Either/or is not an option when it comes to preparedness

Earlier this month, the Biden administration took the official step of declaring the monkeypox outbreak a public health emergency (PHE), which should free up federal funds and resources to fight the spread of the virus. This important move came not a moment too soon, as our country is in the throes of another unforeseen disease outbreak. Yet, even with this recent declaration, funding to properly address the current public health challenges and to beef up our preparedness for those to come remains insufficient.  

The Centers for Disease Control and Prevention (CDC) is already monitoring over 14,000 cases of monkeypox in the United States alone — the highest case count of any country — and that number is increasing daily. Demand for vaccines and therapeutics is also increasing. The Biden administration sent a late-July memo to congressional Democrats asking for nearly $7 billion to combat the spread of monkeypox. The funds would be used to boost the availability of monkeypox treatments, tests and vaccines. The Strategic National Stockpile (SNS) is again suffering from inadequate appropriations to achieve and maintain preparedness goals.   

If all this sounds familiar, it’s because we have seen this movie before with COVID-19.  

In the spring of 2020, as COVID-19 spread across the nation, Congress and the White House were left scrambling to respond. Health care supply chains were unprepared for this scale of respiratory illness. Facilities were not holding stock of respiratory protective devices beyond regular use needs and manufacturers and distributors of these products did not have adequate stock on hand to fill needs. These supply chain failures resulted in states looking to the federal government, in particular the SNS, for support. 

The unfortunate reality we faced was that due to chronic underfunding by Congress, the SNS had limited supply of these materials to shore up the failing health care supply chain.  

Supplemental funds were appropriated, which allowed for the SNS and other government agencies to take extraordinary action to buy material during the event and work to increase production, hopefully long-term, of many of the needed materials. 

Thanks to COVID-19, there is broader awareness of the SNS and its mission. That mission has evolved over time from being prepared for terrorist events such as large-scale bioterror attacks to response to pandemic events and also to meet other outbreak demands, like monkeypox.   

To comprehensively and effectively address current and potential PHEs, there must also be additional funding for the states and other local partners of the SNS. These levels of government play a key part in any emergency response. They are responsible for conducting critical training, transporting MCMs to points of dispensing, as well as putting shots in arms. Fully funding the SNS is a necessary step in the right direction, but if state and local governments aren’t, major roadblocks in our medical emergency response will remain.  

COVID-19 caught us flat-footed, and there is no excuse for that to happen again, particularly when tools to address monkeypox and other possible outbreaks are already available and stockpiled in the SNS. As we again rely on the SNS, this time to address monkeypox, we must not forget its original mission — to protect all Americans in the event of a bioterror attack — which is the very reason we are better prepared to address this current PHE.  

To say our resources have been stretched thin is an understatement, and likely something being noted by countries who don’t have our best interest at heart. We have watched in horror as Russian President Vladimir Putin wages war in Ukraine, and throughout this invasion, many have questioned his mental health. A 2021 State Department report noted that Russia “maintains an offensive BW (biological weapons) program and is in violation of its obligation under Articles I and II” of the Biological Weapons Convention. And we know Russia houses the smallpox virus at the Russian lab Vector, just one of two places it’s known to be housed in the world.  

Let me be clear — the threat of a smallpox attack is just as real now as it was at the origins of the SNS. The price of being unprepared for this type of PHE is too great to risk. We must use our available resources to respond to this monkeypox outbreak, but at the same time we must rebuild and increase stocks of these materials as they are used. 

Making sure our current challenges are swiftly met and that the Strategic National Stockpile is restocked and fully funded for future emergencies must be considered a top priority for Congress and the Biden administration. It’s imperative that Congress provide sufficient funding to both address current PHEs and prepare for those to come. American communities need these vaccines and antiviral treatments now, and we may very well need them at a moment’s notice in the future.   

Greg Burel is former director of the Strategic National Stockpile (SNS) for the Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (ASPR). Burel is president at Hamilton Grace LLC, a consulting firm focused on preparedness and response.