Indiana is staying in Stage 5 of its reopening, Gov. Eric Holcomb said, until at least mid-November. The state is facing more coronavirus cases and hospitalizations.
If a foreign nation invaded our shores, would the federal government insist defense responsibilities be organized by individual states? Would Washington quit the United Nations if we had differences of opinions about how to address similar aggression globally?
Not likely. Visible threats normally provoke and require united responses.
Now consider a stealthy, microscopic enemy, COVID-19, which has inflicted harm, death, despair and economic hardships on every state, city and municipality across our land.
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Despite advance warnings, we were not prepared to take a holistic approach to this. We were not armed with either the knowledge or tools to combat this unprecedented biological threat.
Unlike many other nations, the United States chose to not execute a national plan. Rather, containment and mitigation responsibilities were delegated to each state to make policies about a variety of issues ranging from quarantining and masking requirements, ventilator acquisition and other essential health policy decisions. This is hard to fathom since pathogens do not recognize state borders.
With no treatments in hand, early disjointed pursuits to develop therapies have resulted in hundreds of competing trials with many likely to be partially completed and uninformative.
In the “warp speed” effort to create vaccines, questions are being raised about whether or not to abide by the traditional period of post-vaccination observation (to monitor for unanticipated safety issues and duration of protection needed before widespread use).
Purposely bypassing such longstanding medical standards brings to mind a somewhat metaphorical scenario of shortening normal pregnancies. It can be done — but not without risk of complications.
Timothy R. Franson, M.D., is a principal at Faegre Drinker Consulting, fellow of the Infectious Disease Society of America and past president of the United States Pharmacopeial Convention. (Photo: Gittings Photography)
Further, the Trump administration’s decision to withdraw from the World Health Organization without any alternative global network to ensure America’s involvement in public health preparedness for both COVID-19 and future pandemics should be of concern.
Should any country go it alone in defending against pathogens that don’t respect geographic boundaries, government bureaucracies or politics?
When viewing the evolution of conflicting advice given to the public (from multiple sources) about masking, distancing, testing, therapeutic effectiveness and other like concerns, the ensuing and not surprising erosion in public confidence has led to divergent behaviors and confusion.
Trust cannot be earned amid conflicting advice from politicians, scientists and other entities. As a former FDA associate commissioner recently commented to CBS News, “When it comes to vaccines, there is no margin for error. There is no replacing lost public confidence.”
These observations are not intended as a disparagement of our current government’s policies, but rather as a prescient and prudent call to arms for future generations to better prepare for similar epidemics beyond our current COVID chaos.
The goals our children and grandchildren should seek after our present include:
1. A fully independent sustaining infrastructure (staff and contingency planning) for disaster preparedness and oversight.
2. A renewed commitment to national approaches for all microbial threats, foreign and domestic – and the means and methodologies to support all states, ensuring that the necessary tools and capabilities are readily available on a real-time basis.
3. As the foremost priority, a singular national source of authoritative advice that represents the consensus of best thinking and practices from clinicians, epidemiologists, allied health professionals and political entities — with the tacit agreement to always default to public health interests and truthful transparency.
4. Active engagement in global risk monitoring and data-sharing networks to more rapidly detect and engage these threats.
5. Improved development approaches via collaborative endeavors that fully adhere to rigorous scientific standards. Our battle against COVID-19 will be judged by history, but a brutally honest and introspective analysis of our current successes and failures must act as a roadmap to protect future generations of Americans.
Timothy R. Franson, M.D., is a principal at Faegre Drinker Consulting, fellow of the Infectious Disease Society of America and past president of the United States Pharmacopeial Convention.
Peter J. Pitts is president and co-founder of the Center for Medicine in the Public Interest and was formerly the Food and Drug Administration’s associate commissioner for external relations, serving as senior communications and policy adviser to the commissioner.
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