The third anniversary of the COVID-19 pandemic on March 11 may feel to some like a relief as we transition into a post-COVID era. Yet, many industry leaders, policy experts, and public health officials say it’s a reminder of the need for renewed rigor when preparing for the next pandemic—begging the question, are we ready for the next pandemic?
As America reflects on the pandemic years, there is one aspect of the response the U.S. got right. “The shining star that everyone talks about when it comes to the COVID-19 pandemic response,” said Ambika Bumb, Ph.D., Deputy Executive Director at the Bipartisan Commission on Biodefense, “was Operation Warp Speed.”
What we got right: Operation Warp Speed
John T. Redd, MD, MPH, FACP, Chief Medical Officer and co-founder of The Medical Countermeasures Coalition (MC2), agrees: “Both the vaccine and new therapeutics were developed quicker than they had ever been developed before, and much more quickly than they would have absent the massive effort that Operation Warp Speed represented.”
Experts credit the confluence and collaboration of public and private in response to just about every aspect of COVID as the secret sauce of the pandemic response. “Having coordination and everyone playing in the sandbox together was a huge part of Warp Speed being successful,” echoed MC2 CEO Taylor Sexton. “Having situational awareness across the board was incredibly important and novel for the time.”
“While there was a ton of capital invested in the program,” Redd explains, “It was also the magnitude of the human effort that made it successful. Operation Warp Speed brought together a huge number of people and enabled different parts of the government that don’t always work together to collaborate successfully. It also allowed everyone to really focus on, and achieve, very big concrete goals, including vaccines, diagnostics, and therapeutics development.”
Operation Warp Speed showed unequivocally the power of medical science when everyone works together towards a common goal. Additionally, the program gave the development of mRNA technology the shot in the arm it needed to realize its decades-long pursuit that would change how we treat disease.
Operation Warp Speed had other positive, secondary effects that are still being seen today. As just one example, the Rapid Acceleration of Diagnostics (RADx®) launched by the National Institutes of Health (NIH) was originally an “initiative to speed innovation in the development, commercialization, and implementation of technologies for COVID-19 testing,” according to its website.
RADx is still bearing fruit. Today, the RADx program has expanded to include RADx Tech, RADx Underserved Populations (RADx-UP), RADx Radical (RADx-rad), and RADx Advanced Technology Platforms (RADx-ATP).
“As a result of navigating a debilitating pandemic,” says Bumb, “There’s now significantly more muscle memory of how to respond and keep the country functioning, but also how to keep all these different federal organizations functioning connected and collaborative so that we can effectively respond to the next great challenge.”
While Operation Warp Speed was, undoubtedly, a success, it’s also important to ask where we fell short—and how we can learn from the failures.
What needed improvement: supply chains
Critics have been loud in their consternation over the COVID-19 response, and for understandable reasons. Chaotic messaging in the early days, poor monitoring systems, a struggling social safety net that made stay-at-home orders difficult to maintain, and infectiously resilient misinformation growing alongside a strengthening anti-vaccine movement all made containment, treatment, and recovery a struggle.
But it is important to remember that no one knew then what we know now—especially as we look toward the next pandemic. While agencies and community leaders did the best with the information that they had, supply chain issues stand out as a key challenge that has persisted past the pandemic.
“I think our supply chain resiliency was not there,” explains Sexton. “We saw that there were all sorts of shortages—even outside and COVID.”
“I agree that the supply chain was stressed in the United States and other parts of the world, too,” echoes Redd. “But it was stressed here like it never had been before. And because of those delays, we had a tendency to sort of chase our tails. Delay in procuring and moving ventilators prompted efforts to make new ones. But the supply chain issues over time couldn’t keep up with rapidly-changing methods of patient management, such as the use of prone ventilation, non-invasive ventilation, high-flow nasal cannula, oxygen, all of which spared patients mechanical ventilation, which is better for the patient. That, in turn, led to a need for fewer ventilators.”
