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January 6, 2022

The Pandemic Preparedness Program: Reimagining Public Health

Author Affiliations
  • 1Department of Medical Science, Brown University, Providence, Rhode Island
  • 2Harvard Law, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts
JAMA. 2022;327(3):219-220. doi:10.1001/jama.2021.23656

On September 2, 2021, the White House released its long-awaited pandemic preparedness proposal titled American Pandemic Preparedness: Transforming Our Capabilities.1 Called for by presidential executive order 13987 and National Security Memorandum 1, the proposal, 8 months in the making, comprises a whole-of-government review and update of US national biopreparedness policies.2,3 The pandemic preparedness proposal is ambitious and all-encompassing and acknowledges that the transformation of “our medical defenses” will require “extensive scientific and technological efforts.”1 In this Viewpoint, we review the leading objectives of the pandemic preparedness proposal, discuss the outcome of comparable past federal efforts, and emphasize the imperative of intragovernmental coordination.

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2 Comments for this article
What About Preparedness Beyond the Healthcare System?
Dominique Sprumont, JD, PhD | Institute of Health Law, University of Neuchâtel, Switerland
Adashi and Cohen rightfully raise the key issues in a medical perspective to improve our capacity to prevent, resist and cope with the next pandemic. A new approach to preparedness program in the US and the rest of the world is needed based on the latest experiences acquired during the COVID-19 pandemic. All the elements they address are important and require a rapid answer with adequate resources. Yet it would be a terrible mistake if the preparedness program remain focused on medical solutions and reinforcement of the healthcare systems.

In the countries that were most effective at mitigating the
impact of the first waves prior to the availability of the vaccines, the measures that proved the most efficient were not medical but behavioral and social. They mostly relied on the governments’ capacities to provide to their population the necessary means to adopt the proper protective and preventive measures. For instance, before ordering a lockdown, the people need to be reassured that their revenues are guaranteed. Likewise, requiring students and children to study from home requires that the courses are provided online and that no one is left behind in terms of computer and internet access, and for the children that their parents can care for them at home.

If COVID-19 has taught the world an essential lesson is that under a pandemic inequities become even more inequitable and that poverty is a more deadly factor than the virus itself. It is time to admit that social, economic and legal actions are as important if not more important to cope with the emergence of a pandemic than so-called pharmaceutical measures. It is time to abandon the concept of "non-pharmaceutical interventions" to designate all the measures that are beyond the healthcare system. It is dangerously creating biases within the public health community and the decision makers that those measures are secondary compared to strictly medical ones. Everyone should be worried if the management of the next pandemic relies on the same medical paradigm of the current preparedness approach. This is not to say that we should step away from science. To the contrary, this would be a step toward implementing at last all the knowledge and science available on the social determinants of health.
Pandemic Preparedness Program
Peter Liepmann, MD MBA | Health Care Payment Learning & Action Network

The US had a robust pandemic preparedness program.

It was systematically destroyed between 2017 and 2020.

We had outreach epidemiologists in China. They were eliminated.

We had a robust response framework. It was eliminated.

Countries like Korea that responded promptly had far fewer deaths and cases.

The deaths and disability in the USA from Covid were self-inflicted wounds.