WASHINGTON — What can be done to prevent poor federal responses to disasters, such as the Strategic National Stockpile (SNS) that was woefully under-stocked when COVID-19 hit? That’s the question addressed in a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM).

Responding to public health emergencies has largely been under the purview of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE, pronounced FEM-see), a multi-agency coordinating body within the federal government. Its mission is to ensure the government has the tools needed to save lives, including antibiotics, antivirals, and personal protective equipment, Alan Leshner, PhD, co-chair of the committee that wrote the report, explained Wednesday during an online briefing.

However, he added, “it is an organization that’s had a troubled history and a mixed track record,” with only limited uptake of its ideas.

The report contains a list of 11 recommendations to improve PHEMCE, starting with making sure that the group’s members actually have authority to act, or are close in rank to someone who does.

“The people who represent the various partners need to be of sufficient standing in their respective agencies that they are able to move nimbly and relatively rapidly, so that as recommendations need to be formulated to go to their bosses, they don’t have to go through five or six layers in order to have something happen,” said Leshner, who is a former CEO of the American Association for the Advancement of Science.

PHEMCE needs to better reflect the perspectives of stakeholders, and give them guidance they can act on, he continued.

“One of the issues that we heard repeatedly was that historically, this organization has a tendency to operate … at least in a partial vacuum — that is to say, it didn’t have a lot of input,” said Leshner. “It had a bit of output, but it did not receive enough or take seriously enough” the input it received.

Other recommendations for PHEMCE included:

• Use measurable outcome metrics. “They have to be metrics-driven and have a process for evaluation of what they’re doing at all stages,” said Gigi Gronvall, PhD, co-chair of the NASEM committee. “There needs to be an objective third party to examine what they’re doing and to evaluate how progress is being made.”
• Establish an advisory committee of non-federal and private-sector partners and stakeholders. Related to the above recommendation, Gronvall noted that all of PHEMCE’s members are federal agencies, “But to be able to fulfill the PHEMCE mission, it needs to have private sector involvement,” Gronvall said. “It needs to be able to coordinate beyond the federal government. One of the ways that we suggest doing this is to establish an advisory committee that includes this expertise from the non-federal and private sector partners on it. This advisory committee should be a strong advisory committee that is listened to and is consulted in major decisions. It would provide an opportunity for communication between the non-federal partners and the federal partners … And it would also provide more visibility for the PHEMCE,” which is important because its mission deserves greater visibility inside and outside the federal government, she said.
• Establish an integrated and accessible medical countermeasure data system. “There’s a lot to keep track of with the PHEMCE [mission], and to be able to have all of this so that gaps can be identified and vulnerabilities can be addressed — that would be a great step forward,” said Gronvall, who is also a senior scholar at the Johns Hopkins Center for Health Security.

The report also recommended a root-cause assessment of the COVID-19 experience with the SNS, and figure out the “lessons learned.” Gronvall noted that PHEMCE commissions a report on the stockpile each year.

“We all know that during COVID-19, the Strategic National Stockpile did not have what we wanted it to have,” she said. “We believe that it’s important to not just have an evaluation of what happened in the during the COVID experience, but also to go a little bit beyond that and to make sure that the evaluations of the SNS that the PHEMCE conducts yearly — or should conduct yearly — are producing a good result and that they are leading to a more prepared or better stocked stockpile.”

Committee member Craig Vanderwagen, MD, a retired family physician, pointed out that many of PHEMCE’s efforts focus on developing new products — such as vaccines and diagnostics — that can be useful in public health emergencies, “but the end game is about, how do we get that distributed? What’s the ‘last mile’ set of features?”

The committee wasn’t asked about the SNS’s role as a “last mile” distributor, “but that is an issue that the [Assistant Secretary for Preparedness and Response] and others will have to address very succinctly to ensure that we’re effective in that last mile distribution process,” Vanderwagen said.

In addition, the CARES Act passed by Congress to help with the pandemic asked NASEM to “examine and offer recommendations on how to improve the security of the supply chain,” he added.

Another NASEM committee that Vanderwagen is on has been working on that and is close to finalizing its recommendations, and although they’re not finalized, “we deal very actively and broadly with these issues of last mile and the SNS, and its role in the delivery of these products.” That report likely will come out in January, Vanderwagen said.