves – what worked, what failed and identify bipartisan solutions on how we can improve,” said Guthrie in his opening statement.  

The hearing reviewed key elements within the Pandemic and All Hazards Preparedness Act (PAHPA) to decide what authorizations and programs should be removed, reauthorized, or modified ahead of its September 30, 2023 expiration date.  

 PAHPA was initially signed into law in 2006, in response to the 9/11 terrorist attacks and the subsequent anthrax attacks. The legislation aimed to improve the nation’s ability to prepare for, respond to, and recover from public health emergencies, including natural disasters, chemical and biological attacks, and infectious disease outbreaks. 

It has since been reauthorized several times, with its most recent reauthorization in 2019. As the COVID-19 Public Health Emergency (PHE) quietly ended on May 11, 2023, U.S. leaders are reviewing hard-won lessons from COVID-19 to make the U.S. public health system stronger for the future.  

Public health agencies request more authority 

ASPR 

Dawn O’Connell, Assistant Secretary for ASPR, responded to repeated allegations that ASPR’s response to the pandemic was ineffectual by highlighting three key challenges that need to be addressed for the future – namely, ASPR’s ability to procure supplies, manage deployment of supplies, and staff quickly during critical times.  

“We want to be sure that we have the authorities we need to continue to execute that work with the excellence, efficiency, and expertise the American people deserve.”  

The first issue to address is how ASPR can acquire tools and supplies more quickly. Lacking the necessary authority to contract with private companies, HHS struggled to procure medical equipment like masks and ventilators until ASPR partnered with the Department of Defense (DOD).  

“Using their unique authorities, DOD executed more than $90 billion in contracts for us over the three years of the acute response,” O’Connell shared and requested similar authority so ASPR won’t have to rely on DOD in the future.  

During the pandemic, ASPR was given the authority and funding to expand the American medical supply industrial base and created new factories nationwide. ASPR’s second request is to maintain this authority and manage the creation of personal protective equipment (PPE) and medical supplies in the U.S.  

“The third problem I’m trying to solve is how ASPR can staff critical teams more quickly,” O’Connell continued.  

 CDC 

Dr. Rochelle P. Walensky, CDC Director, had a similar request: in addition to making human resources more robust, she wants the ability to incentivize applicants with student loan forgiveness.  

 Overall, she requests “access to better quality, standardized and timely data” to manage outbreaks.  

Walensky claims that without the data, “We will have to build and negotiate surveillance while we navigate a pathogen.”  

As of May 11, 2023, the CDC will no longer have the legal authority to require labs to report COVID-19 test results. Some states will even lose their authority to collect that data, which will take the CDC back to square one in the face of another public health crisis, says Walensky. 

FDA 

FDA Commissioner Robert M. Califf, M.D., asked for processes that would allow them to better monitor and report potential shortages. 

“The ability and requirement for manufacturers to report surges in demand could help the FDA prevent or mitigate shortages including for some critical over the counter drugs like we saw this Fall,” shared Califf.  

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) expanded the data notification requirements that manufacturers had to meet. The enhanced data collection allowed the FDA to better identify, prevent, and reduce the impact of possible shortages.  

With the end of the PHE, the FDA will revert to collecting minimal data from manufacturers.  

 Bi-partisan solutions 

 Leverage private-public partnerships 

One solution that had resounding, bi-partisan support was that federal agencies needed to better leverage partnership with the private sector to be better prepared against future public health threats. 

Guthrie cites one painful truth: The CDC did not have contracts with testing kit manufacturers until after the declaration of the COVID-19 Public Health Emergency.  

 “This presented significant challenges when attempting to set up a nationwide testing scheme,” Guthrie continued and “presented challenges in grasping the full extent of the spread when timing is crucial.” 

He praised Operation Warp Speed, a public-private partnership initiated in 2020 to accelerate the development, manufacturing, and distribution of COVID-19 vaccines, therapeutics, and diagnostics,  as a “successful private-public partnership and should be viewed as a model going forward.” 

Restoring trust in public health agencies 

Guthrie and Rodgers used their introductory remarks to address the nationwide divide exasperated by the pandemic and the loss of trust in the public health agencies. One way they hope to restore trust in public health agencies is to require a senate confirmation hearing for all incoming CDC directors and an investigational review of the Administration for Strategic Preparedness & Response (ASPR).  

 It is currently unclear what elements of PAHPA will be kept moving forward as members of the health committee evaluate past successes and failures to determine a bipartisan solution.  

“America’s public health security is a critical part of our national security, which requires our government to be equipped to respond to all types of hazards, whether deliberate, accidental, or natural,” said Rodgers and Guthrie in a statement.  

“Reauthorizing these important biodefense and public health preparedness programs will require us to consider lessons learned from the government’s immediate response to the COVID-19 pandemic, and also be forward thinking about the next possible threat — whether it’s chemical, biological, radiological, nuclear, a cyberattack, or another emerging infectious disease. Doing so will require bipartisan cooperation and work, which we look forward to continuing in this hearing.”