Our 117th Congress will shortly look to pass, as it has done for the past 60 years, the National Defense Authorization Act (NDAA). This is a priority, given its national security implications, as the NDAA helps to outline defense policy and the disbursement of over $800 billion of annual funding.
However, there is no similar process for pandemic preparedness policy and funding; and this is somewhat jarring, as COVID-19 has cost more American lives than all U.S. wars combined since the Civil War.
This must change. Preparing for our next pandemic is as urgent a priority as emboldening military readiness in 2022, in the face of similarly, asymmetrical threats.
In its fiscal year 2023 budget, the Biden administration included a $88.2 billion request for mandatory funding, available over five years, for pandemic preparedness and biodefense. Critics were quick to point out then that there was no associated overarching plan to guide the request. To that end, the administration recently released its National Biodefense Strategy and Implementation Plan, which provides detailed goals particularly related to the development, distribution, and dispensing of medical diagnostic tests and countermeasures.
This plan includes the development and deployment of diagnostics tests within days of a biological incident, vaccine development within 100 days in addition to sufficient production within a 130 days, and finally, the development and deployment of therapeutics within three to six months.
However, while ambitious, these goals won’t be achieved without a commensurate sustained increase in funding levels. Further, the private sector relies on the government’s financial incentives to develop medical material that otherwise would not have an explicit market.
And so, one must ask if the administration’s requested amount for pandemic preparedness is the right number. Outside estimates vary, including some which are higher and others which focus solely on shoring up our nation’s public health infrastructure.
The bottom line is that it’s clear that additional resources are required.
While how we pay for these resources is a legitimate question, the economic argument of inaction must also be considered. Estimates are that the cost of the COVID-19 pandemic for the U.S. in GDP loss range from $1.3 trillion and $2.4 trillion (overall harms range from $10 trillion and $22 trillion).
So, what should be done? In an ideal scenario, Congress should create a similar process for pandemic preparedness to what is done for military readiness through the NDAA. Specifically, the Senate Health, Education, Labor & Pensions Committee and House Energy & Commerce Committee should lead an annual process to create an authorization bill focused on pandemic preparedness policy, which would then provide guidance to appropriators as to the optimal funding of pandemic preparedness programs.
A nurse checks on a patient in the acute care COVID-19 unit at the Harborview Medical Center on Jan. 21, 2022, in Seattle, Wash.
Karen Ducey/Getty Images
If creating such a process is too laborious, Congress could alternatively include pandemic and biodefense programs in the annual NDAA, given their role in protecting the safety of the American public; since pandemics can also lead to global economic and political instability, their impact on our trading partners and allies further impacts our national security.
The additional sums required for pandemic preparedness would constitute a rounding error in the overall budget directed by the NDAA.
Another option, recommended by the Bipartisan Policy Center, includes creating a permanent budget designation outside annual appropriations to fund mission-critical biodefense programs identified by Congress and upon recommendation by federal departments and agencies. Examples of programs include the Strategic National Stockpile and the National Center for Epidemic Forecasting and Outbreak Analytics. There is precedent for such a budget designation in the Overseas Contingency Operations (OCO) fund, which in the past supplemented defense operations and was not subject to annual appropriation limits.
With increased funding should come increased accountability, and to that end, Congress should establish an independent National Board on Pandemic Preparedness to provide oversight and ensure that the U.S. is equipped to respond to future public health threats. Such a board, which would consist of cabinet-level officials and public representatives, would establish a set of metrics for the evaluation of federal preparedness capacity and capability, gauge how the nation is faring against these metrics, and develop an annual report to Congress on the state of pandemic preparedness.
Strengthening the role of the White House to direct federal departments to coordinate their efforts and conduct joint pandemic planning exercises would also enhance the nation’s level of readiness. Such a provision has been included in the bipartisan PREVENT Pandemics Act championed by Senators Patty Murray (D-Wash.) and Richard Burr (R-N.C.) and passed by the Senate HELP Committee; the bill should be advanced and considered by both chambers.
Safeguarding lives from threats, foreign and domestic, is ultimately a function most Americans agree the federal government must prioritize.
Whether it’s a microbe or a missile, we should not have a double standard with respect to preparedness. This is a lesson learned from COVID-19 that we should heed.
Anand Parekh, MD, MPH, is chief medical advisor at the Bipartisan Policy Center, and former deputy assistant secretary of health at the U.S. Department of Health and Human Services.