Several recent announcements have demonstrated how little has been learned from the response to the COVID-19 pandemic, and the potential need for a national reckoning to assess shortfalls and develop recommendations for preparing for and responding to future pandemics and other biological risks.

To this end, the United States should create a national commission—not unlike the 9/11 Commission—to develop a way forward. To date, no such reckoning has occurred, yet changes are being implemented at lower levels of government in an uncoordinated manner and the “ad hoc-ery” continues to guide our preparedness and response efforts to emerging infectious diseases. The U.S. response to the monkey pox outbreak provides ample evidence of government's continuing inability to mount a coordinated national response to a significant biological event.

Recent reporting indicates that the Biden administration will be reorganizing the Department of Health and Human Services (HHS) by elevating the Office of the Assistant Secretary for Preparedness and Response (ASPR) to a separate office within the department, and on par with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration. Since ASPR's creation in 2006 following a confused response to Hurricane Katrina, ASPR and the CDC have had a challenging relationship with overlapping, or at least unclear responsibilities, that have contributed to federal preparedness and response activities that are not optimally coordinated or synchronized. The friction between these two HHS organizations has been highly visible in decisions concerning the strategic national stockpile stockage and guidance regarding the return of hundreds of Americans to the United States in the early days of the COVID-19 pandemic.

The recent White House announcement that a monkey pox response team is being stood up demonstrates that the “ad hoc-ery” continues. This is not to say that having a group at the White House monitoring the monkey pox response is not important, but rather that a team with the mandate “to mitigate the spread of the virus, protect individuals most at risk of contracting the virus, and care for those who have been afflicted with it” would be better placed under an established organization with the proper command and control arrangements, responsibilities and authorities, and interfaces with key partners and stakeholders. The ad hoc approach is made more clear as the White House announcement never mentions a role for ASPR, CDC, or FEMA.

Read the full article about public health mandates by Daniel M. Gerstein at RAND Corporation.