Since the end of the COVID-19 pandemic, there has been an unfortunate decline in policy interest in preparations for the next one.
Congress has not acted to renew the federal (PAHPA), which expired in September. This leaves federal programs to promote such preparedness on autopilot, without necessary reforms. With the expiration of temporary funding for the U.S. Department of Health and Human Services (HHS) on March 8, Congress can finally pass a budget for the current fiscal year. But both funding and practical preparedness policy reforms are essential for effective pandemic preparedness. The federal response to COVID was mixed at best. — the 2020 initiative that developed and delivered safe and effective COVID-19 vaccines in record-breaking time — has been widely praised. But some federal recommendations, e.g., regarding , lacked a credible scientific basis and were made without regard to public comments. The U.S. COVID-related death rate was than in most other industrialized democracies, and much of the federal response would have been unnecessary with more effective, thorough and focused pandemic preparedness. Poor organization and management hinder pandemic preparedness planning. The lead federal agency for preparedness, the Administration for Strategic Preparedness and Response ( ), is one of four major HHS agencies with pandemic preparedness responsibilities. But only two of ASPR’s four strategic goals directly involve preparedness and response. The Centers for Disease Control and Prevention (CDC) issued a “2022–2027 CDC Strategic Plan” that it “advances science and health equity and affirms the agency’s commitment to one unified vision— equitably protecting health, safety, and security,” but it does little to highlight strengthening of pandemic preparedness and response. The strategic plans for these HHS agencies do not reflect the systematic data-driven approach called for by the . The act directs agencies to identify their goals and establish milestones to measure progress, and also to link requests for additional funding to such progress. The milestones and goals underlying the administration’s fiscal 2024 budget request for pandemic preparedness fall well short of the GPRA standards. They do not provide a reasoned basis for evaluating budget requests. Congress should require that HHS adopt preparedness performance standards that allow a fair and full evaluation of the expected effectiveness and cost-effectiveness of preparedness programs. This means expressing the performance of federal preparedness programs in terms of reductions in expected pandemic-driven damages — i.e., disease, death and economic disruption. Others have noted that an estimate of the probability distribution of an epidemic of given intensity is necessary to assess global losses of lives and economic damages and to motivate global coordination and resource mobilization, but federal agencies have not developed such estimates. HHS needs to develop models about how expected damages from pandemics might be reduced by specific actions to improve preparedness, such as increased stockpiling of medical countermeasures or earlier development of universal vaccines. It should also state by how much specific increases in federal funding to ASPR and CDC could reduce expected damages from future pandemics. In the short run, HHS could use prediction markets and periodic expert elicitation to develop estimates of the odds of another COVID-level pandemic by a given date. created a prediction market for infectious diseases and found that it predicted trends of three out of five disease indicators more accurately than the preexisting methods. A 2006 expert elicitation study assessed pandemic influenza risks from bird flu and concluded there was a chance of efficient human-to-human transmission in the next three years. Such explicit and easy-to-interpret estimates are not found in reports on pandemic preparedness by federal health agencies. They certainly should be. The key to improving pandemic preparedness in the U.S. is not simply additional funding, but also better management of federal resources. Congress needs to demand use of objective, quantifiable performance metrics in reauthorizing PAHPA and funding federal pandemic preparedness.