six months before the current outbreak, Congress passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019, which offered funds and planning authority for just such a crisis as we now face.[2] This act was a reauthorization and an extension of half a dozen similar acts passed over the previous two decades, which acts were themselves extended in countless congressional spending bills, all of which resulted in countless plans....
Pervasive Pandemic Preparedness Planning
After the avian influenza scare of 2005, Congress did the thing it does best, demand that somebody else come up with a plan. With the help of some of the best known names is Congress, Congress passed the Pandemic Preparedness and Response Act in December of the following year.[3] The act ordered the administration to convene a Pandemic Influenza Preparedness Policy Coordinating Committee, with most of the Cabinet in attendance, to write a plan for a biological catastrophe.[4] The result was, first, a White House Homeland Security Council National Strategy for Pandemic Influenza, followed the next year by National Strategy for Pandemic Influenza Implementation Plan. The latter plan contained 233 pages of nebulous suggestions, such as recommending that, in a crisis, the government should be “providing anticipatory guidance and dispelling unrealistic expectations about the delivery of health and medical care.”[5] These general plans in turn birthed numerous individual departments plan, such as the Department of Defense Implementation Plan for Pandemic Influenza.[6] To supplement these federal plans, the Preparedness Act, and its subsequent iterations, also mandated that states create their own Pandemic Preparedness Plans, which have to be submitted regularly to the Centers for Disease Control and Prevention for approval. These plans total thousands of pages.[7]
Even before the 2006 act passed, however, the Department of Health and Human Services decided to issue its own Pandemic Influenza Plan, in 2005, and it issued one again 2009, and again in 2017, with similar vague exhortations. The subsequent versions of the plan contain no discussion of the National Strategies upon which the Coordinating Committee labored so diligently.[8]
...After 9/11, the government began writing regular National Response Frameworks, published by the Department of Homeland Security, on how to deal with any national emergency, including a biological attack or pandemic. ... Another of the annexes birthed from the Framework was, of course, a specific Biological Incident Annex.[11] The Annex claims that it “serves as the Federal organizing framework for responding and recovering from a range of biological threats,” although what the other plans do is therefore made unclear.[12]
the Department of Health and Human Services (HHS), apparently on its own initiative, created a National Health Security Strategy for the United States in 2009, with updates in 2015 and 2019, describing responses to pandemic and infectious disease outbreaks. Surprisingly, the plan contains no reference to the hundreds of pages of pandemic planning from other departments, or even from other plans written by HHS itself. [13]
...the more comprehensive National Security Strategy, issued by the White House National Security Council, which itself also includes plans to deal with an epidemic, and demands the government “detect and contain biothreats at their source.”[14] But the White House also issued numerous specific plans to deal with biological threats outside of the so-called NHSS and the NSS. As a sampling, there was the 2006 Homeland Security Presidential Directive-10, “Biodefense for the 21st Century,” and the 2009 National Strategy for Countering Biological Threats (featuring the peerless “Objective Seven,” which demanded that the government “Transform the international dialogue on biological threats”) and the 2016 National Security Council’s Playbook for Early Response to High-Consequence Infectious Disease.[15] In the National Defense Authorization Act of 2017, Congress mandated that the White House convene a group of interagency officials to write a specific National Biodefense Strategy, which was released to understandably little fanfare the following year. The strategy offers such inimitable insights as “Biological Threats Originate from Multiple Sources,” including “naturally occurring outbreaks.” Its relation to previous pandemic plans is not clear, since none of them are cited. [16]My highlights as that seems particularly relevant. The authors of these plans aren't even reading each others' plans, and possibly not even aware of them!
It goes on like this. Judge has meditations on how all these plans should be turned in to action, including suggestions for centralization. I'm not sure that reorganizations are the key. Rather, these plans all stopped short of implementation. How many masks do we need? Where do we buy them? Who is in charge of shutting down air travel? This sort of thing needs to be implemented and then practiced, just as your grade school had fire drills.
But certainly my previous impression that we had no plans and needed to create one was false in the extreme.
My favorite scene from Raiders of the Lost Ark
We have top people working on it. Top.
Yes, when I was at the US Dept. of Labor Office of Policy I remember colleagues being assigned to work on planning document for a pandemic. Yes there were plans developed. Question is why we got blindsided by this one and seemingly in so much trouble, inadequate testing and insufficient supplies of protective gear for health care workers https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf
ReplyDeleteA focus on process will give rise to the situation described by J. Glock. Compare this to the actions of the General Motors executive committee in the 1920s which completely revamped GM's product-market strategy in a 30-day period that reorganized product lines and factories to challenge the Ford Motor Company's dominance of the U.S. automobile market. The executives focused on outcomes, rather than process.
