I’ve written before about how the use of science at federal agencies has suffered and what Congress can do to help. Now, my organization, the Jacobs Institute of Women’s Health, is one of dozens of groups recommending steps to restore the role of science in the executive branch. Restoring Science, Protecting the Public: 43 Steps for the Next Presidential Term is a resource for presidential campaigns and transition teams, endorsed by a wide range of public health, environmental, good-government, consumer, and human and civil rights organizations.
COVID-19 has demonstrated just how crucial it is for government decisionmakers to heed and prioritize science when responding to this public health crisis. For that to happen, US federal agencies must collect robust public health data and ensure that scientists are able to give advice based on their expertise without pressure from elected officials to downplay the severity of the situation. COVID-19 is disproportionately killing Black people, but CDC isn’t giving us racial and ethnic data for all COVID cases and deaths. We need accurate information about where and how the disease is spreading and evidence-based guidance about how we can reduce its toll. For science to inform action, changes across the executive branch are necessary.
The 43 steps include recommendations in eight areas: agency scientific independence, data collection and dissemination, federal advisory committees, federal personnel policy, regulatory reform and science, restoring strength to scientific agencies, scientific communications, and whistleblower protections. I’m going to quote at length from the Preface, “Restoring Scientific Integrity Is Essential for Beating COVID-19,” because it shows how actions in all these areas can improve our ability to save lives during this pandemic and future crises:
Protect government science from political manipulation. Government leaders need to make decisions about requiring public health measures such as physical distancing, approving therapies and vaccines, and determining whether and how people can return safely to work that cannot be done remotely, such as manufacturing. To make these decisions, they must have access to accurate information presented without political interference. The administration should ensure agencies’ scientific independence by restoring the voices of experts in policymaking, directing agencies to strengthen scientific integrity policies and infrastructure, and protecting government scientists. (See the memo “Agency Scientific Independence.”)
Ensure public access to data collected by the federal government. Results from government-sponsored research into COVID-19 testing, treatments, vaccines, and disease course, as well as information about the federal response, must be accessible so researchers can conduct additional analyses and leaders of organizations and state and local governments can make informed decisions. The administration should reverse a recent trend toward restricting data and denying Freedom of Information Act (FOIA) requests, and institute new safeguards that will ensure the continued collection, dissemination, and preservation of data and protect against its improper removal. (See the memo “Data Collection and Dissemination.”)
Restore the role of independent expert advice in government. Federal Advisory Committees (FACs) have long been a valuable source of independent information for the federal government on a wide range of issues, including vaccines, diseases, and how populations are disparately affected by diseases and inequities. However, a recent executive order capping the total number of FACs and requiring that the current number be slashed calls into question the extent to which federal agencies will be able to rely on FACs to address COVID-19. The administration should rescind damaging directives that restrict committee membership and activity, and should instruct agencies to improve transparency and conflict-of-interest management. (See the memo “Federal Advisory Committees.”)
Ensure government leaders are qualified, ethical, and accountable. Trust in federal officials is particularly important when educating the public about pandemics and related health behaviors, but appointing senior officials with conflicts of interest and insufficient scientific credentials can compromise that trust. To demonstrate its commitment to qualified and accountable public servants, the administration should commit to reforms of personnel practices and ethics rules. (See the memo “Federal Personnel Policy.”)
Restore the role of independent science in the regulatory process. As COVID-19 creates a new reality for our health-care system and economy, regulatory changes will be needed for topics ranging from telehealth to worker protections. The administration should remove unnecessary steps in its review of proposed public protections, reassess the role of cost-benefit analysis, increase transparency in rulemaking, and decrease barriers to participation in the notice-and-comment process. (See the memo “Regulatory Reform and Science.”)
