Coronavirus in Context: Emergency Preparedness: What Went Wrong and Are We More Prepared for the Future?

[MUSIC PLAYING]

I know many of you are concerned about our current response to the coronavirus pandemic. But more importantly, how prepared are we for a potential resurgence in the fall or a second wave? I chatted with Dr. Luciana Borio, who served on the National Security Council's Pandemic Response Team. She'll tell us exactly how prepared we are. I think you'll want to listen. Dr. Borio, thanks for joining me.

My pleasure, John. It's great to be here. Thank you for inviting me.

You're an expert in emergency preparedness. Can you tell our viewers what exactly does that entail?

Well, it entails many, many things. But the goal is to be able to prevent morbidity and mortality in the setting of a unexpected catastrophic crisis, usually a public health emergency, a public health crisis. Whether it is pandemic flu, pandemic coronavirus, which affects, you know, very broad, uh, numbers of people across the US and the globe, or weather it's a more focused epidemic, that's what we do in emergency preparedness.

Is that what you were doing as part of the National Security Council's Pandemic Response Team?

Yes. So at the NSC, the National Security Council staff, we coordinate policy. So we bring together all of the assets of the US government that have a role to play in biodefense. And I say biodefense because, you know, biodefense is really-- a lot of people think that it's, you know, only addresses deliberate threats like bioterrorism.

But biodefense really is agnostic to the origin of a threat, so our job is to prepare, whether it's a man-made, an accidental, or a naturally occurring event. So we've grouped together all those components of the US government to, um, you know, work together to have a stronger biodefense enterprise for, uh, the American people.

Hey, Dr. Borio, why does it seem that we were so unprepared for the current pandemic?

We were unprepared for the current pandemic. It's important to put it in perspective. This is the worst public health crisis in the last 100 years.

Wow.

So the-- on the scale of, you know, 0 to 10, this is pretty close to a 10.

But everyone does preparedness drills. Everyone, you know, is-- is talking about how do we, you know, respond to these type of outbreaks. So why is it that we're unprepared?

Yes. So you it have been challenging to any system that, even, you know, a system that-- that was better prepared. I think it's important to just keep that perspective, that it would have been challenging no matter what. But there are many things that we could have done better.

I think one of the most important, uh, points where we lost our-- our footing was with the issue of diagnostic tests, not being able to rapidly augment, ramp up distribute diagnostic tests to detect the cases, to conduct surveillance, to care for patients, to even facilitate the conduct of clinical studies. The diagnostic tests are the backbone.

What do you think, you know, was the problem there? Just, you know, just didn't do it correctly or just lack of skills?

So two things. One, we always leverage the CDC to get us started, and they have always delivered. So it works well because one, they always deliver. And, uh, the demand for diagnostic tests at the early stages of-- usually at the early stages of a-- a new epidemic infectious disease-- diseases is not a super, uh, large, like it is for a pandemic involving a respiratory disease.

So the CDC unfortunately was not able to deliver us the tests that were-- that performed the way we needed them to perform. And because we have relied on the CDC, you know, over and over again, the private sector was not really used to, uh, you know, rushing in at the earliest onset to deliver those tests either.

The last time that we relied heavily on the private sector for those tests was during the 2009 H1N1 flu pandemic. But remember that a lot of these tests already existed in the marketplace, because they were flu tests that had to be slightly modified to deal with the new strain. This was a new virus and they had to start from scratch. They took their time.

OK. So testing was an issue. What were the other issues?

I think the other issue was the failure to realize that by the time the epidemic was recognized in eastern China, that given the features of this virus, highly transmissible respiratory disease, that, and given the travel volume between the US and China, and the global, actually, travel-- and how travel, you know, takes place nowadays.

There was a failure of imagination to realize that the-- this outbreak really seeded the globe pretty quickly. And by the time it was recognized, it was inevitable. The cases were already circulating in small numbers, pretty much across the globe.

So focusing on the-- you know, the border issues may have helped delay the large introduction of cases into America. But it clearly was not going to be sufficient to contain it. And it's only a temporizing measure. We need to be able to look inward and begin to look for cases here.

Let's talk about what's on everyone's mind. How prepared are we today for the current pandemic as well as, potentially, any resurgence or second wave?

Yeah. So I think we're only going to regain our economic and health security once we have a safe and effective vaccine that can be broadly distributed to the American population, and actually across the globe. And there are many companies that are already, you know, very avidly engaged in developing those vaccines.

Now, nothing is certain about science. I think it's nice that everybody is leveraging the most advanced technologies that exist today, even, uh, those that may not have had a precedent, such as in a licensed vaccine used in a certain platform. We're still, you know, trying to see if that might be the solution for, uh, this pandemic. And I think that's great.

