We’re in the midst of one of the gravest tests America has ever faced. It’s a moment to set aside partisanship and make decisions in the interest of the American people.
While we’re depending on President Donald Trump to provide sober leadership, our collective health and financial well-being depend not on him alone, but on all of us. We all have to do our part. But we also need a national plan on testing.
It’s never too early to draw lessons from a crisis. This is the context for a piece that assesses the federal preparation and response to COVID-19 — and outlines ways to do better in the future.
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Trump says he inherited an old system for testing viruses as part of pandemic preparedness. But the record suggests otherwise.
He became president after multiple recent pandemics (SARS, MERS, H1N1) and after Congress in 2013 passed pandemic legislation granting new authority to streamline billions in funding. The president’s transition team received stark warnings on pandemic risks from the Obama administration, including a Situation Room briefing on pandemics on Jan. 13, 2017.
Trump also inherited a White House staff with a pandemic directorate embedded in the National Security Council, an entity chaired by the president. Later, that directorate was abolished by then-National Security Advisor John Bolton.
Further weakening America’s capacity to respond to a pandemic crisis, the Trump administration took steps to limit access to health care for millions of Americans.
Bottom line: We find ourselves in a desperate game of catch-up, with our health system ill-equipped to test for or treat this pandemic and our economy at risk of another recession.
Which brings us back to the lessons we are learning today and how to ensure an effective pandemic response tomorrow.
A critical first step is to admit where we are and be realistic about where we are going. For instance, it’s clear we are still a long way from fulfilling the promise of widely available testing with prompt results.
Most people don’t even know whether they’re eligible for testing or how to get a test. We need to replicate the steps taken in China and South Korea, where they are isolating testing locations and providing health workers with secure, protective equipment.
The most effective national tool to secure vital supplies such as tests, masks and personal protective equipment is the 1950 Defense Production Act, which the president has used sparingly. As a result, states are competing and bidding up prices for the same equipment. Addressing this issue will allow for the rational, need-based distribution of essential medical equipment.
More broadly, we should adopt a national plan that funds and secures approval of sufficient numbers of point-of-care diagnostics for viral pandemics. That work is underway, but we need detailed reports every day that identify and set out to cure all bottlenecks.
We also need to launch a new public-private partnership to discover, develop and secure approval for better POC diagnostics for future pandemics that includes research and development engines like the National Institutes of Health and giant corporations, but also small biotech firms and leading academic labs.
We should pursue the use of existing funding tools such as economic prizes to rapidly overcome research funding hurdles. Sometimes the NIH peer-review grant process is too slow or too academic for quick policy action. The Biomedical Advanced Research and Development Authority, which is within the Department of Health and Human Services, is an example of a government entity that can move nimbly and in a practical, task-oriented manner.
Establishing a guaranteed government-funded stockpile to ensure steady demand for a set of POC diagnostic products will be vital, even if those products are only used episodically.
Finally, we should adjust the responsibility and accountability of the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services and the Food and Drug Administration on diagnostics for public health epidemics and pandemics. The epidemiology and expertise of the CDC is world-class, but it has demonstrated an inability to get to scale and cooperate on new tests with the World Health Organization and with private companies seeking samples. This must change.
At times, the FDA has been overly bureaucratic. And often it can’t adequately regulate lab-developed tests from hospitals and others, because those tasks are the responsibility of CMS — a giant federal payment or insurance company. That approach simply isn’t working, as our inability to produce science-based diagnostic tools at pandemic scale proves.
There are other challenges, including plans to deliver testing capacity to state and local governments and locales like drive-through testing. We must examine every aspect of the entire supply chain of parts, from reagents, to machines that read genetic sequences, to distribution.
Lastly, our national plan must solve for the availability of well-trained personnel to administer and use test results.
Make no mistake: Trump’s handling of COVID-19 is a story of missed opportunities. But the truth is no American president is immune to mistakes.
How he leads in the days ahead will shape his legacy. That legacy can include a stronger, better system for pandemics. It’s a forward-looking challenge at which we all want him to succeed.
David Beier is a managing director of Bay City Capital, a health care venture capital firm, and he served as chief domestic policy adviser for Vice President Al Gore. Andrew Sullivan is a founding partner of Hudson Pacific, a San Francisco political and public affairs strategy firm.
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