During the pandemic, the longevity of the supply chain issues speaks to its legacy as a major need. And just like the success of Operation Warp Speed was dependent on connection and collaboration, improving the supply chain will require a similar toolset.
Are we ready for the next pandemic?
The short answer is no—but it’s not so simple.
“We are better prepared than we were before COVID,” explains Redd. “We’ve made great developments, and we had many successes, some failures, and we’ve tried to respond and improve as a country for future pandemics. While I do think that we’re better prepared for the next one, I don’t think we’re fully prepared, no.”
As Redd explains, there are several areas the U.S. needs to focus on when it comes to preparedness, particularly improving supply chains and ensuring that medical countermeasure development remains well coordinated.
“There’s going to be an understandable urge after the effort of the pandemic to take a break and exhale, or move on to something else,” Redd warns, “but unfortunately, as we’ve seen with the rapid expanse of COVID-19 variants around the world, we can’t let our guard down. We’ve got to keep our attention on this and keep all pulling our oars in the same direction to make sure we really are ready for the next pandemic.”
Sexton, for his part, discussed the need to maintain appropriate resources to promote the continuation of advanced research and development. “We were very fortunate to have mRNA capability around the time of COVID, but it was ten years in the making. It wasn’t something that we just picked up out of nowhere,” he said. “As such, we need to continue to develop things like platform therapeutics and platform vaccines and the sort of things that are a little bit more threat agnostic. And that’s going to take a considerable amount of resources.”
“We also need to modernize our data systems and capabilities to be able to communicate better among our interagencies,” continues Sexton. “We can also learn from the expanded contractor system that we saw during COVID that brought public and private more effectively together.”
Bumb adds, “We need to discuss how to tackle and improve the workforce for frontline workers, meaning nurses and critical infrastructure folks.”
“We also need to secure the national distribution of diagnostics, therapeutics, PPE, and items in the stockpile through Administration for Strategic Preparedness and Response (ASPR) and have clarity on what the plan is for the distribution of emergency materials,” Bumb continues. “Additionally, we need to invest in the development of key technologies.”
As such, the Bipartisan Commission on Biodefense recently developed an Apollo Program for Biodefense. It defines 15 technology priorities, including vaccine candidates, point-of-person tests, therapeutics, advanced manufacturing capabilities for medical countermeasures, PPE, and surveillance capabilities, needed to quickly contain future outbreaks.
If history has taught us anything, it’s that collaboration is key. Luckily, there is an opportunity to improve our pandemic preparedness strategy: the Pandemic and All-Hazards Preparedness Act (PAHPA).
PAHPA reauthorization is key to prepare for the next pandemic
PAHPA was first passed in 2006 to overhaul preparedness and response activities by the U.S. government in times of crisis. The law was reauthorized in 2013, but lapsed, only to later be amended and re-signed into law in 2019. Now, amidst the post-COVID landscape, the importance of the law is undeniable.
“This should be the biggest PAHPA reauthorization we’ve had, maybe since the beginning of the original PAHPA,” explains Sexton. “This is the opportunity to take a lot of these lessons learned and institutionalize the statute and make sure that we’re more prepared than we were before. We need to make sure that we don’t let what we’ve already done and learned atrophy.”
“The same goes for the funding,” he continues. “We had loads of funding that went through the system during COVID, but I worry that if we rolled funding back to even FY22 levels, we’d be in a really, really bad place.”
The upcoming PAHPA reauthorization will be a leviathan piece of legislation—all the better to maximize its impact. Topics and funding range from the Strategic National Stockpile to the Biomedical Advanced Research and Development Authority (BARDA), the Administration for Strategic Preparedness and Response, and beyond. If tackled effectively, a strong PAHPA could have a huge impact on future pandemic preparedness.
But PAHPA drives home the issue at hand regardless—we must plan for the next pandemic now.
“It is possible to never have a pandemic again,” Bumb concludes, “if we properly invest in the technologies and infrastructure we need to invest in. A 100-billion-dollars-over-10-years investment would insure us against another pandemic. We just have to understand the economic value of investing now versus trying to catch up later as a pandemic is raging.”