By Skandan Ananthasekar
On May 12th, the Council on Strategic Risks (CSR) hosted an event with former leaders from the Department of Health and Human Services Administration for Strategic Preparedness and Response (ASPR) on reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA). The event held in the Rayburn House Office Building gave Congressional staffers the unique opportunity to hear the experienced perspectives brought to the discussion by Dr. Craig Vanderwagen, Dr. Robert Kadlec, Dr. Gerald W. Parker Jr., and Dr. Kevin Yeskey. Panelists discussed opportunities for the nation to enhance preparedness for and prevention of biological events, especially in light of evolving threats the world faces.
Created in the aftermath of Hurricane Katrina, ASPR coordinates, leads, and supports the public health response for all types of hazards. Among other responsibilities, ASPR develops public-private partnerships to deliver diagnostics and medical countermeasures (vaccines, therapeutics, etc.) for health security threats. As part of this responsibility, ASPR maintains the Strategic National Stockpile as a capacity buffer for times of public health emergencies. A few common themes emerged from the panelists’ opening remarks.
The first is the need to continue building out ASPR’s role in supporting its state, local, tribal, and territorial (SLTT) partners by better engaging and integrating with SLTT entities. ASPR needs to better understand the capabilities and limitations of different jurisdictions in order to support them. As Dr. Yeskey put it, “response begins and ends at the local level.”
ASPR can build resilience by supporting communities in the inter-crisis times, not just during disasters. Panelists recommended embedding ASPR staff within SLTT agencies, having staff participate in exercises at the local level, and offering guidance to locals on their preparedness and response plans. Other recommendations included establishing regional medical operations centers to serve as neutral coordinating bodies, strengthening ASPR’s relationship with FEMA, and expanding the Regional Disaster Health Response System pilot sites.
A second common theme was about institutionalizing successes and remedying failures from the COVID-19 pandemic. The panelists pointed to Operation Warp Speed (OWS) as a success that demonstrated the values of leadership, collaboration, and coordination. PAHPA reauthorization presents an opportunity to enable the ecosystem that allowed OWS to succeed and think about strategies for incentivizing public-private partnerships. Despite serious difficulties, the scientific enterprise, especially sectors not traditionally associated with biodefense, developed innovative solutions during the COVID-19 pandemic. ASPR can work closer together with private partners to invest in similar groundbreaking innovations.
A failure from the COVID-19 pandemic that panelists agreed on was foreign supply chain dependency. Building medical supply chain resiliency will rely on data that offers transparency across the supply chain from raw materials to distribution. Having transparent data will offer opportunities across the spectrum of mitigation, preparedness, and response to prevent supply chain shortages.
The panelists recommended that ASPR be the responsible party for situational awareness not only about the supply chain but also around pandemic early warning, healthcare capacity, and medical countermeasures development. Reintroducing a “control tower” concept within ASPR could allow the agency to coordinate and anticipate resource needs based on real-time data and ensure that SLTT partners can access resources. Through its Industrial Base Management & Supply Chain Program Office, ASPR can also work with manufacturers and distributors to have a more robust medical stockpile at baseline.
Dr. Kadlec and other dedicated civil servants tried to increase preparedness and ensure adequate personal protective equipment in the early days of the pandemic. However, the pace of action in February 2020 was another issue noted by panelists. One recommendation from the panelists was to establish a special fund under the control of the Secretary of Health and Human Services that allows the Secretary to take immediate action during a crisis.
Other recommendations offered by panelists include incorporating the biosecurity recommendations proposed by the National Science Advisory Board for Biosecurity in March 2023 and strengthening the role of the National Disaster Medical System.
Underlying all the recommendations is a need for clear, additional authorities to allow ASPR to operate as it should. As the panelists noted, ASPR has the tools it needs to support its mission but lacks sufficient authorities. As CSR has previously recommended, additional flexible acquisition authorities would allow ASPR to rapidly respond to public health emergencies. In addition, ASPR’s roles and responsibilities as a recently elevated operating division must be clearly articulated. In particular, as Dr. Kadlec noted, it will be important to leverage ASPR’s role as a coordinating body within HHS to ensure mission focus and broad situational awareness in future public health emergencies.
To continue identifying how reauthorizing PAHPA can increase preparedness for biological threats, whether natural, deliberate, or accidental, CSR will host additional interactive discussions with biodefense experts and Congressional members and staff over the coming months.
Links to publications mentioned by panelists during the event are provided below.
- The National Academies Report on Building Resilience into the Nation’s Medical Product Supply Chains
- National Science Advisory Board for Biosecurity Report on Proposed Biosecurity Oversight Framework for the Future of Science
- The Office of the Director of National Intelligence 2023 Annual Threat Assessment of the U.S. Intelligence Community
- The Center for Security and Emerging Technology Analysis of Viral Families and Disease X