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Introduction

Coronavirus disease 2019 (COVID-19) is by far the worst public health crisis of our lifetimes, said Dan Hanfling, vice president at In-Q-Tel. He recounted the daily death counts, the vast number of people who died over the 2 years thus far, and how so many people became numb to the tragedy. The controversies that erupted over the very things that had been taken for granted for decades were numerous, he noted. Hanfling recalled a convening in 2009 that occurred at the National Academies of Sciences, Engineering, and Medicine around developing a systems framework for crisis standards of care, which has become a critical component of response over the last 2 years. What was highlighted at that time was the duty to plan, he said, and that planners had the responsibility to plan for a catastrophic emergency. He then asked the question, “What happened to the plans? How did the United States reach this point that it suffered worse than many nations?”

Hanfling recalled that core pillars of U.S. preparedness and response machinery, especially the Centers for Disease Control and Prevention (CDC), the Office of the Assistant Secretary for Preparedness and Response (ASPR, now the Administration for Strategic Preparedness and Response since July 2022), and the Food and Drug Administration (FDA), were undermined by political pressures and tensions during the pandemic. It was a matter of when, not if, an event of this nature would happen, he said. But somehow, the planning was not enough. To say that no plans were in place is to misstate the truth. There were plans—they just were not good enough, and in large part were ignored, he concluded.

To address these issues and lay the groundwork for what will be needed to assure a robust and successful future in public health emergency preparedness, the National Academies of Sciences, Engineering, and Medicine (National Academies) Forum on Medical and Public Health Preparedness for Disasters and Emergencies held a workshop to explore key components, success stories, and failure points throughout the entire public health emergency preparedness and response enterprise during COVID-19 (see Box 1-1).¹ The main goals were to consider opportunities for more effective planning for, and response to, catastrophic disasters, pandemics, and other large-scale public health emergency planning at the federal, state, local, tribal, and territorial levels. Using key components of past National Academies reports to frame workshop discussions, participants examined specific lessons learned from the COVID-19 pandemic and explored potential paths forward.

ORGANIZATION OF WORKSHOP

The hybrid workshop was held over 2 days, May 17 and 18, 2022, in Washington, D.C., and virtually online. The first day included sessions and keynotes on public health emergency preparedness planning before and during the pandemic, assessing various capabilities, funding levels, surveillance, considerations for medical countermeasures and supplies, and challenges and successes with risk communication and public engagement. The second day’s sessions focused entirely on coordination, governance, and leadership across levels of government and public–private partnerships. This proceedings summarizes discussions held over these 2 days.²

ORGANIZATION OF PROCEEDINGS

This proceedings document is organized into six chapters. Following the introduction, Chapter 2 highlights public health emergency planning both before and during COVID-19. Chapter 3 focuses on coordination of surveillance domestically and globally, as well as considerations for robust medical countermeasure response and sustainment of the medical supply chain. Risk communication and public engagement, including

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¹ The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

² The workshop agenda is available in Appendix A. A full list of biographies of workshop speakers and planning committee members is in Appendix B.

ethics and equity, are covered in Chapter 4, and Chapter 5 reviews various types of coordination among different levels of leadership and governance. Finally, Chapter 6 concludes with reflections and ideas on future directions from members of the workshop planning committee and the leadership of the Forum on Medical and Public Health Preparedness for Disasters and Emergencies.

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