The chairman of the Senate Intelligence Committee said a critical challenge in confronting the threat of pandemics or biological attacks is acknowledging that “the architecture of government is not designed in a way that allows innovation to happen and for it to be deployed quickly.”
In an address Tuesday to the Texas A&M University and the Scowcroft Institute of International Affairs Pandemic & Biosecurity Forum in Washington, Sen. Richard Burr (R-N.C.) characterized the state of pandemic research and response in this country as “a lot of people jumping up saying ‘why the hell won’t you let me try.'”
“When we talk about Washington stovepipes, we’ve got a stovepipe when it relates to pandemics,” he said. “We broke that down right after 9/11 and in the subsequent years as we designed a [Biomedical Advanced Research and Development Authority] BARDA and [Pandemic and All-Hazards Preparedness Act] PAHPA and things that were focused on pandemics, and focused on things that were unknown. It was the right step for us to take.”
Today, he said, the effort keeps to “certain lanes” both in the administration and Congress, “and that’s what makes it difficult to get updates and reauthorizations out.”
“I don’t want to restate what the challenge is that infectious disease, either natural or intentional, presents to us as a society and presents to the world … I want to deal with what the problem is. The problem is the architecture of government.”
The conference coincided with the release of the Scowcroft Institute’s third annual white paper, Community Resilience, Centralized Leadership & Multi-Sector Collaboration in Pandemic Preparedness and Response, which includes 26 recommendations such as crafting strong national surveillance systems that monitor and sound the alarm on trends such as antimicrobial resistance, continued worldwide investment in line with America’s Global Health Security Agenda released in 2014, and whole-of-government planning that also includes whole-of-society response integrating human, animal, and environmental sectors.
In light of the conflict and community distrust that has stymied response to the latest Ebola outbreak in the Democratic Republic of the Congo, the report calls for rethinking how cultural factors and even religious leaders can be woven into comprehensive epidemic response.
The report also calls for senior-level White House leadership in both pandemic preparedness and response efforts.
Burr said that the current government system is “designed to take the least amount of risk, with the up-front knowledge of knowing that it will take a long time for you to run all the hurdles.”
He stressed that a technology deployed today will likely be obsolete 18 to 24 months from now.
“A system that restrains the deployment of technology on one side, and incentivizes the innovation of technology on the other, has to come together and figure out how we make these two mesh,” he said. “If not, we have great intellectual property that’s not able to affect people’s lives.”
The senator lauded BARDA for shepherding through FDA approval 35 new therapies in a system that brings together innovators and the federal government. “But on things like Ebola, that was on the original list that NIH had worked for years on, and NIH chose to shelve the technology and not develop it further,” Burr continued. “Nobody realized how important it was until we had an Ebola outbreak. And all of a sudden we scrambled as a nation, we scrambled as a globe to try to figure out how do we discover a therapeutic remedy or how we take a technology off the shelf and how we utilize that to solve an epidemic.”
“My plea to you today is we’re not limited to an occasional outbreak of Ebola,” he said. “Today it’s Ebola. Last year it was Zika. Today it’s measles — we forget there were 6,500 confirmed cases of measles in Venezuela in June 2017; we’ve had three million refugees go to Brazil and Peru. Between 2015 and 2018 Brazil reported one case of measles. Last year, they reported 10,000 cases of measles.”
“We’re seeing tremendous warning signs about what we need to do either in development or surveillance… that ought to set off alarm bells within our pandemic community.”
And as long as the government structure stymies innovation, “I would tell you we have a much bigger problem.”
“We’re up against adversaries across the world who have no historical limitations like we do, who look back at history and say well we have to do this before we do this, before we do this, before we do that. They utilize innovation today and they deploy it tomorrow,” Burr said. “And they usually get the value out of their technology because they’ve had it deployed long enough, versus the American model where it’s devalued on the day we deploy it because the technology is obsolete. We can’t afford to do that relative to healthcare. We can’t afford to do it as it relates to the risk of pandemics. And it’s absolutely crucial that we look at all the components and figure out how do we transform at least the healthcare space, if not the entirety of the United States government?”
Burr emphasized that he’s “not sure I want to trust the Russian Ebola vaccine that people have chosen to use in the Congo with limited success, from what I’ve read — I’d rather take the technologies that have been vetted here or somewhere else that have some degree of science and approval behind them versus a wish, or hope and a dream.”
The senator said he’s not suggesting weakening U.S. quality control or the need for FDA approval, but maintaining both while crafting a new innovation architecture that “would lead to a new partnership: government, academia, the private sector, possibly shared manufacture.”
“Innovate and deploy as quickly as we possibly can,” he said. “I’ve never believed that our population could potentially be at more risk than it is today. I am convinced globally that the rest of the world can benefit greatly on the advances we can make and we can share.”