Washington, We Have A Problem

President Biden's "Mission Control" for Improving U.S. Pandemic Response is Missing Two Things

Last week President Biden announced a new pandemic preparedness plan for the United States. While details are lacking in the 27-page plan, here I will offer two high-level critiques. First, everything in the plan suggests the need for a new federal agency, similar to agency reorganization after 9/11, but the plan does not actually make that recommendation. Second, the plan fails to recognize the current lack of high-level expert advice in the pandemic, a capacity that is sorely missing.

The plan cites the Apollo moon program of the 1960s and 1970s as precedent:

“The mission of transforming U.S. pandemic preparedness and biodefense capabilities should be managed with the seriousness of purpose, commitment, and accountability of an Apollo Program. There should be a centralized ‘Mission Control’, acting as a single, unified program management unit, that draws on expertise from multiple HHS agencies, including NIH, CDC, BARDA, FDA, and CMS, as well as other departments such as DoD, DoE, and VA.”

The Apollo program could not make for a more inappropriate choice as an institutional analogy. Apollo was a single-agency mission under NASA, with a simple, specific technical goal, which was achieved without any need to implement policies across broader society. For all of its technical achievements, the Apollo program was ridiculously simple in comparison to dealing with a global pandemic.

The Apollo “Mission Control” was located in Houston, Texas and had a singular focus on spaceflight missions. The Biden plan describes what a pandemic “mission control” might look like.

Mission Control should have the responsibility and authority to (i) develop and update plans with objective and transparent milestones; (ii) regularly assess and publicly report on mission progress; (iii) shift funding to ensure that goals are achieved; (iv) coordinate linkages across performers in government, academia, philanthropy, and industry; and (v) conduct periodic exercises to evaluate national pandemic preparedness by deploying national capabilities, including by rapid product development.

This sounds a lot like a federal agency. U.S. pandemic plans developed first under George W. Bush and then under Barak Obama envisioned the federal response being led by the Department of Health and Human Services. That plan also identified key responsibilities for the State Department, U.S. Agency for International Development, Department of Defense, Department of Agriculture, Department of Homeland Security and the Department of Transportation.

The reality of the COVID-19 pandemic has shown the federal response to be far more complicated than this, with the US government listing more than 100 federal agencies participating in the response to the pandemic. The Trump Administration struggled mightily with inter-agency coordination, which is one reason that it bizarrely had lead-agency responsibility ping-ponging from HHS to FEMA and back again in 2020. Inter-agency coordination is challenging in the best of times – it is impossible with incompetent leadership.

It is best to think of President Biden’s “Mission Control” as a placeholder for a new federal agency for pandemic preparedness, intelligence and response. Much like the Department of Homeland Security emerged in the aftermath of 9/11, Congress and the White House should work together to outline what a new federal capability to deal with pandemics might look like. One thing we should all agree on is that the current approach has failed comprehensively and a new approach is needed, to continue to deal with COVID-19, but also with inevitable future pandemics.

The Biden plan acknowledges in passing the importance of independence expert input:

Mission Control should seek the input of outside experts on critical issues and consider establishing working group(s) that focus on scientific and technical assessments, improving public health and ensuring that the capabilities serve all communities, especially the most vulnerable.

Yet, U.S. policy making on COVD-19 under President Biden, like that under President Trump, still lacks high-level, independent expert advice to inform the overall pandemic response. This oversight compromises policy making and enables the politicization of science.

Expert guidance helps to legitimize decisions. For instance, when the Food and Drug Administration recently approved the Pfizer-BioNTech COVID-19 Vaccine, it was the end of a process informed by expert advice.  FDA vaccine approval is informed by an independent expert committee – called the Vaccines and Related Biological Products Advisory Committee – to provide guidance on “safety, effectiveness, and appropriate use of vaccines.”

A clean separation of advice and decision making is fundamental to important US government decision making because it helps to insulate experts from actual or perceived political influences. For politicians that separation enhances democratic accountability by making clear who is responsible for important decisions. The US government utilizes more than 1,000 expert advisory committees, involving tens of thousands of experts, arguably making it the global leader in connecting expertise with policy.

That global leadership is what makes the US government’s failure to establish a high-level advisory committee for COVID-19 utterly incomprehensible. Any new approach must depend to a much greater degree on independent expert advice.

Consider masks, which were politicized from the start. The U.S. Surgeon General Jerome Adams Tweeted on February 20, 2000: “STOP BUYING MASKS!” and members of Trump’s Coronavirus Task Force engaged in a campaign to tell the public that masks simply were not effective.  We later learned in admissions from Dr. Anthony Fauci that this guidance was not grounded in scientific evidence, but couched in the language of evidence in an effortto protect the limited supply of masks for health professionals. No matter how noble the intent, the resulting hit to credibility has been long-lasting.

An independent advisory body could have short-circuited the early politicization of masks by clearly and unambiguously summarizing the state of knowledge on the role of masks in limiting the spread of disease. Making such knowledge public – along with inevitable accompanying uncertainties and areas of ignorance – would have made it more difficult for the Trump Administration to make the obviously inconsistent argument that masks protect health workers but not you and me. The politicization of masks that began in February 2020 still reverberates with us today, with mask wearing now bizarrely associated with one’s political affiliation.

Any new federal organizational structure must reflect that expert advice takes multiple forms. In some cases, policy makers simply want to know what the scientific community knows: what is the public health benefit of masks? Is a vaccine safe? In other cases, policy makers want to know their options and the possible consequences of those options: What are the benefits and costs of returning students to schools? How might we integrate concerns about public health with the economy? The composition and activities of an expert advisory body will depend on its purpose.

Around the world during the pandemic, many counties have engaged high-level expert advisory committees, such as the Science Advisory Group for Emergencies (SAGE) in the United Kingdom and the “Novel Coronavirus Expert Meeting” in Japan. These bodies performed more or less well as we have learned in a 17-country comparative analysis of science advice that I am leading. But what stands out in the case of the United States is the absolute lack of such a high-level governmental advisory body. This vacuum of legitimized expertise has helped to turn the US COVID-19 response into a scientific and pseudo-scientific free for all.  

The Biden Administration is to be applauded for its recognition that a new approach to pandemic policy making is sorely needed. However, its proposed path forward lacks the institutional ambition that will be needed for a truly successful new approach. A new federal agency is needed with pandemic response as its mission. Inter-agency coordination won’t cut it. In addition, the Biden Administration’s plan fails to reflect the central importance of independent expert advice, both for informing policy making and for navigating political currents. The U.S. can and must do better in its pandemic policy, because we aren’t through this one yet, and there will more to come.