ReplyDeleteWhy this obsession with centralization? Things will go wrong if they can, so one wants many actors dealing with the problem. What do we have States for?
ReplyDeleteDare I say that all the extant plans suffered from the planning fallacy. None seem to address the fundamental challenge of decision making when dealing with exponential growth, so early action, is essential, but don't have the data to give the value of most of the key decision parameters.
ReplyDeleteThe plans reflect a deep institutional problem which is that our society has become so wealthy we spend too much time managing tiny risks and are heavily biased toward inaction. Institutionally and culturally, we just aren't set up to pivot toward a bias to action. If was preparing the next plan, that's what I'd be addressing (and making sure it was clear who was to implement the plan and that they had practiced it regularly).
Did our leaders even know about and review these plans?
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ReplyDeleteThe impetus for the planning came from the highest levels:
"George W. Bush in 2005: ‘If we wait for a pandemic to appear, it will be too late to prepare’: A book about the 1918 flu pandemic spurred the government to action." by Matthew Mosk on April 5, 2020
https://abcnews.go.com/Politics/george-bush-2005-wait-pandemic-late-prepare/story?id=69979013
"American Foreign and Defense Policy: Between Scylla and Charybdis" By Mark Helprin | April 16, 2020
https://www.nationalreview.com/magazine/2020/05/04/american-foreign-and-defense-policy-between-scylla-and-charybdis/
"Fifteen years before the coronavirus pandemic, I wrote a speech for a world-renowned physician who was coincidentally the majority leader of the United States Senate, and thus not without influence. He went, wholeheartedly, all-in, delivering it in the Senate, at Harvard Medical School’s most important annual lecture, at Davos, at the Bohemian Grove (where the only Bohemian to enthuse sufficiently to request a copy was Henry Kissinger), and elsewhere."
Some time after 20 Jan, 2009. The impetus was lost and the plans drifted into the warehouse above referenced. Without any more research, I suspect that the new administration arrived that day utterly transfixed by the still boiling financial crisis that had exploded in September 2008. By the time that had been wrestled to the ground, they were occupied by their plans to revise health insurance financing. Pandemics never got back on their agenda. A new administration came in on 20 Jan 2017. They in turn were totally distracted by the controversy over their election, subsequent investigations, and the impeachment.
In November you will have your choice of senile fools to elect to organize the next administration.
We are in very deep kimchi.
One of my neighbors put up the only realistic political sign I have seen:
Everybody Sucks | We're Screwed 2020
https://www.amazon.com/VIBE-INK-Everybody-Screwed-Political/dp/B07SKZDK2G
I do Incident Response and Management as part of my job. It's the same thing over and over. It's the decisions, not necessarily the plans at issue. You have to be willing to make the decisions. Planners are not the decisions makers. One can go back and find a whole series of table top exercises out there regarding a pandemic. The people organizing these exercises found where the weaknesses were. It's the decisions made. "If you choose not to decide, you still have made a choice"-- RUSH (The Band).
ReplyDeleteThis again strengthens the case for response to be managed at the local level and with localities prepared to handle events by themselves. That means local authorities having enough bed since, medical equipment, lab capacity, and tracers. These should be rolled into general civil defense (remember when we used to do that?) preparedness, particularly because many of the resources will be common. They are likely to be even more in common going forward, as our terrible response to this virus just raised the status of pathogens as a potential weapon.
ReplyDeleteFederal and state governments can be useful in giving advice and periodically running war games to test preparedness. But the whole system needs to operate expressly with the idea that local authorities will make the decisions and there will be little or no federal or even state coordination. Not only to protect against incompetence, but for the very practical reason that the relevant people may become sick or (in a military action) may die or may be cut off from communications. I have little hope that failing at this would dramatically change who gets elected at the local level. But publishing the results of war games might be sufficiently embarrassing to get local elected officials to nominate competent people to avoid the bad press, and that's probably enough.
Seasonal flu outbreaks are also likely to be good ways to test these folks.
One thing is certain about all those "plans" that have been drafted over the years. Plenty of federal employees made lots of money sitting down and discussing and drafting the plans, which often have no chance of ever working in reality.
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