As the COVID-19 pandemic surge peaks and we begin to think about reopening our economy, our policy makers should immediately address how to prepare for the next one, for it is inevitable that a next one will occur.
I share with you my exact words from an address I gave at the National Press Club on December 8, 2005. Not because they were prescient of what was to come 15 years later, but because we as nation failed to act. Let’s not make that mistake again.
My exact words as delivered:
“But our hands are not tied. In fact, the policy implications become crystal clear. By immediately outlining and implementing a specific policy prescription, we can minimize not only the direct economic effects of a pandemic, but perhaps more significant, greatly reduce the costly indirect effects of panic, fear and paralysis.
There are 6 steps we must take.
1. Communication
Number #1 is communicating with the public.
To allay irrational fear, communication must be the bedrock of every public policy response. Communication—of accurate, reliable, consistent information—isn’t an option—it is the antidote—the vaccine for irrational fear. (Think Katrina.)
Failing to effectively communicate with the public—both before and during the pandemic—would be analogous to having a fire escape plan for your home, but neglecting to share the plan with your family. You don’t want your family jumping out the window when there’s a ladder under the bed. To minimize losses, you not only create an emergency plan, you tell people about it – again and again and again..
Prior to the pandemic—today—we must organize a communications structure with representatives from public health, law enforcement, military, and government to serve as the liaison to the public. It must be grounded in trust and reliability. During an outbreak, the communications structure should update the public every 6-8 hours on what they need to know—educating them on symptoms, cases, deaths, outbreak locations, and when and where to find care.
2. Surveillance
Second is surveillance. Remember the forest fire? We must stomp on the sparks before they ignite. The sooner we detect, identify and contain avian flu—in animals and in humans—the better the economic prognosis will be. That’s why we need a real-time international threat detection system. And that’s why I’ve proposed $1 billion to build it. By developing rapid testing technology, by training more epidemiologists, by enhancing our global partnerships, and by helping developing nations compensate farmers for livestock culled we can contain the flames before they spread.
3. Antiviral Agents
Third are antiviral agents. Antiviral agents (and believe it or not there are only 2) are the only front-line therapeutic tool we currently have to treat the avian flu, and slow its spread. But the bad news is, our current supply is inadequate. Today we have 4.3 million courses of Tamiflu stockpiled. That’s enough to treat less than 2% of the U.S. population. We must increase that number to provide Tamiflu for at least 25% of the population. A five day course of Tamiflu for 75 million Americans would cost approximately $1.35 billion—a tiny fraction of the economic impact of a full-blown pandemic.
4. Vaccines
Vaccines are our best line of defense—for prevention. Yet, unfortunately, until we identify the strain—which we can do only when sustained human-to-human transmission occurs—we can not begin to produce a targeted, fully effective vaccine. With our current grossly inadequate vaccine manufacturing capacity, it could take as long as a whole year to achieve “bug to drug”—that’s the window of time between first identifying the specific strain and manufacturing a vaccine available for distribution. In a time of pandemic, that’s an unacceptable wait.
We have a dangerously inadequate vaccine manufacturing base in this country. Why? Bottom-line: there’s so little profit and so much uncertainly in vaccine manufacturing today.
30 years ago there were 24 vaccine manufacturers. Today there are only 5… and only 1 on U.S. soil (Sanofi Pasteur).
In the United States we have 18,000 (not millions) doses of a test vaccine stockpiled, and 22 million more on order—enough to treat 11 million people—clearly far less than we need.
How do we grow our manufacturing base?
5. Research and Development
5th is research and development.
Vaccines and antivirals our best tools for the present. But research is our best hope for the future. We must harness the best minds in academia, and in the public and private sectors. We need to bring them together to form a “Manhattan Project for the 21st Century” which can help us better defend against naturally occurring, accidental, and intentional threats — including infectious diseases.
One example is targeted research for a cell-based flu vaccine. By investing in cell-based manufacturing technology, rather than relying on antiquated egg-based technology, the window for bug to drug can be cut from a year to less than six months. With tens of thousands of people dying every week, every moment counts.
6. Stockpiling & Surge Capacity
6th, we need to stockpile and prepare for surge capacity.
If identification and vaccine manufacture represents the “bug-to-drug” portion of the equation, stockpiling of medicine and surge capacity represents the “drug-to-person” side— that is, to respond with medical treatment.
Our current health infrastructure simply and unequivocally lacks the capacity to respond effectively to a severe pandemic. We don’t have the number of hospital beds, ventilators, health care personnel, morticians, vaccines, antivirals, or communication networks we need. All would be overwhelmed.
Being prepared means training first responders, and ensuring a civilian volunteer corps to step in and help handle the surge. It means allocating adequate surge facilities—vaccination sites, treatment centers, laboratories, and morgues. Has your community done so?
Our goal should be building a stockpile of antiviral agents for 75 million people, and putting in place a specific plan to deliver them. As soon as an effective vaccine is available, we must begin stockpiling, with the objective of having 300 million vaccinations—enough for every American.
We know that a pandemic influenza is no longer a question of if, when.
While there is no way to predict when an avian pandemic will occur, what we CAN predict, what we DO know, is the cost of being under-prepared.
The study I report on today sends a strong message.
A $675 billion potential hit to our economy — almost half of which is brought on by factors which CAN be eliminated by planning—gives us every reason to act now with a prescription, and immediately implement the course of action. Now is the time to act.
The 6- point prescription is simple—communication, surveillance, antivirals, vaccines, research, stockpile/surge capacity. We have the intellect, the ingenuity, the tools, the knowledge to minimize the blow.
Science and technology afford us the power to allay the direct effects. Sound public policy—grounded in communication and information — renders us the ability to ease the indirect effects.
My duty as an elected official, and as a doctor, is to ensure that we begin filling that prescription today. Our economy, our country, our lives depend on it.”
That was 2005. As Majority Leader of the US Senate, I failed to sufficiently make the case and comprehensive preparedness legislation never passed.
The prescription remains the same. This time around let’s make it happen.
You can watch the full 2005 remarks on C-SPAN here: https://www.c-span.org/video/?190239-1/pandemic-flu-preparedness
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