COVID-19, monkeypox, and infant formula shortages are just a few of the public health challenges the federal government has faced over the past months and years. Despite the federal response to these challenges, criticism of agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration has come from both sides of the aisle in both the Trump and Biden administrations.
Several recommendations have recently been proposed for optimizing the role of federal agencies. However, many of these can have unintended consequences. In any reform, it is imperative that priority be given to strengthening leadership and coordination across the federal bureaucracy without eliminating critical missions and roles.
First, reports of an internal review at the CDC stemming from its response to COVID-19 have led to a stringent financial structure, lack of authority to collect public health data, and an overly long review process for scientific research. A number of concerns have been revealed. guidance. The CDC has also been criticized for inadequately communicating scientific guidance during the pandemic in a way that considers real-world impacts. Potential solutions to address these issues include requiring Senate approval of the CDC director for greater accountability, giving the CDC the power to collect key public health data, and in an emergency. This includes identifying ways to quickly redistribute funds.
One idea that shouldn’t be considered, however, is to drop “prevention” from the CDC’s name and abandon its focus on non-communicable diseases to become only an infectious disease response agency. As we know, the vast majority of deaths in America are attributable to preventable chronic diseases, and 90% of the nation’s $4.1 trillion annual health care bill is responsible for chronic illnesses and mental illness. It is for people with disease. CDC’s mission not only plays a central role in promoting health and preventing disease at large, but its work also helps Americans become more resilient to emergencies such as her COVID-19. It is also designed to hold. A recent study estimated that two-thirds of hospitalizations for COVID-19 are due to obesity, hypertension, diabetes and heart failure, all preventable chronic diseases.
Second, the FDA is reportedly restructuring its food safety program after investigating a nationwide shortage of infant formula and an inability to ensure the safety of produce, baby food, and water. increase. Solutions voiced in recent U.S. Senate hearings include new leadership structures to consolidate food programs, new models for public-private sector collaboration, and additional resources to hire and retain staff.
An idea that should not be considered is to exclude “food” from the FDA’s mandate. This mission has included food safety oversight for nearly a century, creating a new agency (and therefore perhaps a new silo). Instead, the better choice is for the FDA to prioritize not only food safety, but also healthier foods. Defining the term “healthy” should be a top priority for authorities. Because poor diet now surpasses smoking as the leading risk factor for death in the United States. must fulfill its mission as a public health agency to
Third, Congress created the Assistant Secretary of State for Preparedness and Response (ASPR) position and title in the Department of Health and Human Services (HHS) more than 15 years ago to assist the nation’s response to public health threats. However, HHS secretaries do not always authorize the ASPR to act on their behalf or to give clear direction to HHS agencies. The Biden administration has proposed moving the ASPR from an office supporting the secretary to an agency equivalent to her CDC, FDA, etc., but this does not solve the lack of coordination and creates another silo. There are also risks.
A better idea would be for Congress and the Secretary of Health to clarify and reinforce the roles and responsibilities of ASPR leadership during the federal response to the pandemic. This is a recommendation recently issued by the Future Health Task Force of the Bipartisan Policy Center (BPC). The BPC task force will also link ASPR’s leadership within HHS with the creation of a new White House Deputy National Security Advisor for Pandemic and Biothreat Preparedness to coordinate and direct all federal departments and agencies. , recommended that all biodefense preparedness and operational response efforts be held accountable.
Finally, one policy goal to pursue, especially in light of the experience of COVID-19, is to strengthen the country’s public health infrastructure so that it can meet a wide range of challenges. This requires renewed federal leadership as well as sustainable long-term investments in state and local governments.
At this point, recommendations by the Commonwealth Fund Commission on National Public Health Systems to establish positions in HHS, such as Undersecretary of Public Health, should be considered favorably. This position helps oversee and coordinate the development of the national public health system with federal agencies, states, local governments, tribes and regions. Given the urgency to ensure program integrity and budget transparency, the Commission recommended that HHS, under existing statutory mandates, reconfigure and support the position of Undersecretary of Health in this role currently. recommended to be
As we approach the midterm elections and the 118th Congress in 2023, calls for reform and government oversight of the country’s federal public health structure are likely to grow. It is important to scrutinize not only the merits of the proposal, but also the unintended consequences. While the federal government should consider reorganizing or redeploying jobs, it should focus on strengthening its leadership capacity to meet all urgent and long-term public health challenges to achieve a healthier nation. I have.
Anand Parekh, MD, MPH is Chief Medical Advisor for the Bipartisan Policy Center and former Deputy Assistant Secretary for Health and Human Services.