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Strategic Testing: The Importance of Ongoing Biosurveillance to the Future of Health Security

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
February 14, 2022

Recently, Florida Governor Ron DeSantis and Florida’s surgeon general drew criticism for comments made about the use of COVID-19 testing in the state. They indicated that the state needed to move beyond a “testing psychology” and use testing only if someone “has a reason” or if it is “likely to change outcomes.” Such comments were made in the context of a debate between state leaders and the Federal government about when to transition to a post-pandemic stance. These comments were also made as the U.S. Congress and other advisory groups are calling for increased use of tools like genomic surveillance, which requires the use of extensive testing, to prevent future pandemics. Political leaders promoting policies that would limit available information about current, as well as future threats hinders such recommendations for the future and puts vulnerable populations at risk.

In December 2021, the National Biodefense Science Board (NBSB) released recommendations for how to improve the National Health Security Strategy for the U.S. Department of Health and Human Service Office of the Assistant Secretary for Preparedness and Response. Their recommendations included incorporating a One Health perspective to allow for better coordination among emergency response agencies. This would be accomplished through the creation of an integrated information sharing system that would allow for rapid data sharing and more flexibility for surveillance activities. Such a data system should incorporate information regarding human and animal health, as well as agricultural and environmental data. This type of system should also allow for better tracking of the health status of vulnerable populations. Such efforts will require regular testing of the population, including those groups that historically are less likely to engage with the public health and/or medical establishment.

The NBSB also recommends conducting a national risk assessment for public health medical supply chains and publishing an emergency allocation strategy. The board notes that just-in-time purchasing practices and a lack of transparency contributed to supply chain shortages during the pandemic, and that “political, social and emotional pressures” led to some of the more vulnerable populations receiving inadequate resources. The recommendation notes that allocation should be based on “acceptable tenets and decision-making mechanisms.” While it is not clearly stated, it is likely that the use of appropriate epidemiological evidence would be included in these tenets and mechanisms. Therefore, surveillance data will be important for determining when a public health threat is emerging, where it is most prevalent, and who is most at-risk. As discussed in a previous article, it is important to use practices like resilient cooperative procurement to promote more stability in the supply chain and allow the supply chain to more easily absorb shocks. However, such a procurement system, which establishes variable prices based on circumstances, requires signals to indicate a change in stress on the system. Biosurveillance data derived from testing samples will provide those signals.

In January 2022, Senator Richard Burr (R-NC) and Senator Patty Murray (D-WA) of the Health, Education, Labor and Pensions (HELP) Committee unveiled a discussion draft of the PREVENT Pandemics Act. Among numerous other reforms, the bill would seek to modernize “biosurveillance capabilities, data collection and access, epidemic forecasting and vaccine distribution tracking.” The draft includes provisions for additional resources for genomic sequencing, analytics and surveillance, with support from the HHS Secretary and the director of the Centers for Disease Control and Prevention (CDC). Such measures may include providing grants to entities to that perform genomic analysis and establishing Centers of Excellence to support innovation in genomic epidemiology. If the practice of genomic surveillance is to become institutionalized within our public health system, it will need support from political leadership. This calls for more support for regular testing, not less.

It is noteworthy that the draft legislation contains less explicit references to vulnerable populations, One Health and engaging in a more comprehensive review of the supply chain. Genomic surveillance and the other measures listed are important to strengthen moving forward, but they must be in service of alleviating inequities in health security, monitoring for risks spilling over from animals to humans and promoting more adaptability in the supply chain. In regard to the section of the discussion draft addressing the supply chain, the focus is largely on promoting greater surge capacity for manufacturing and strengthening the Strategic National Stockpile. While it is important to have such safeguards in place, they should not take the place of a system of procurement that is structured to respond quickly to disruptions and prevent shortages. Such a system would be especially important to those most likely to experience a health emergency first.

In conclusion, political rhetoric, like that employed by Governor DeSantis, risks taking American attitudes backwards when it comes to preparing for public health emergencies. In order to realize the benefits of genomic surveillance, and the elements of protecting vulnerable populations and realizing a One Health perspective that it serves, we need the public to embrace monitoring for the health risks facing society, hidden or not. Evaluating risk must not be limited to what is already visible. As COVID-19 has taught us, once the risk manifests, it is often too late.

Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of “Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies.”  Myers serves as an academic advisor to the Continuity of Supply Initiative and assistant director of Indiana State’s Center for Genomic Advocacy. Email: [email protected]; Twitter: nagremye1980

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