Biodefense strategy has a long, tangled history
Decades of warnings, lessons failed in the end
Former U.S. Sen. Joe Lieberman says it was as if Paul Revere rode across the country and no one paid attention.
For more than two decades, Robert Kadlec has warned leaders that the United States is not just vulnerable to a pandemic but doomed by dysfunction if one were to strike.
Several years ago, his warnings gained traction.
Congress passed a law in 2016 mandating a federal plan to protect against contagious diseases.
In 2018, President Donald Trump adopted a National Biodefense Strategy. It largely followed recommendations of a commission founded and directed by Kadlec, a retired Air Force colonel and physician who has held senior positions at the White House, Senate and Pentagon.
Kadlec was appointed to oversee preparedness and response at the Department of Health and Human Services.
But the document approved by Trump was a blueprint, not a game plan. The ideas weren’t implemented before COVID-19 arrived in the USA. And the federal government’s response shows it.
One example: The government has been criticized for taking too long to create and distribute tests to detect the virus. There are shortages of medical supplies and equipment such as protective masks and ventilators. Anticipating such shortages, the biodefense strategy calls for setting up excess manufacturing capacity to produce these necessities quickly in an emergency.
The same biodefense strategy called for a Cabinet-level committee to oversee protection against contagious diseases, but it never met to discuss the coronavirus outbreak.
The Coronavirus Task Force created by Trump one month into the epidemic did not include Kadlec, the person who had warned of this sort of catastrophe for years.
The nation’s biodefense network remains a labyrinth, according to the Bulletin of Atomic Scientists, in which responsibility is shared by at least 19 federal agencies, three executive offices, 50 political appointees and all state, local, tribal and territorial governments. Their roles are codified in a dizzying mix of laws, directives and action plans.
The system is so complex, a Department of Energy lab used its policy mapping tool known as the “Spaghetti Monster” to illustrate the linkages.
The National Biodefense Strategy is supposed to untangle that mess. Among its sweeping goals: “Ensure decisionmaking is informed by intelligence, forecasting, and risk assessment.” And “Rapidly respond to limit the impacts of bioincidents.”
Lieberman and Asha George, executive director of the Bipartisan Commission on Biodefense, said those objectives have not been implemented.
In February, in the heat of the coronavirus pandemic, the Government Accountability Office concluded the national strategy has “no clear, detailed processes, roles, and responsibilities for joint decision-making.”
Even the administration’s messaging about coronavirus seemed to defy principles of the biodefense strategy. It calls for “timely, regular, coordinated, and consistent” communication to the public. On the same day this month,
Trump downplayed COVID-19, saying it is “something we have tremendous control over.” His top infectious-disease expert, Anthony Fauci, said it could kill hundreds of thousands of Americans.
“It really is a Pearl Harbor moment, and are we going to be able to gear up?” Lieberman asked. “Here we are now, it’s a crisis and maybe going to be a catastrophe. … We’d be in a lot better shape if people had acted earlier.”
A senior administration official, who refused to be identified because he was not authorized to speak publicly, said the biodefense strategy laid out a single, coordinated effort across the federal government for the first time, and its goals are being implemented in response to the coronavirus pandemic.
The administration official said the steering committee outlined in the biodefense strategy was superseded by the Coronavirus Task Force. The official said Trump created the biodefense strategy to improve response time in situations such as the coronavirus pandemic, and it’s working.
20 years of warnings
In March 2019, Kadlec told Congress the nation’s biological protection system was understaffed by 2,000 workers. “Emerging disease outbreaks, particularly those with pandemic potential, are an international flight away,” he said.
Ten months later, the novel coronavirus broke out of China and traveled halfway around the world to the USA. It was a chance to put strategy into action.
Over the years, Kadlec sounded his fears in sometimes apocalyptic scenarios. He could not be reached for an interview for this story.
In 1998, Kadlec envisioned an anthrax assault on New York City. “Conservative estimates put the number of deaths occurring in the first few days at 400,000,” the Vancouver Sun reported. “Beyond the immediate health implications of such an attack, the potential panic and civil unrest would create an equally large response.”
In 2001, Kadlec anticipated a genetically modified disease. “It’s not your mother’s smallpox,” he warned. “It’s an F-15 Stealth fighter – it’s designed to be undetectable, and to kill . ... We are flubbing our efforts at biodefense.”
His mission began with the Defense Department in the 1990s. He moved to the White House during the 2000s as director of biodefense on the Homeland Security Council and as a special assistant to President George W. Bush.
Kadlec repeatedly told Congress that U.S. biodefense plans were disastrously flawed. No central leadership. Muddled national strategy. Insufficient money, supplies and manpower.
