WASHINGTON – In a White House consumed by the coronavirus pandemic, one of the president’s less visible advisers is driven by the fear that the next outbreak could be even worse.
Dr. Beth Cameron had been preparing for an event of this magnitude for decades. As a senior national security official on biodefense in the Obama administration, she took part in the government’s response to the Ebola crisis, and in reaction to that scare wrote a “pandemic playbook” that she left for the Trump administration in 2017.
But the National Security Council office on pandemic preparedness that she helped to lead was shuttered, and when the worst pandemic in a century struck last year, her playbook was ignored.
Now she is back in the role – rebuilding her old office from scratch, reimagined, and providing Oval Office briefings to a new president who has vowed not only to end the current pandemic but to prevent the next one.
“We have a no-fail mission of monitoring and standing up a response to emerging biological threats,” Cameron, head of the National Security Council Directorate on Global Health Security and Biodefense, told McClatchy. “He is leaning forward on every aspect of our work.”
Within his first days in office, President Joe Biden reestablished Cameron’s team and signed an executive order calling for the creation of a national center for epidemic forecasting and outbreak analytics – a nerve center that would help the government track and project the course of viruses moving through populations.
Cameron’s NSC team is looking outward, coordinating with foreign governments and alliances to prepare for the next emergency that, like COVID-19, may come from overseas. The proposed national center – which has funding in the American Rescue Plan signed into law by Biden – would look inward, improving the country’s data collection, early warning systems and state and local reporting on public health threats.
Together, those two offices mark the beginning of an overhaul to the country’s biodefense infrastructure – an effort that experts say is long overdue.
The proposed national center could become home base for the myriad of small offices across the government keeping track of mathematical infectious disease models and, in theory, streamline local health care data.
Scientists inside and outside of government who warned that a disastrous global pandemic was inevitable have been asking for a central office like this for years.
“One major challenge with the COVID-19 pandemic, and with previous biological threats, has been accessing real-time data and integrating data streams across the U.S. government and national healthcare systems,” Cameron said in an email.
“We urgently need a National Center for Epidemic Forecasting and Outbreak Analytics to modernize the U.S. disease warning system in order to scale action to prevent, detect, respond to, and recover,” she said.
FORECASTING THE NEXT STORM
Some of the leading experts on infectious diseases say the coronavirus outbreak in the United States could have been far less devastating from the start.
Evidence collected over the past year indicates that the novel coronavirus known as SARS-CoV-2 showed up a few times on the West Coast in late 2019, but didn’t take off. The first cases identified in the Seattle area in January 2020, scientists say, were largely contained.
But a single biotech conference in Boston led to hundreds of thousands of infections within those critical early weeks, possibly allowing the virus to take hold.
“There’s definitely a scenario with a coordinated federal response where we had caught the East Coast introductions in time, and have what would’ve amounted to a completely different future with COVID-19,” said Dr. Sam Scarpino, director of the Emergent Epidemics Lab at Northeastern University.
“One thing that’s generally true about epidemics, and we’ve seen this play out with COVID, is that you either stop it or you don’t,” he said. “There’s very little room for middle ground.”
The coronavirus pandemic showed that epidemic forecasting – the ability to identify a new virus quickly, map its trajectory, and potentially stop it – is crucial to national security.
Those forecasts are most critical at the very start of a pandemic, when decision-makers – from local mayors to the president – are relying on them to gauge the threat.
A single model published by academics on March 16, 2020, that warned of catastrophe from COVID-19, projecting half a million deaths in the United Kingdom and over 2 million in the United States, jolted the White House and shocked the U.K. prime minister into ordering a nationwide lockdown.
The U.S. government, despite repeated calls by scientific professionals within both Republican and Democratic administrations, has yet to standardize the public health data that cities and states collect and send to the federal government.
Experts say that lessons from the pandemic and a newfound political will could help lead to real institutional reforms.
Creating a central office was the project of Dr. Nathaniel Hupert, founding director of the Preparedness Modeling Unit at the Centers for Disease Control and Prevention in 2008, over the course of a decade. His last CDC contract ended in November 2019, shortly before scientists estimate the coronavirus took hold in the United States.
When he first started, a “fusion cell” of experts at the Department of Health and Human Services, in partnership with eight analysts at the Defense Threat Reduction Agency, worked every morning to process computer models on viral threats.
But for the most part, the models they worked with were created outside of government.
