Battling Biological Threats: Complacency, Progress, or Both?
As 2023 opens, there are reasons to be hopeful that the United States can bridge its political divides and keep its eye on what is most important to protect Americans against future biological threats—building a bipartisan consensus, driving forward a new national policy doctrine on health security, strengthening U.S. capabilities, and achieving measurable, sustained progress. Realism, of course, is still very much in order. The environment remains very challenging. And stark new challenges continue to emerge, such as recent action by Congress to rescind the Covid-19 vaccine mandate for U.S. servicemen and women. Yet there is reason to be cautiously optimistic.
The coronavirus pandemic has passed its three-year mark at a murky, hazardous, and yet still promising moment. The United States, like many other countries acutely impacted by Covid-19, is yearning to achieve a normalization while continuing to face serious disease and mortality at home. Outside U.S. borders, the runaway outbreak in China, following the end of zero-Covid policies there in early December, reminds us of the fearsome damage the virus can wreak and the continued risk of dangerous new subvariants in 2023 that could rapidly pose serious global consequences. In the meantime, many low- and middle-income countries achieved woeful vaccine coverage, continue to struggle with vaccine uptake, and remain ill-equipped for current and future threats.
Though 1.1 million Americans have died from Covid-19 and 300–400 still perish each day, pressures persist within the United States to move beyond this tragedy, amid a legacy of acute polarization and division that surrounds many, if not most, pandemic interventions, and which has eroded public trust and confidence in science and public health authorities. Throughout 2022, U.S. policymakers have repeatedly faced tough financial and political impasses in securing new substantial funding to continue to support a robust Covid-19 response and to build the capacities essential to future pandemic preparedness.
On the surface, it seems improbable that the United States will learn strategically from its many stark, sobering experiences with the pandemic, or reliably build on its dramatic successes such as the Trump administration’s Operation Warp Speed and the Biden administration’s critical achievements, including delivery of vaccines, tests, and therapies throughout the United States. Indeed, many observers continue to argue that the United States is succumbing inexorably to the cycle of crisis followed by complacency that has chronically afflicted health security. And that we risk losing the concerted bipartisan action so fundamental to sustaining U.S. commitments on global HIV through the past two decades of the President’s Emergency Program for AIDS Relief (PEPFAR), the Global Health Security Agenda, and recent U.S. efforts to battle Covid-19 at home and abroad.
Yet, that conclusion is premature. The generation of new U.S. security policy continues apace. And lately, significant bipartisan action by Congress in health security has proven within reach, despite tough odds.
Over the course of 2022, several important new national security directives and policies were issued, including the National Security Strategy , National Biodefense Strategy and Implementation Plan , and National Defense Strategy which significantly advanced thinking on health security and what specifically is required to better protect Americans. Early in 2023, the Department of Defense (DOD) Biodefense Posture Review is anticipated, which should build on these gains. As 2022 concluded, bipartisan legislative action successfully brought the National Defense Authorization Act and the FY 2023 Omnibus spending bill to the president’s desk for signature. While each had mixed results, all nonetheless helped move forward the health security agenda. What are the lessons from these developments that may guide thinking and action in 2023?
Reflections from 2022
Global health security elevated. Global health security, including biodefense, has been elevated to new prominence in U.S. national security thinking. The spirit of the new policy doctrines is not at all hesitant, complacent, or ambiguous. Quite the contrary. The consistent underlying argument, visible across the different national security policy documents, is that the United States must be resolute and clear, leaning forward not backwards, investing in new capabilities sustained over many years to protect Americans and the larger world against future dangerous biological threats. The core message, communicated much more strongly than in the past, is that these are matters of U.S. national security. Of course, this begs the question: Will this security status translate into commensurate budgets and sustained action?
White House leadership consolidated. Though the White House may eventually choose to end the national public health emergency declaration in 2023, there are no signs of stepping back from a lead role in driving U.S. government efforts forward into the future. As outlined in the National Biodefense Strategy , the White House is to play a sustained muscular role along multiple fronts. It is charged with overseeing the strategies, budgets, and implementation of performance across key goals laid out in the National Biodefense Strategy across the full spectrum of executive agencies, while ensuring available vaccine quantities are adequate to control a biological incident within 100 days of onset. It is responsible for ensuring cabinet-level buy-in to biopreparedness, including participation in annual health emergency exercises. The White House Office of Management and Budget is to annually review the true funding requirements of agencies and departments to achieve their biodefense mandates. The White House is on the hook to assist 50 countries to achieve specific health security aims and catalyze actions in another 50 countries, and see that the Director of National Intelligence conducts annual biothreat assessments. The Bioeconomy Executive Order , issued in September 2022, outlines a similar, parallel role for White House leadership in biotechnology and biomanufacturing, including heightened investment in biosafety and biosecurity.
