The theme at SBM this week is questions for Trump’s nominees for key health positions within the federal government. David got the ball rolling with an excellent summary of the nominees and questions for each. Jonathan followed up with his own list of questions. I would like to continue the theme, focusing on our preparedness for the next pandemic.
It is arguably the defining feature of Trump’s first administration that he bungled the response to the COVID19 pandemic. Even before the pandemic, Trump disbanded the NSC directorate for global health and security and bio-defense, a unit dedicated to preparing for and responding to either bioweapons or a pandemic. Trump himself fueled anti-masking misinformation and promoted false cures like hydroxychloroquine. He denied the severity of COVID in the initial phases and delayed an effective response.
As a result there have been over 1.1 million American deaths from COVID. The pandemic was very disruptive to the US economy resulting in lost jobs and a spike in inflation. We can never know what would have happened if there were an optimally effective US response, but we know that despite our wealth and resources we faired worse than most other similar nations. Trump does get credit for greenlighting an idea coming out of the FDA, Operation Warp Speed, to accelerate the approval process for COVID vaccines. But then his administration bungled the roll out of the vaccine, again causing delay.
I know that for most people we would like the COVID pandemic to be a distant memory, a time of shutdowns, masking, and fear. It feels like a once-in-a-lifetime event, something to talk about to future generations like living through the depression. I hope this turns out to be true, but it would be folly to count on it. Already experts are warning of the potential for the bird flu pandemic to spillover to humans. There are animal-to-human cases, but currently no human-to-human transmission. But this is what spillover events are – viruses that can infect animals and humans mutating to trigger a human epidemic or even pandemic.
To prepare for when (not if) the next pandemic hits, the Biden administration created the Office of Pandemic Preparedness and Response Policy (OPPR). If you are in the mood, you can watch two and a half hours of congressional testimony about how we should be preparing for the next pandemic, and lessons learned from COVID. What you will find are largely competent professionals getting deep into the weeds of public health policy and pandemic preparedness.
In my opinion, a high priority for approving any Trump nominees for key federal health positions is their attitudes about COVID and how to prepare for and respond to the next pandemic. These people might be the ones in charge when the next COVID hits. As we have seen, that response can save or cost hundreds of thousands of lives, and dramatically affect all of society. So – here are some questions for them:
Was it a mistake to shut down the NSC directorate for global health and security and bio-defense? Do you support the OPPR and its mission?
What additional steps would you recommend to prepare for the next pandemic?
What should be the relationship between federal health policy and scientific evidence, including academic, research, and professional institutions?
Given the COVID experience, how do you view the role of public health policy, such as masking and isolation, as tools for controlling the spread of dangerous infectious diseases?
How do you view the role of public vaccination programs in managing pandemics?
Is it responsible to rely upon natural herd immunity as a primary measure of managing a pandemic?
What background and experience prepares you for the responsibility of protecting the public health, in general and in the face of potential future pandemics?
What steps would you take to foster public trust in government health institutions and their recommendations?
These are all questions I would have loved to see asked of the candidates during the campaign. Unfortunately, that is not the kind of media or culture we have in this country. It is also amazing how quickly even big life-changing events go down the public memory hole. You would think, just a few years after a massive pandemic, these would be key questions for any future executive.
At the very least, this should have been a major issue in the campaign. Who would you want to have in charge if another pandemic hits over the next four years? I may not have liked the collective answer that the US voting public gave, but at least the question should have been asked. And so here we are, facing a frightening line-up of nominees for key federal health positions, presenting a spectrum of anti-science ideology and a concerning lack of credentials.
Our one thin reed of hope is that senate Republicans will actually do their job.
Questions About Pandemic Preparedness