US Pandemic Revamp Raises Worry of ‘More Cooks in the Kitchen’

An effort to give new powers to a US health emergency preparedness and response office is unlikely to clarify what part of the federal government takes charge in future pandemics, say former health officials.

Last week, the Department of Health and Human Services confirmed that it would elevate and give new duties to what has been known as the Office of the Assistant Secretary for Preparedness and Response. Under its new name — the Administration of Strategic Preparedness and Response — it will become an “operating division” on par with the Centers for Disease Control and Prevention, Food and Drug Administration and National Institutes of Health.

Covid-19 revealed how federal offices and agencies, as well as state and local public health offices, lack coordination or central control. Elevating ASPR is meant to better align some of those functions. But former health officials from the office and other agencies say that the changes don’t provide clarity on which parts of the federal government will be responsible for certain emergency-response activities. They also caution that the office needs additional resources.

Nicole Lurie, the assistant secretary for preparedness and response under President Barack Obama, describes ASPR’s role as “the place where all of emergency response sort of comes together,” reporting directly to the secretary of Health and Human Services.

“To think that making a move like this is going to magically solve our preparedness and response problems, I think is really, really naïve,” Lurie said. “I’m not sure it’s a good thing to become an equal among equals because it benefited before from having a more neutral role.”

Drugs, Disasters and Supplies

ASPR oversees several offices that were core to the Covid response, including the Biomedical Advanced Research and Development Authority, the National Disaster Medical System and the Strategic National Stockpile. Its record is not perfect – the national stockpile was found to be in disarray in the early days of the pandemic, when medical protective gear some expected it to have on hand ended up being in short supply. But it played a pivotal enough role, and other agencies struggled enough, that it will gain new powers.

“As you can see from Covid and of course even now with monkeypox, the role of our ASPR has increased dramatically,” HHS Secretary Xavier Becerra told reporters Thursday. “It is critical to have an operation at our disposal that lets us respond quickly, aggressively.”

Efforts to make the ASPR an operating division began in 2019 by former Assistant Secretary Robert Kadlec, according to former HHS officials who spoke on condition of anonymity. The Covid-19 pandemic made its necessity even clearer, according to the current head of the office, Dawn O’Connell, in a memo sent to staff last week.

In an interview Thursday, O’Connell said she approached Becerra about the changes in April, frustrated that some priorities for her office had to be offloaded to other agencies to get done, because of what she described as bureaucratic headwinds. She told Bloomberg that she had not had the power to hire or contract needed employees. Even as the US normalizes life with Covid, it’s now dealing with rising threat of monkeypox, she said.

ASPR’s new powers include greater hiring, contracting and funding authorities. But those do little to fix problems in other parts of government, such as a lack of funding for local public health or federal data-collection powers.

Overlap Worries

The conflict between the CDC and ASPR’s missions is inherent in those agencies’ names; the CDC is in charge of controlling and preventing disease, and ASPR is in charge of preparing for and responding to health crises.

Phil Ferro, a longtime career official at ASPR and former director for countering biological threats at the National Security Council, expects the change to lead to “more cooks in the kitchen,” and he worries that the government’s ability to respond quickly will suffer.

“People need to really think very carefully about how adding a new organizational structure — especially overseas with USAID and CDC — how are those authorities going to be assigned, delegated?” said Ferro, who is now president of the biotech startup Paratus Sciences. The United States Agency for International Development oversees the nation’s humanitarian-assistance programs abroad.

While at the NSC, Ferro watched infighting between the CDC and ASPR over getting passengers off the Diamond Princess cruise ship and back to the US for quarantine. “When we put that plan together, it was incredibly complex because CDC had the authority overseas and as soon as we crossed onto sovereign US soil and that plane landed in Washington, it was ASPR’s responsibility.”

O’Connell said that the changes will still leave ASPR as the “the coordinating body within the department.”

“This wasn’t meant to be in juxtaposition to anything at CDC, NIH, FDA,” she said. “And it didn’t mean taking anything from CDC NIH, or FDA – it just means giving us the capability we need. This wasn’t a play for us to add new responsibilities.”

Sarah Lovenheim, the assistant secretary for public affairs at HHS, reaffirmed that ASPR will continue to serve as a coordinating entity, and said ASPR and CDC “work hand-in-glove together.”

Money Matters

Though ASPR lacked muscle under the Trump administration, President Joe Biden asked Congress in March for $40 billion in mandatory funding over five years for the office. A House appropriations proposal would give the agency $3.7 billion, and a Senate proposal would give it $3.6 billion for fiscal 2023, just under the $3.8 billion Biden requested for the first year.

Any improvements to disaster response “will be contingent upon ensuring that this enhanced operational capacity is going to be adequately funded,” said John Redd, an epidemiologist who was ASPR’s chief medical officer until January but spent most of his career at the CDC. The public health agencies have often seen funding in boom-and-bust cycles, and public health officials worry the history will repeat itself.

The government’s response to monkeypox – there are more than 4,900 US cases so far — may be the best indication of how that will play out, said Soumi Saha, senior vice president of government affairs at Premier Inc., a member of the Biden administration’s health care supply chain resilience working group.

“Who we elevate to be leading that work is going to be, I believe, really telling on the future of who really is going to be leading pandemic response in the future,” she said.

--With assistance from Alexander Ruoff.

To contact the authors of this story:
Shira Stein in Arlington at sstein51@bloomberg.net

Riley Griffin in New York at rgriffin42@bloomberg.net

To contact the editor responsible for this story:
Drew Armstrong at darmstrong17@bloomberg.net

Mark Schoifet

© 2022 Bloomberg L.P. All rights reserved. Used with permission.