Just moments after the inauguration, President Biden restored the National Security Council Directorate on Global Health Security and Biodefense as a lead element of U.S. policy and simultaneously established the position of Covid-19 Response Coordinator. As 2022 ended, Congress, on a bipartisan basis, made the decision to further solidify the White House role in future threats. In the 2023 Omnibus spending bill, Congress passed a provision, contained in the PREVENT Pandemics Act , creating a new White House Office of Pandemic Preparedness and Response. Its director, appointed by the president and with a staff of up to 25, will serve on both the Domestic Policy Council and the National Security Council. The office’s mandate is to advise the president on pandemic preparedness and biothreats, coordinate the response across the entire federal government, and evaluate readiness.
The National Defense Authorization Act (NDAA) incorporated the Global Health Security Act , spearheaded on a bipartisan basis by Representative Gerald Connolly (D-VA), directing the president to create a Global Health Security Agency Interagency Review Council to implement the Global Health Security Agenda. To lead that work, the NDAA further directs the president to appoint a U.S. Coordinator for Global Health Security.
The core questions are whether the White House can maintain its focus on biological threats amid the war in Ukraine and other geopolitical crises, and whether Congress will provide the resources necessary to build the capacities outlined in these strategies.
DOD’s critical role is increasingly visible. The evolving new doctrine on national security recognizes that DOD must address global health security threats from all sources, including the potential utilization of increasingly sophisticated bioweapons by terrorist groups or near-peer state actors. Regardless of the source, prevention through deterrence, increasingly sensitive detection capabilities, and the ability to rapidly develop and produce new treatments are necessary to combat existing and future chemical and biological threats.
The National Biodefense Strategy acknowledges DOD as a key institutional partner in every critical biodefense area to a degree not seen before. DOD carries special responsibilities in biosafety and biosecurity, and is designated in the strategy to serve as the co-lead department in two critical areas: (1) detecting, responding to, and preventing transmission of healthcare-associated infections and antibiotic resistant pathogens, and (2) addressing biological weapons, and strengthening implementation of the Biological Weapons Convention and UN Security Council Resolution 1540 prohibiting member states from supporting non-state actors for nuclear, chemical, or biological weapons.
The strategy emphasizes that DOD is an integral part of the ecosystem driving research and development of next generation technologies based on transparent, innovative, and sustained partnerships among industry, universities, and international partners such as the European Health Emergency Preparedness and Response Authority (HERA) at the European Commission. DOD develops measures to detect, prevent, and treat diseases likely to pose threats to military personnel and inhibit operations, which in turn has provided valuable discoveries and field research and clinical experience to treat Ebola , malaria, and anthrax.
The link between DOD and the historic development of mRNA vaccines against SARS-CoV-2 provides exceptional proof that DOD is vital to strategizing for the future development of essential vaccines, therapies, and diagnostics against dangerous pathogens. The rapid development of Moderna and Pfizer Covid-19 vaccines was dependent on the mRNA vaccine platform created through research sponsored by the Defense Advanced Research Projects Agency (DARPA) over a decade ago in the search for ways to rapidly protect military personnel against unknown infectious agents.
Recent experience has also revealed the need to update the Defense Production Act (DPA) to better meet today’s challenges and realities. The DPA was written in 1950 at the beginning of the Korean conflict in the context of the early phase of the Cold War. Although applicable across the federal government, many authorized activities, such as rapid authorization of multibillion-dollar contracts, have defaulted during crises to DOD as the only organization possessing the capability. Serious costly delays were experienced during the response to Covid-19 as lawyers puzzled over how 70-year-old language applied to current realities. This is an area that needs serious attention from both the administration and Congress.
Collaboration and cooperation among the numerous DOD entities contributing to biodefense has advanced during the course of the pandemic. The recent decision to expand the definition of biodefense to include natural, accidental, and intentional sources is valuable in changing the focus from source-based to symptom-based discussion. Although a seemingly small point, this encourages all parties, regardless of the inclination to biosecurity and biosafety, or a clinical and public health orientation, to begin immediately working on actions rather than first debating responsibility.
There will be keen interest in the outcome and recommendations of the Biodefense Posture Review, expected to be released in early 2023. This internal study is mandated to unify and modernize DOD’s broad, comprehensive biodefense capabilities, and synchronize these efforts with those of other federal departments in line with the recently released National Defense and Biodefense Strategies. This is an encouraging step. In the future, DOD should regularly conduct and publish biodefense posture reviews in a manner similar to the nuclear, ballistic missile defense, and space posture reviews.