Recognizing that the best data was being collected by universities, not the federal government, Hupert would try to get advance notice from top scientists at Harvard University and Imperial College in London on what they were working on. The goal, he said, was to avoid the CDC learning of a scary new study or model from a university press release.
“Typically there was a mad scramble before the [CDC] director’s briefing at 8 a.m. to find the study, read the study, figure out whether it should be something that should be influencing policy or not,” Hupert said in a phone interview.
The very first time the CDC featured a pandemic forecasting model in its threat simulations was in 2012, when a single slide on modeling was included at a conference. Ever since, the handful of modeling experts at the agency have worked separately, assigned to specific diseases.
When the COVID-19 pandemic hit, the agency found itself relying on outside academics to produce models and projections that became the basis of emergency policy decisions.
“We need to get much better at sort of day in, day out use of models,” said Dr. Dylan George, a vice president at In-Q-Tel who worked on biodefense under former President Barack Obama. “Right now the system is manual and bespoke. It’s really personality driven. It’s not really a system – it’s a collection of people.”
The American Rescue Plan signed into law by the president on Thursday included $500 million to support data surveillance and modernization initiatives at the CDC, and to “establish, expand, and maintain efforts to modernize the United States disease warning system to forecast and track hotspots for COVID-19, its variants, and emerging biological threats.”
The administration has not outlined how much of this funding would go to the creation of the national center, what form the center will take, or when it would be established.
Over the years, Hupert faced pushback within the CDC from individuals who wanted to keep expert modelers assigned to disease offices and not become centralized.
“If it gets off the ground, it would have to be something that is approved,” a CDC official said. “It’s just going to be a question of how long it takes.”
Dr. Caitlin Rivers, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, has advocated for the creation of a center of this kind for years.
“What I would like it to be is something like the National Weather Service, but for infectious disease forecasting,” she said.
“In peacetime, when there’s no outbreaks or epidemics happening, this sort of center would be working to advance the research and development so that the best models are available when there is a crisis,” Rivers said. “And when something pops up, the center would pivot to supporting decision makers at the federal, state and local levels to help us prepare for what’s coming.”
One way in which the structure of the National Weather Service could serve as a model for a future national center is by drawing a direct connection between national epidemic forecasts and local communities.
“What the National Weather Service is really good at doing is building regular forecasts at the local level, and making those available for local weather forecasters and local governments and everyone to use in their own decisions,” Scarpino said.
“They understand that you need to provide information at the level where it is most operationally relevant, and quite often that’s at the zip code, county, municipality level, where these decisions are really being made,” he said.
PREPARING AN INTERNATIONAL RESPONSE
A national center would take years to develop.
At the White House, Cameron is trying to build up international connections that were either spurned or severed during the Trump administration.
“There is no such thing as overpreparing,” Cameron said. “That includes a strong commitment to cooperation with governments and other partners so that when an emergency comes, we have a ready, coordinated response.”
“This is something the United States didn’t do in early 2020,” she added.
One early test for Cameron came from a flare-up of Ebola cases in West Africa in February. The identified number of cases was small, a vaccine against the disease now exists, and the CDC said that the threat of spread to the United States was “extremely low.”
But the White House, nevertheless, responded aggressively, coordinating closely with local West African governments and funneling travelers from the region to six U.S. airports for observation.
“She’s exquisitely focused on not only COVID, but what the next thing is that’s going to hit us,” said George, who considers Cameron a good friend. “Both Obama and Trump were hit with multiple health emergencies – not just one at a time. She knows this and is trying to make sure that we can be prepared as we get hit by a second infectious disease outbreak.”
“That’s keenly pressing on her brain,” George added. “They are trying to put together systems that would enable a broader early warning.”
Biden rejoined the World Health Organization after former President Donald Trump’s withdrawal and directed billions of dollars in federal funding to a vaccine alliance partnered with the COVID-19 Vaccines Global Access, or COVAX.
He also assigned Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the chief medical advisor to the president, to help rebuild ties with international health organizations.
“Global pandemics require a global response,” Fauci said in an interview with McClatchy on Wednesday. “Getting back in global leadership on global health is one of the things that we will do,” he said.
“That will be very closely related to strengthening the global health security network, so that you have good communications and transparency among countries, sharing information in real time,” Fauci said.
As more Americans get vaccinated, and as the country approaches the end of the pandemic, Biden’s goal will be to cement the emergency offices such as hers as “enduring institutions,” Cameron said.
“That means we must simultaneously ensure our investments in the COVID-19 response translate into the capability we need to prevent the next biological catastrophe,” she said.
