Adashi EY, Cohen IG. A Legislative Blueprint for the Next Pandemic. JAMA Health Forum. Published online July 24, 2020. doi:10.1001/jamahealthforum.2020.0882
On June 9, 2020, Senator Lamar Alexander (R, Tennessee), chairman of the US Senate Committee on Health, Education, Labor, and Pensions (HELP), issued a white paper titled Preparing for the Next Pandemic.1,2 Replete with recommendations aimed at fortifying the national response to future pandemics, the white paper draws on lessons learned from the national response to COVID-19 as well as from 2 decades of national pandemic planning.1,2 Written with soon-to-be crafted legislation in mind, the white paper solicited “comments, responses, and any additional recommendations” that were to be received no later than June 26, 2020.1,2 In arguing for this tight timeline, Senator Alexander went on to say that “even with an event as significant as COVID-19, memories fade and attention moves quickly to the next crisis. That makes it imperative that Congress act on needed changes this year.”1,2
Perhaps the most troubling facet of the white paper is its conclusion that “many of the challenges Congress has worked to address during the last 20 years still remain.”1,2 As such, this conclusion was based on a meticulous review of past efforts of the federal government to prepare for a future pandemic.1,2 The inescapable take-home message is that decades of federal planning for a future pandemic fell short of the mark. The warning signs were everywhere. Reports issued by the Government Accountability Office, Inspectors General, and several presidential administrations noted multiple deficiencies, many of which came into full view during the COVID-19 pandemic.1,2 This was not merely a case of outright inaction. A significant complement of specific enabling statutes was enacted by 4 presidents.1,2 Appropriated, highly targeted funds were distributed to states and hospitals.1,2 Key functionalities, such as the Biomedical Advanced Research and Development Authority, were established.1,2 What appears to have been missing was continuous leadership powered by a sense of urgency and informed by past precedents. No flight of imagination was required to envision the wreckage that was bound to be wrought. That said, continuity of purpose is a rare luxury of history wherein distraction is the coin of the realm. Much has happened over the last 2 decades (eg, 9/11) that required the nation’s undivided attention. Viewed in this light, the HELP white paper is all about renewing the collective commitment to prepare for the next pandemic.
The 5 recommendations made by the white paper were based on “lessons learned from COVID-19 and the past twenty years of pandemic planning.”1,2 All of the 5 priority foci are viewed as constituting a starting point for further conversation and deliberation. The first recommendation calls for the acceleration of research and for the development of tests, treatments, and vaccines. The second recommendation advocates for the expansion of the national capacity to detect, identify, model, and track emerging infectious diseases. The third recommendation urges the rebuilding and maintenance of federal and state stockpiles and the improvement of the medical supply surge capacity and distribution. The fourth recommendation touts the improvement of the public health response capacity at the state and local levels. The fifth recommendation calls for improved coordination between federal agencies during a public health emergency. As viewed by Senator Alexander, the aforementioned recommendations comprise an invitation for feedback that “Congress can consider and act on this year.”1,2 Missing in the mix, however, are foolproof legislative solutions that will assure the ongoing national commitment to a heightened state of preparedness during interpandemic lulls. Similarly absent is the imperative of a clear and coordinated chain of command. Failure on these scores runs the risk of repeatedly and unnecessarily placing the nation in harm’s way.
The public feedback sought by Senator Alexander arrived in rapid succession. More than 30 health care–focused interests made their opinions known. Medical specialty organizations led the way. The American College of Physicians, the largest specialty organization, commended the prospect of legislative proposals to “combat…future pandemics.”3 Hospitals and health systems proved equally supportive. The American Hospital Association applauded the effort to improve “our nation’s health care system preparedness.”4 Favorable feedback was also afforded by medical schools (eg, Association of American Medical Colleges), clinical chemistry laboratories (eg, American Association for Clinical Chemistry), pharmacists (eg, American Pharmacist Association), and health care group purchasing organizations (eg, Healthcare Supply Chain Association).
The first pandemic-inspired statute to be enacted, the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, was passed by overwhelming majorities in both the House and the Senate.5 Similar pluralities saw to the passage of the CARES Act (Coronavirus Aid, Relief, and Economic Security Act).5 More of the same held true for the Paycheck Protection Program and Health Care Enhancement Act.5 Absent comparable ongoing bipartisanship, it is unlikely that the 116th Congress will pass a comprehensive pandemic preparedness bill prior to its adjournment on January 3, 2021. Matters are unlikely to be helped by the fact that the final 6 months of the legislative calendar will be increasingly engrossed with the looming November 3 elections. One might draw some comfort from historic precedents, such as 9/11, which was followed by the enactment of multiple statutes within a year of the attack, including the USA PATRIOT Act.6
Whether the US Congress will “pass legislation this year to better prepare for the next pandemic” remains an open question.1,2 The subject matter, however, cannot—indeed, must not—be avoided. Failure to act to redress the shortcomings of the national pandemic response is not an option. Viewed in this light, nothing but plaudits are due to the HELP Committee for its initiative. Note is also made of the fact that the HELP Committee may be uniquely suited to lead the legislative charge in question. Known for the highly collegial and effective partnership between Senator Alexander and his Democratic counterpart Senator Patty Murray (D, Washington), the HELP Committee stands out as a bipartisan paragon.7 It would seem vital that “Congress…take stock now of what parts of the local, state, and federal response worked, what could work better and how.”1,2 Only in so doing will the testing, tracing, and treatment of patients in future pandemics be up to the task of saving lives.
Corresponding Author: Eli Y. Adashi, MD, MS, Warren Alpert Medical School, Brown University, 272 George Street, Providence, RI, 02906 (firstname.lastname@example.org).
Conflict of Interest Disclosures: Prof Adashi reported serving as co-chair of the Safety Advisory Board of Ohana Biosciences, Inc. No other disclosures were reported.
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Eli Y. Adashi, MD, MS Eli Y. Adashi, MD, MS, is Professor of Medical Science and the former Dean of Medicine and Biological Sciences at Brown University in Providence, Rhode Island. A member of the National Academy of Medicine, the Association of American Physicians, and...