Federal agencies must recalibrate to meet today’s health challenges


COVID-19, monkey pox and infant formula shortages are just a few of the public health challenges the federal government has faced in recent months and years. Despite the federal response to these challenges, criticism from agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration has come from both sides of the aisle during the Trump and Biden administrations.

Recently, several recommendations have been proposed to optimize the role of federal agencies; however, many of them can have unintended consequences. It is essential that any reform prioritize strengthening leadership and coordination across the federal bureaucracy without eliminating core missions and roles.

First, reports of an internal review at CDC, prompted by its response to COVID-19, highlighted a number of concerns such as a rigid financial structure, lack of authority to collect public health data and excessively long review processes for scientists. tips. The CDC has also come under fire during the pandemic for failing to communicate its scientific guidance in a way that considers real-world implications. Potential solutions to address these issues include requiring Senate confirmation of the CDC director to increase accountability, giving the CDC authority to collect basic public health data, and identifying ways to quickly reallocate funds. in case of emergency.

One idea that shouldn’t be considered, however, is to drop “prevention” from the CDC’s name and shed its focus on noninfectious diseases in order to make it solely an infectious disease response agency. As we know, the vast majority of deaths in the United States are from preventable chronic diseases, and 90% of the $4.1 trillion in annual health care spending goes to people with chronic and mental illnesses. Not only is the CDC’s mission critical to promoting broader health and preventing disease, but its work also ensures that Americans are more resilient to emergencies such as COVID-19. A recent study estimated that two-thirds of hospitalizations related to COVID-19 were attributable to obesity, hypertension, diabetes and heart failure – all preventable chronic diseases.

Second, the FDA is reportedly revamping its food safety program after the nationwide shortage of infant formula and investigations into its failure to ensure the safety of products, baby food and water. Solutions expressed at a recent US Senate hearing include a new leadership structure unifying food programs, new models for collaboration between the public and private sectors, and additional resources to hire and retain staff.

One idea that should not be considered is to remove “food” from the FDA’s mission, which for nearly a century has included food safety oversight, to create a new agency (and thus likely a new silo ). Instead, making sure the FDA starts prioritizing not just food safety, but healthier foods, is a better bet. On the latter, aggressively tackling excess sodium and added sugars while defining the term “healthy” on food labeling should be a top priority for the agency, because poor diet is now the leading risk factor for mortality in the country, having overtaken smoking. In addition to tobacco, which the FDA also regulates, the agency must above all fulfill its mission as a public health agency regulating these two main risk factors for disease.

Third, Congress created the position and office of the Assistant Secretary for Preparedness and Response (ASPR) in the Department of Health and Human Services (HHS) more than 15 years ago to support the nation’s response to public health threats. However, HHS secretaries did not always empower the ASPR to act on their behalf or provide clear direction to HHS agencies. The Biden administration has proposed moving the ASPR from an office supporting the secretary to an agency on par with the CDC, FDA, and others, but that doesn’t address the lack of coordination and, alternatively, risks create another silo.

A better idea would be for Congress and the Secretary of HHS to clarify and strengthen ASPR’s leadership roles and responsibilities during a federal pandemic response, a recommendation recently made by the Task Force on the Future of Health from the Bipartisan Policy Center (BPC). Improved hiring and contracting powers of the office should also be included. The BPC task force also recommended coupling ASPR leadership within HHS with the creation of a new White House Deputy National Security Adviser for Pandemic and Biothreat Preparedness to coordinate, direct and hold all federal departments and agencies accountable for all biodefense preparedness and operational response efforts.

Finally, a policy objective that should be pursued, particularly given our experience with COVID-19, is to strengthen our country’s public health infrastructure so that it has the capacities to respond to a wide range of challenges. . This requires long-term, sustainable investments in states and localities in addition to renewed federal leadership.

At this point, a recommendation from the Commonwealth Fund Commission on a National Public Health System to create a position at HHS, such as an Undersecretary of Public Health, should be viewed favorably. This position would help oversee and coordinate the development of a national public health system with federal agencies, states, localities, tribes and territories. Given the urgency of ensuring program alignment and budget transparency, the commission recommended that HHS, under existing statutory authority, may reconfigure and sustain the position of assistant secretary for health to fill this role now.

As the midterm elections and the 118th Congress approach in 2023, there are likely to be growing calls for reform and government oversight of the country’s federal public health structure. It is important that proposals are reviewed, not only on their merits, but also on unintended consequences. While considering a reorganization or reassignment of tasks, the federal government should focus on building its leadership capacity to respond to all emerging and long-standing public health challenges, so that we can achieve a nation in better health.

Anand Parekh, MD, MPH, is chief medical adviser at the Bipartisan Policy Center and former deputy assistant secretary for health at the Department of Health and Human Services.


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