Politicization of DOD force health protection raises an alarm. The FY 2023 National Defense Authorization Act rescinds DOD’s Covid-19 vaccine mandate within active and reserve components. This legislation raises tough questions that threaten the foundation of military readiness, presenting an enormous challenge to a military ethos that has historically subsumed individual rights to the collective good. The unvaccinated represent a threat to the health of the force, as evinced by the incapacitation of the aircraft carrier USS Roosevelt in 2020. The unvaccinated hamper U.S. military operations within countries requiring vaccination. While civilian control of the military is a bedrock principle in the United States, decisions impacting the readiness of that military force should rest with armed forces leadership.
What to make of this dramatic spillover of America’s politicization of the pandemic? Will trust and confidence in vaccines among servicemen be eroded? Will the larger divisions in American society now be magnified inside DOD? Will all vaccinations be subject to higher skepticism and resistance? Will it be much more difficult to prepare military personnel, active and reserve, against future biological threats? Clearly, much more concerted work is needed to strike the correct balance between civilian oversight and military operational control, minimize further future erosion of DOD autonomy and capacity, and guarantee U.S. force readiness, which is now in peril.
Geostrategic foes require an evolving strategy. While the rising confrontation with China is at the very center of the U.S. evolving national security and defenses strategies, U.S. cooperation and dialogue on health security are not ruled out. Indeed, the Xi-Biden meeting in late 2022 at the G20 Summit in Bali concluded with a joint call for reopening talks on health and climate change. The calculations are mixed: the United States has, above all else, to acknowledge the heightened threat posed by China, including not turning away from the continued stalemate over Covid origins and the continued threat posed by Chinese disinformation and misinformation with respect to Covid-19 and U.S. technologies. The United States will continue to press China to share genomic sequencing data at the scale and geographic specificity needed to understand the patterns of transmission and whether dangerous new variants are emerging, as Covid-19 races across China (predicted to rapidly infect more than half of its weakly protected population of 1.4 billion in the coming few months). At the same time, there is the need to keep open lines of dialogue and coordination in preparing for future pandemics.
Russia stirs a more focused reaction. Disinformation, misinformation, and conspiracy thinking have moved to center stage amid Russia’s war against Ukraine, and directly challenge the legitimacy and credibility of U.S. government health security programs. The latter threat is seen most vividly in the Russian disinformation assault on DOD’s peaceful laboratory programs in Ukraine and elsewhere.
Recent experience with China, Russia, and others argues for far more proactive and robust strategy, budget, and programs to redress disinformation and misinformation regarding DOD biodefense activities. The problem has become simply too big and pernicious a threat.
The U.S. Centers for Disease Control and Prevention still has bipartisan support—with reservations . The FY 2023 Omnibus spending bill which Congress passed in late December and the president signed into law did affirm, in a shared, bipartisan spirit, the critical role the U.S. Centers for Disease Control and Prevention (CDC) plays in pandemic preparedness and response. It raised CDC’s overall budget while increasing investments in public health infrastructure, funded the Center for Forecasting and Outbreak Analytics (CFA) through the routine budget process and codified its data mission using language from the Prevent Pandemics Act, and increased the investment in cross-cutting areas such as data, public health workforce, laboratories, and genomic sequencing. Unfortunately, the Omnibus did not move forward on mandating the sharing of state and local data with CDC as a critical element of responding to emerging biological crises, a reflection of the continued acute political sensitivities and differences of view surrounding data. Much more work remains in that area. The Omnibus also, based on the Prevent Pandemics Act, requires Senate confirmation of the CDC director as of January 2025, along with greater reporting requirements. Both measures reflect the desire for greater accountability and transparency in CDC’s leadership and performance .
Complacency is not an option regardless of partisan identity. As 2023 opens, there is apprehension that partisan divisions and politicized health security approaches may worsen as the United States moves into a divided government of ultra-thin margins. That risk is real and undeniable. It is however no less true that the colossal, explosive Covid-19 outbreak in China concentrates our imagination on the continued pandemic threats we face, while the very real possibility of dangerous new variants persists across the world. At home, the Biden administration is elevating the status of health security as a matter of national security, with bipartisan support in Congress. At the same time, bipartisan cooperation within Congress, and between Congress and the Biden administration, lives on, as witnessed in the NDAA and the Omnibus, pushing the health security agenda forward. These steps give us reason to hope and plan for a 2023 that can focus on bridging divides and make measurable progress to prepare our nation for the future biological threats we will surely face.
Thomas R. Cullison is a senior associate (non-resident) with the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. J. Stephen Morrison is senior vice president and director of the CSIS Global Health Policy Center.