Ensure federal agencies that use and produce science can perform effectively. Now more than ever, we need the Centers for Disease Control and Prevention, Food and Drug Administration, National Institutes of Health, Occupational Safety and Health Administration, and other public health agencies to have the staffing, leadership, and resources they need to conduct effective disease surveillance and support the development, testing, approval, and distribution of lifesaving therapies and vaccines. The administration must fill open positions quickly, undo recent actions that have harmed recruitment and retention, and create robust budgets. (See the memo “Restoring Strength to Scientific Agencies.”)
Ensure public and policymaker access to independent science. Local leaders and the public need access to scientific expertise in order to make informed decisions about the public health measures they adopt as COVID-19 knowledge and circumstances evolve. Agency policies that require scientists to receive approval before speaking with journalists or the public can delay action, distort findings, and reduce trust in federal scientists’ communications. The administration should affirm that the era of government censorship of scientists and scientific information is over, require agencies to develop media policies that allow scientists to share their expertise without political vetting, and advance other initiatives to improve scientific communication. (See the memo “Scientific Communications.”)
Help civil servants and contractors feel safe when reporting agency shortcomings. Under the many pressures that a pandemic creates, agency missteps are inevitable. Responding to those missteps with transparency and good-faith efforts to improve, rather than with punitive efforts to silence and discredit whistleblowers who raise serious concerns, can strengthen both agency functioning and public trust. The administration should increase protections for whistleblowers by strengthening policies, training, and the infrastructure for handling whistleblower complaints. (See the memo “Whistleblower Protection.”)
Restoring an executive-branch environment that prioritizes science will save lives. I hope those in the White House in 2021 heed these recommendations.
memo at the request of RI Sen S Whitehouse-
COVID chronicles:
REBUILDING A ROBUST PANDEMIC PLANNING AND RESPONSE SYSTEM
‘‘Pathogenic microbes can be resilient, dangerous foes. Although it is impossible to predict their individual emergence in time and space, we can be confident that new microbial diseases will emerge.’ Institute of Medicine, Emerging Infections: Microbial Threats to Health [1992]
In addition to the human toll the COVID-19 crisis has upended much of the economy and exposed glaring weakness in the US health care system and its ability to operate in a pandemic. This is at once apparent in the level of risks, infections and illness to those workers whose primary occupation is to care for the infected and the sick. Apparent as well in the gross failure in those manufacture and supply chains essential for workers’ safety as well as in timely testing.
As discussion about rebooting the economy takes place its imperative that we rebuilt a robust pandemic planning and response system since that will be the critical domain where anticipated surges and revisits by COVID-19 [ and also evolving new emerging infectious diseases will best be controlled]. If we get that right than downstream crises like those that have hit the meatpacking and nursing homes and other sectors may well be more effectively contained.
There has been ongoing infectious preparedness plans designed to stop, slow, or limit the spread of a pandemic in the United States for decades. These plans address limiting domestic spread and mitigating disease but also sustaining infrastructure and reducing the adverse effects of the pandemic on the economy and society. These plans have been developed by many sectors in response to potential small, medium and large scale outbreaks.
Infection control plans received sustained attention in response to the HIV epidemic in the 80s. Added impact was the emergence of multidrug resistant forms of tuberculosis– still a major deadly microbial disease throughout the ‘outside’ world. Growing concern about the threat from emerging infectious disease was consolidated in a 1992 report by the Institute of Medicine (IOM) with the charge:-‘‘Pathogenic microbes can be resilient, dangerous foes. Although it is impossible to predict their individual emergence in time and space, we can be confident that new microbial diseases will emerge.’ Emerging Infections: Microbial Threats to Health [1992]
In the 90s the Centers for Disease Control [CDC] launched a nationwide effort to revitalize national capacity to protect the public from infectious diseases imbedded in a comprehensive platform (Preventing Emerging Infectious Diseases: A Strategy for the 21st Century 1998). Interest in infection control planning and response was amplified for the avian flu and other flu outbreaks including a SARS virus that resembles SARS-CoV2 after the turn of the century. Infection control planning and response then took on even more urgency with the anthrax scare after ‘911’ and the fear of a possible deliberate use of smallpox created networks of bioterrorism policies, practices and agencies.
