COVID-19 has revealed how vulnerable the world still is to pandemics.
The total cost of the pandemic in the United States is estimated at $16 trillion. Even if a pandemic of this magnitude only happens once every 100 years, it would be worth it for the government to spend up to $160 billion every year towards preventing the next pandemic. For reference, the US spends $175 billion each year on counterterrorism. Despite having “a 9/11 in deaths every day” for much of the pandemic, the federal government has not moved to act in even a remotely proportionate manner.
Last September, the White House put together the American Pandemic Preparedness Plan, a comprehensive 10-year, $65 billion agenda to prevent the next pandemic. More important than the amount of money is that the plan contains ambitious yet achievable goals to “transform our medical defenses,” “ensure situational awareness,” “strengthen public health systems,” “build core capabilities,” and “manage the mission.” These phrases are more than just platitudes. They include plans to create vaccines and therapeutics for each viral family, set up an early warning system using genomic sequencing and clinical data, invent next generation personal protective equipment (PPE) and buildings, accelerate biosafety and biosecurity innovation, and establish an international infrastructure for pandemic preparedness.
Despite the White House’s ambition, Congress has mostly fallen asleep at the wheel — in the Build Back Better Act there was a grand total of $2.7 billion authorized for pandemic preparation funding, and of course, that bill has yet to pass. The one notable exception to this trend has been the Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act introduced by Senators Patty Murray (D-WA) and Richard Burr (R-NC).
There was hope that the PREVENT Pandemics Act would finally be the legislative vehicle for fulfilling many of the goals of the American Pandemic Preparedness Plan. And while Murray and Burr should be applauded for their efforts, unfortunately, the provisions in the current draft legislative text are unlikely to actually prevent the next pandemic. But all hope is not lost — there is still time to improve the bill.
Already, there are notable differences between the old discussion draft that was released at the end of January 2022 and the new text that just came out ahead of the markup hearing. The current draft includes a section on public health information communication and combatting disinformation, which, given the freedoms enjoyed in the US, will be an important component of a pandemic response. It even directs OSTP to establish and update policies around federally funded research that may create pathogens of pandemic potential (i.e., gain-of-function research), which may be among the most impactful components of the PREVENT Act towards actually preventing a future pandemic.
But the bill, as it currently stands, lacks the ambition — and commensurate funding — necessary to actually deliver on the promise of its name.
Here’s how the total spending for the White House plan compares to the Senate’s.
Two categories — grants for state stockpiles and awards to support community health and health workers — authorized “such sums as may be necessary.” It is highly unlikely those sums will bring the PREVENT Pandemics Act totals in line with the American Pandemic Prevention Plan and, even if they did, it would not be the highest value use of those resources.
Some categories, like regulatory changes and medical countermeasures (e.g., diagnostics, vaccines, and therapeutics) were included in the Senate plan, but did not have additional funding authorized. For full context, the authorization amounts as outlined in the PREVENT Pandemics Act and duration are included below.
Some might argue that while the White House is asking for funding over 10 years, the PREVENT Pandemics Act funding is for one to six years, so there is still the chance to fund the rest of the American Pandemic Preparedness Plan down the road. But this strategy ignores the political reality that public support for pandemic preparedness legislation is likely at its highest point right now as COVID is still fresh in voters’ minds. The odds of passing additional funding bills in the future will continue to go down as the urgency of the pandemic grows more remote in the minds of voters. Waiting to incorporate pandemic preparedness funding into the standard appropriations process might also prevent the timely initiation of preparedness policies, such as a sustainable program for real-time virus monitoring. Many of these programs would even be useful against the near-term threat of a seasonally-driven COVID-19 wave expected this fall and winter.
Not all pandemic prevention problems can be solved with more funding. Money alone won’t transform the CDC from a sluggish academic institution back into the dynamic agency that eliminated malaria in the US. Money alone won’t provide the interdepartmental, interagency coordination needed to commit to and remain accountable for pandemic preparation.
But funding is necessary for the kind of research, development, and implementation that is required to prepare vaccines or monitor for new outbreaks. As an example, in its American Pandemic Preparedness Plan, the White House requested $24.2 billion to create a vaccine for each viral family. This works out to about a billion dollars per vaccine, which, compared to the $18 billion that was put into Operation Warp Speed, would be a bargain. The Senate bill does, in theory, also cover vaccines. However, the draft only requires the Assistant Secretary for Preparedness and Response to report annually on the successes and challenges of creating medical countermeasures, and does not actually provide the funding required to do so.
The saving grace may be a new component added to PREVENT. The Act would create an Office of Pandemic Preparedness and Response Policy (OPPRP) within the Executive Office of the President. This office should be able to coordinate with the Office of Management and Budget to request the appropriate funding and then direct the productive use of these funds. Hopefully, the OPPRP will remain in the final version of the bill and Congress will eventually appropriate the funding needed to achieve everyone’s goal of preventing future pandemics.