Preparing for Pandemics, Natural and Manmade

Bob Graham and Jim Talent
The Hill, June 11, 2009

The 2009 H1N1 swine flu epidemic should remind Americans of two important truths: Mother Nature is full of surprises, and preparation matters.

The fact is, the United States is not doing enough to prepare for disease emergencies, either natural or deliberate. We should immediately commit to doing more: by innovating drug and vaccine development; increasing funding for public health and hospital readiness; and improving international cooperation surveillance and response. Over the last several years, the U.S. government has prepared extensively for an avian influenza pandemic by forging partnerships with the private sector to manufacture vaccines and funding university scientists to pursue influenza research. Instead of avian flu, however, this time we were surprised with a different kind of influenza virus. Wasted effort? No, the preparation was well worth it. Americans can rely on the millions of doses of effective antiviral medicines stockpiled whether treating avian or swine flu, and we can now make new flu vaccine in a matter of months. We are becoming more innovative in our ability to respond to future flu outbreaks, as those investments in new technologies and vaccine manufacturing bear fruit.

Unfortunately, we are not nearly as prepared to respond to any infectious disease besides influenza, whether sent from Mother Nature or as part of a deliberate attack. No one doubts that new diseases will emerge and that they could be a health risk to many Americans and even a threat to national security. The scenarios are easy to anticipate: An entirely new virus could take the world by storm, as SARS nearly did in 2003. Treatments for old plagues could become ineffective, as antibiotic resistance makes the drugs we have useless.

Or an epidemic could be the result of a deliberate attack. In our commission report, “World At Risk,” we concluded that unless we act urgently and decisively it was more likely than not that terrorists would successfully attack a major city with a weapon of mass destruction by 2013, and we identified bioterrorism as the weapon most likely to be used. One month later, the director of national intelligence publicly agreed with our assessment. In response, the commission was granted an unprecedented one-year extension to turn our recommendations into actions.

One of the best ways to reduce the chance of a bio-attack is to become better prepared to deal with its consequences; terrorists are less likely to use a weapon if its effect is limited.

But what if they do attack? The answer is preparation. Start by adequately funding the office within the Department of Health and Human Services charged with developing the medicines we will need in a public health crisis. The office is the Biomedical Advanced Research and Development Authority (BARDA), created in 2006. Its mission is to make sure that the nation has the right drugs and medical countermeasures not only for flu, but for emerging diseases, as well as chemical, biological, radiological and nuclear public health threats. The team at BARDA has already hired top talent, and is working effectively with the private sector. However, they have received little funding for the rest of their mission. It’s time to correct that.

The outgoing Bush administration asked Congress for $900 million in additional funding for BARDA. That funding could and should have been included in the stimulus package but was not. Congress should speedily correct that omission.

This is a national security issue — just as important as the capability to produce world-class military hardware and technology. It’s also a no-regret investment.

Improving the infrastructure to respond to a public health crisis is an opportunity for U.S. national security and for global American leadership, technical innovation, and economic stimulus. The United States has an opportunity to lead the world by innovating how vaccines and medicines are made, so that they can be made more rapidly and less expensively. Right now, there is a lot of room for improvement: It requires 10 to15 years and approximately $800 million from start to finish for one product, and 80 percent of all drug candidates that enter clinical trials fail to get FDA approval. Reducing costs and delay would position the country to make unprecedented contributions to global health.

It goes without saying that the best medicines in the world will do no good if they don’t reach the people who need them. Hospitals and public health systems need to be prepared to receive medicines, and have the capacity to deliver life-saving care.

As John F. Kennedy said, “The time to repair the roof is when the sun is shining.” Now, before the next public health emergency, is the time to invest in our nation’s ability to respond to a public health emergency, so that we will have the tools we need to prevent, contain, and treat disease.