But do we need to be practical, Dr. Borio, for a vaccine? Most experts, when you really start to unpack it, are saying it's at least 12 to 18 months for the broader population.

Absolutely. So it's going to take a while to be able to find out which vaccines work. And, uh, we can do it faster in a pandemic, sadly, because there's so many cases. So we're going to do the studies. But then you have to scale up manufacturing. A lot of the developers are already, you know, establishing partnerships to do that, to be able to make a lot of it.

They have to be placed in bottles. They have to find the needles and syringes. So there's a whole distribution around that too. So it's going to take a while to make it, to have enough safe and effective vaccine that can be given to everybody who-- who needs it and wants it.

So what can viewers do? I mean, this is something that's going to be with us for a while. I think we have to be realistic, right? So we can all stay, you know, locked in, unable, um, to have economic revival, you know, access to-- to food and exercise. So what do we do? Give us your advice.

So the way I like to think about this is that we're here today. And we know that we're not going to be able to go back to normal until we have a safe and effective vaccine. So what do we do in between, right? And we-- you know, there's a lot of confusion, I think, in people's minds about that.

So look, in the beginning, we used a very blunt instrument, which is shelter in place. And we like to say that we did that because we wanted to avert a catastrophic failure of the health care system. We wanted to flatten the curve. But we also did that because, you know, we didn't know how to stop this outbreak, how to-- how to slow it down to save lives.

So it's slowed down, but it's a really blunt instrument. So the most important is, of course, for people that are sick, to stay home and for their contacts to quarantine themselves. And we know that most of the transmission really happens in-- within household settings or congregate settings.

We also have to recognize that a large number of people do not exhibit symptoms when they have this infection, and they may be transmitted. So they're contributed to the epidemic, so they must maintain some type of social distancing. This is not going to go away. The social distancing or physical distancing is not going to go away. We're going to have to wear masks. We're going to have to be really attentive to our environment, to, uh, environmental hygiene. And I think that the idea of being indoors with a lot of people is going to be a no no for the foreseeable future.

How long is the foreseeable future?

Until we get a vaccine that is safe and effective.

Um, you are chief scientist at FDA. You know that most trials fail. You know, to do everything, you know, right the first couple of times is hard. We definitely should have hope, but that's not a strategy. So what do you do if a vaccine isn't effective as-- as much as we would like or that it takes longer?

You know, we have to be realistic and have other-- you know, other plans too. So I think that once we have a very safe and effective, uh, treatment, therapeutic. I think it's going to be a game changer. And in the summer, we're going to begin to see a lot of monoclonal antibodies beginning to get tested.

Right now the scientists are really busy tweaking them, and, you know, it's bioengineering at its best. And those monoclonals are very, uh, potent and they have a, you know, they could really treat, uh, the infection. But they can also act as a vaccine as a preventative to h-- high risk, at risk populations if they can make enough of it.

So, you know, I'm an optimist. And I, you know, my job, at least, you know, whether-- whether at the FDA or, you know, NSC staff, where they also think about, you know, what do we do if something doesn't work? Like, how do we backstop the situation? And I think the monoclonals are going to be really critical.

What keeps Dr. Luciana Borio up at night?

These days, I think that we need to really remember that, um, you know, science and facts matter and they should be able to-- they-- they must inform our actions. We always have options, a set of options to act upon, but they must be informed by the best available science.

There's been a proliferation of clinical research that had been so poorly designed or so underpowered. And it really is a waste of resources, you know? And it puts patients at risk needlessly, because these patients are volunteering for clinical research with the understanding that this clinical research is well done and you'll generate, you know, knowledge that can benefit, um, all of the population. So I'm really worried about this proliferation of poorly executed design research that distracts from our ability to find the cures that we need right now.

Are things going to look any different three months from now or is that too soon to have any real impact?

I think we're going to be able to find this optimal balance. We're going to be-- we're going to, um, become more accustomed with the new normal that we're experiencing. I think people are going to recognize that, you know, there will be more social distancing, more telework, more use of face masks, that the risk outdoors is much smaller than the risk of indoor transmission.

So people are getting more comfortable in the outdoors and they are going to-- and again, take more precautions indoors because it's needed. So I think that, you know, eventually, we're going to get this right. We're going to find out exactly what are the tools that we have that are going to work best so that we don't have to feel that we're living under, you know, in a-- in a horror movie sometimes.

Well, Dr. Borio, I want to thank you for joining me.

It's my pleasure. Thank you so much, John.

And I want to thank you for watching Coronavirus in Context.