Under the umbrella of the National Response Plan (NRP) which provides the mechanisms for a comprehensive coordinated response to all ‘Incidents of National Significance’. These are defined as ‘high-impact events that require an extensive and well-coordinated multiagency response to save lives, minimize damage, and provide the basis for long-term community and economic recovery’. Though the NRP principal focus was (and is) terrorist attacks and natural disasters, in 2005 and 2006, the White House Homeland Security Council issued a National Strategy for Pandemic Influenza and the National Strategy for Pandemic Influenza Implementation Plan “aimed to stop, slow or otherwise limit the spread of a pandemic to the United States; limiting domestic spread, mitigating disease, suffering and death; and sustaining infrastructure and lessening the effects on the economy and society as a whole.” (The National Strategy and Implementation Plan has not been updated since 2005-06.)
The Department of Health and Human Services (HHS) issued its own Pandemic Influenza Plan in 2005. This Pandemic Influenza Plan was updated in 2009 and, more recently, in 2017. (Coronavirus is not influenza virus so it remains a question as to how National Response Plan-related initiatives apply–although both viruses share the same route of exposure.)
However, as each disease threat waned, so did attention and resources to these plans. There were still highly articulate analyses and research on infection control and response in many sectors, especially health care, emergency response and in the military. When the EBOLA virus threatened a potential for a world-wide pandemic in 2014- 2016 the Obama administration assembled a pandemic response unit within the National Security Council. They even presented a mock influenza epidemic scenario for the incoming Trump administration. The Trump administration disbanded the unit.
‘Manufacturers, hospitals and the government all lost critical time because of the disarray in the protective equipment in the supply chain.’ The Wall Street Journal 4,30,2020
THE FIVE DOCUMENTS BELOW CAN SERVE TO HELP REBUILD A ROBUST PANDEMIC PLANNING AND RESPONSE SYSTEM, REDIRECTING A CRISIS THAT HAS BEEN MET WITH A HERETOFORE HIGHLY DYSFUNTIONAL NATIONAL RESPONSE.
They embrace but are not limited to:-
-viral research in the fields where pandemic organisms originiate;
-vigilant monitoring for spillovers;
-reform of medical information recording and communication systems;
-systems to develop diagnostic tests and testing rapidly and in abundance;
-improved surge capacity by medical providers;
-supple supply chains for PPE, ventilators, engineering controls;
-research and development in infectious disease transmission and methods of environmental control;
-coordination of planning and decision among multiple jurisdictions;
-research on NPI non-pharma interventions (isolation, quarrantines, social distancing etc.;
public education and drills on NPI;
public health leadership;
-sustained and reliable funding cycles.
• CDC, Preventing Emerging Infectious Diseases: A Strategy for the 21st Century 1998). Provide a broad and specific new direction for planning for and responding to pandemic outbreaks based on our goals: surveillance and response, applied research, infrastructure and training, and prevention and control. [https://www.cdc.gov/MMWR/PDF/rr/rr4715.pdf]
• 2016 National Security Council Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents is online at https://assets.documentcloud.org/documents/6819268/Pandemic-Playbook.pdf.
• ‘After the Storm’ Dr Siddhartha Mukherjee, The New Yorker May 4, 2020. A world famous NYC oncologist addresses how COVID-19 had revealed deep flaws in the system of American medicine, and outlines the experience and opinions of many front line clinicians and experts trying to function within the dysfunctional system and suggests ways of recovery.
• First Opinion: We need the real CDC back, and we need it now,’ Dr Ashish K. Jha, April 29, 2020 [https://www.statnews.com/2020/04/29/we-need-the-real-cdc-back-and-we-need-it-now/ ] Dr Jha has recently been appointed as Dean of the School of Public Health at Brown University.
• ‘How to stop the Next Pandemic’ by Jennifer Kahn, New York Times Sunday
Magazine April 21,2020 [www.nytimes.com/2020/04/21/magazine/pandemic…
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RI Committee on Occupational Safety & Health
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