The White House is proposing a $65 billion pandemic preparedness initiative. A 27-page outline released last month calls for $65 billion in spending over the next 7 to 10 years. This includes a $15 billion allotment as part of the $3.5 trillion budget reconciliation bill that is currently being debated in Congress.
What’s missing are essential public health components, including comprehensive plans on how to equitably distribute and provide access to developed and procured medical technologies, as well as ways to improve outreach and information campaigns. These items can’t be an after-thought. As we’ve (hopefully) learned from the Covid-19 pandemic, they’re integral to winning the battle.
Director of the Office of Science and Technology Policy and Science Advisor to the President, Dr. Eric Lander, said the White House proposal includes requisite funding for vaccine and drug development, as well as for improving testing and pandemic detection systems. This is certainly true.
In fact, 60% of funding would be allocated to vaccine and drug development, with $24.2 billion going towards vaccines, and $11.8 billion, therapeutics, largely centering on antivirals and antibodies. The remaining 40% would fund diagnostics, early warning systems, enhancements to the nation’s real-time monitoring capabilities, upgrades to personal protective equipment that can be used against a wide range of pathogens, and unspecified “improvements in public health and global health initiatives.”
The plan calls for an Apollo-like “mission control” center to coordinate pandemic preparedness across agencies, such as the Food and Drug Administration and Centers for Disease Control and Prevention.
In some respects, the proposal builds on the Trump Administration’s public-private partnership called Operation Warp Speed, which emphasized vaccine, therapeutic, and diagnostic test development, yetpaid lip service to public health, and relegated most follow-through courses of action, such as distribution, to decentralized entities at the state and local levels.
Undoubtedly, spending on research and development of vaccines, treatments, and diagnostics is vital. Equally important, however, is ensuring that developed products are distributed equitably and affordably, that there is sufficient supply everywhere, and that intensive, targeted (especially at the at-risk) outreach is part and parcel of any vaccination, treatment, and testing campaign.
And, it’s the allocation, delivery, and community-based outreach aspects of such campaigns which have frequently been mishandled. Perhaps the most visible failures include testing (to this day, it remains difficult for too many Americans to get tested and receive timely results) and the vaccination program. Vaccine supply has not really been an issue in the U.S. In fact, the nation has had a glut of vaccine doses for quite some time. Yet, getting enough people vaccinated, as well as doing an adequate job in targeting the at-risk, have been problematic. It’s a problem when only 82% of the over 65 age group are fully vaccinated, while in peer nations – similar Gross Domestic Product per capita – the number is over 96%.
Further, the White House plan omits inclusion of a substantial amount of investment in the long-term sustainability of state and local public health. Local public health departments have lost 55,000 jobs since the 2008 recession. And, the problem of a resource-constrained public health sector goes back many decades. In essence, as the sociologist Paul Starr wrote, public health in the U.S. has been relegated to a secondary status. It’s less prestigious than clinical medicine and poorly financed. The White House plan does little to change that.
There are even things not included in the plan which the federal government could do at present that wouldn’t cost a penny; mandatory data tracking, for example. The U.S. has no comprehensive national data for fully vaccinated people who have been hospitalized. It’s imperative to systematically collect and disseminate national data on key indicators of Covid-19 disease, differentiated by vaccination status (vaccinated, partially vaccinated, unvaccinated). The Secretary of Health and Human Services can mandate this data collection. Now. Yet, inexplicably he doesn’t.
There are no easy solutions. In a nation that grants states, counties, and municipalities considerable autonomy with respect to data collection, as well as vaccine allocation, delivery, and community-based outreach, pursuing a public health agenda is a daunting task. This is especially the case, given that 26 states have curtailed public health powers amid the pandemic.
Moreover, the political divisions on Covid-19 vaccination – mandates and the like – have become ingrained. The consequences of this bitter polarization could imply resistance to vaccination efforts of all kinds, including those aimed at new vaccine-preventable diseases. Understanding and countering this trend are urgent public health priorities now and in the future.
Today, it’s crucial to reach at-risk communities with “culturally competent messaging” about Covid-19 prevention and vaccine safety and effectiveness. And, anticipating future pandemics or health crises, it ought to be an urgent priority to earmark public health resources for social and behavioral research to systematically monitor disinformation and develop solutions to combat it.
The Biden Administration’s pandemic preparedness proposal presents a fabulous science plan of action. But, it continues to implicitly downplay the importance of public health.