In 2014, he founded a nonprofit organization, the Blue Ribbon Study Panel on Biodefense, to attack the problem as a civilian. He persuaded Lieberman, an independent and former Democrat, and exHomeland Security Secretary Tom Ridge, a Republican, to co-chair the effort.
That panel, renamed the Bipartisan Commission on Biodefense, completed a scathing report in 2015 and sent it to President Barack Obama. “The Nation lacks the leadership, coordination, collaboration and innovation necessary to respond,” the commission wrote.
It proposed a blueprint for biodefense with clearly defined roles and the vice president in charge. It warned that pandemics carry “the possibility of millions of fatalities and billions of dollars in economic losses.”
The report caught the eye of lawmakers. Just before Obama left office, Congress passed a law mandating the creation of a plan.
Trump released the National Biodefense Strategy in September 2018. By then, he had appointed Kadlec as an assistant secretary of Health and Human Services, in charge of preparation and response.
Untangling the nation’s plans
In 2004, after the severe acute respiratory syndrome (SARS) outbreak, President George W. Bush signed a directive that focused on biological weapons and addressed how to contain and treat infectious diseases.
Five years later, after the H1N1 epidemic, Obama issued his own strategy to combat “infectious diseases of natural, accidental, and deliberate origin.”
After Americans who traveled to West Africa contracted Ebola in 2014, biodefense responsibility was still spread across Washington bureaucracies.
Members of the blue-ribbon panel studied the system for a year. They concluded the nation’s risks from biological threats had reached “critical mass.”
The first of its 33 recommendations in 2015 called for centralized command. Kadlec had argued for years that biodefense directives must come from the top – above Cabinet secretaries – and from someone who could take an active role.
“Leadership of biodefense should be institutionalized at the White House with the Vice President,” the report said.
Former homeland security adviser Lisa Monaco said the Obama administration agreed with the spirit of that recommendation, though not the letter. Near the end of his administration, Obama created a unit within the National Security Council assigned full-time to disease preparedness.
“In 2018, unfortunately, that structure was dismantled,” Monaco said, referring to Trump’s decision to eliminate the White House pandemic office. Monaco is a member of the Bipartisan Commission on Biodefense and a public health adviser to former Vice President Joe Biden, who seeks the Democratic nomination for president.
Strategy put to the test
Once a biodefense strategy was adopted, it was only a matter of time before it would be tested.
Trump designated a Cabinet-level steering committee to oversee its implementation, but that committee has never met to confront COVID-19.
Instead, on Jan. 29, a day before the World Health Organization declared a global emergency, the president announced a Coronavirus Task Force. That arrangement isn’t mentioned in the Biodefense Strategy.
By Feb. 26, the virus had reached 37 countries outside China and established a foothold in the USA, where there were more than 50 known cases and countless undiagnosed because of a shortage of test kits.
That day, Trump named Vice President Mike Pence to lead the task force.
Lieberman and George noted that the Coronavirus Task Force is dominated by White House advisers and Health and Human Services administrators, and one name is noticeably missing: Robert Kadlec, the federal health official responsible for preparedness and response. His boss, Health and Human Services Secretary Alex Azar, is on the task force.
The Department of Health and Human Services did not respond to questions and an interview request.
On March 2, Kadlec was named to lead Health and Human Services’ response.
‘Hung up in the bureaucracy’
The next step after creating the biodefense strategy, George said, was to implement it and untangle all those laws, policies and duties. That got “hung up in the bureaucracy.”
“It didn’t really work,” she said, referring to the strategy. “I don’t know if ‘dismayed’ is the right word, but I look at what’s going on right now, and I just think, geez, there’s so much that could have been done in advance.
“It bothers me that people are going to get sick and die because we didn’t have plans and policies.”
By mid-March, Americans were panic-buying at supermarkets, wiping out supplies of toilet paper and pasta. Major cities shut down gathering places; some ordered residents to shelter in place.
Amid this turmoil, the GAO completed a review of the National Biodefense Strategy it began in 2018, well before COVID-19 emanated from a wet market in Wuhan, China.
As the disease spreads, the GAO said in a report to Congress, “the federal government must take necessary steps to protect the American public. … However, the Strategy is only as good as its implementation.”
Friday, Trump defended the nation’s response to the pandemic: “This administration inherited an obsolete, broken, old system that wasn’t meant for this. We discarded that system . ... And we’re very proud of what we’ve done.”
To which Kenneth Bernard, a former assistant surgeon general who wrote the 2004 biodefense plan under Bush, replied: “If it was broken, why didn’t you fix it two years ago?”