On June 7th, the Council on Strategic Risks (CSR) hosted an event with former Executive Office of the President (the Executive) policymakers on the importance of reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA). Signed into law in 2006, PAHPA created a new Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services—creating a new set of authorities for HHS to respond to a host of crises. This webinar gave Congressional staffers the unique opportunity to hear the experienced perspectives brought to the discussion by Rear Admiral Kenneth Bernard, USPHS (Ret.), Dr. Tracie Lattimore, and Dr. Rajeev Venkayya. Together the panelists served in the current and last four administrations, which let them provide an unparalleled perspective on how the White House oversees and coordinates federal responses to biological threats and how a strengthened PAHPA could improve executive leadership.
The White House’s Roles
Dr. Venkayya, former Special Assistant to the President for Biodefense at the White House, underscored the importance of the White House’s role in crisis response. As he stated, “the reality is that no single department, including HHS [Department of Health and Human Services], could properly or fully anticipate and address all of the issues that would be created by a pandemic virus.” He noted that given the scale and complexity of addressing biological threats, interagency coordination is imperative regarding information flows, feedback and what actions are, or are not, being taken.
Dr. Lattimore, who spent 20 years serving in a number of roles across the US government, noted that a key role of the White House is to “decrease gaps” and “reduce redundancies” in execution across the interagency, so a response can be more effective and “dollars go further.”
Emphasizing the importance of this leadership function, Rear Admiral Bernard, former Special Assistant to the President for Biodefense on the Homeland Security Council (HSC), among other roles, suggested that the White House should create a combatant commander-like position for biological preparedness whose role it is to prepare for, coordinate, and lead in times of biological crises. He continued, “We don’t need another czar. We need somebody whose job it is from day one to do the job…not during the pandemic only.”
All the panelists agreed that while the White House has the capacity to lead, it does not have the resources nor staffing to implement policy; this is the role of departments and agencies. An effective response in a time of crisis is therefore dependent on the degree to which departments and agencies are prepared, empowered and resourced to execute policy and their statutory requirements. This is similar to a coach ensuring that a team has the skills and equipment to perform and that the team has gained confidence through rehearsing. Ensuring that the interagency has clear roles and is appropriately funded for biological crisis response—before another one occurs—will aid in the White House being effective.
Dr. Venkayya also emphasized that the role of the Executive is to remove roadblocks to responses. He explained that the Executive provides an oversight role to find and address areas of response which require focus. “This is really a way of monitoring what the Government is doing, directing departments and agencies to address areas of the response that need to be strengthened…and where there are breakdowns in collaboration and coordination, the EOP [Executive Office of the President] can step in.”
The panelists underscored the importance of legislation which provides greater resources and mandates to federal departments and agencies. If PAHPA reauthorization provides the Department of Health and Human Services (HHS) greater funding and responsibilities, it could also expand the Executive’s toolkit in coordinating response and, also limit the number of legislative and legal hurdles that would have to be overcome during a crisis.
The Information Imperative
After noting the leading role that the Executive plays in biological crisis response, the panelists touched on the importance of data sharing and information loops. As the principal coordinator, the White House’s capacity for effectively directing the interagency during a crisis is highly dependent on the quality and quantity of information they are receiving from federal, state, local, and tribal governments.
Dr. Lattimore touched on this issue, noting, “[It] is incredibly important to ensure that we’re building a system that is connecting the surveillance on the front end of a response to medical countermeasures…We have to be able to trade information. Information is the most important commodity in these responses.”
The Urgency of Preparedness
Finally, the panelists touched on the issue of preparedness and how we can best build a system of response prior to the next crisis. Rear Admiral Bernard explained the cyclical response we often see during crises, stating “during an epidemic…things like [Operation] Warp Speed” happen “because the actual electorate is paying attention and the senior leadership is paying attention.” However, given the scale of threats posed by biological risks, moving toward a steady state of preparedness, rather than episodically after a crisis occurs, is essential.
Dr. Lattimore laid out what could be done in this period of upcoming legislative opportunities by exploring how “surveillance data” could feed into “one common operating picture” across a whole host of pathogens. She added that more could be done with existing funds to expand data collection, medical countermeasure production, and information flow to address current capacity gaps.
In his concluding remarks, Rear Admiral Bernard summarized the importance of PAHPA reauthorization, stating that Congress should “authorize and fund the development of processes in the interregnum between epidemics, because that’s how we’re going to do better, and we’re going to save money and people’s lives in the long term.”
CSR is grateful to share the perspectives from these panelists on the importance of coordinated response to biological crises. We will host additional interactive discussions with biodefense and pandemic prevention experts and Congressional members and staff over the coming months.
A link to our previous PAHPA event can be found here.