With flu season on the horizon, the COVID-19 pandemic and seasonal flu may converge. Little is known about the interaction of SARS-CoV-2 and the influenza virus in people, and simultaneous COVID-19 and flu surges could overwhelm hospitals.

What should be done to prepare for this possibility in the nearterm, as well as the future convergence of regularly occurring endemic diseases (like seasonal flu) with outbreaks of novel diseases? What might the toll of such a convergence be on Americans if the US is not prepared?

In May 2018, the Trump Administration disbanded the National Security Council Global Health Security and Biodefense unit, which was responsible for pandemic preparedness in the White House.

Should an equivalent body be reestablished or otherwise put in place? Why or why not? Would you make any improvements to such a body?

The Administration’s Strategic National Stockpile was found lacking in the face of COVID-19. N95 masks, for example, were very limited, and US frontline healthcare workers had to make do with unsatisfactory personal protective equipment. More than 400 US health care workers have died from COVID-19.

What are your recommendations for maintaining an effective US stockpile of medical supplies?

A December 2018 report commissioned by the Department of Health and Human Services preparedness office asserts that consolidation in the biodefense industry “has created ‘vulnerabilities in the supply chain,’ while also raising the prospect of inflated costs because of a lack of competition.” The report cited the company Emergent Biosolutions “as a primary example of increased concentration in the supply of ‘medical countermeasures,’” like treatments and vaccines.

Do you agree with this assessment? Please explain why or why not, any improvements you believe should be made, and how to achieve those improvements.

In 2016, “the pandemic playbook” was produced by the Obama Administration National Security Council. The 69-page playbook lays out hundreds of tactics and key policy decisions for responding to infectious diseases and biological threats.

Recommendations in the playbook include the swift detection of outbreaks, rapid assessment and procurement of personal protective equipment, continually evaluating diagnostic testing capacity, securing supplemental funding for response, and considering use of the Defense Production Act. “The Trump Administration was briefed on the playbook’s existence in 2017,” but in responding to COVID-19, the Administration “lagged behind the timeline laid out in the playbook.”

Based on US and international experiences with COVID-19, what key lessons would you include in a pandemic playbook?

How much impact would having more domestic production capacity for personal protective equipment (like N95 masks and medical gowns), drugs and their ingredients, ventilators, and other medical supplies have on preparedness and response to disease outbreaks? If the impact would be positive, how should this be accomplished?

Hospitals operate on tight budgets and are not generally set up to handle surges of patients suffering from highly contagious diseases, or to serve those contagious patients simultaneously with patients with more typical needs such as elective surgeries or non-infectious disease emergencies like heart attacks or wound care.

Should hospitals be incentivized to move infectious disease care into separate facilities funded by separate operating budgets, perhaps even transitioning these facilities to non-profit status? Would incentives like tax write-offs for maintaining medical supply stockpiles or constructing negative pressure rooms be helpful? Please explain how hospitals should adapt to be better prepared for the next pandemic.

The US does not have a universal health care system. Health care costs brought on by the pandemic, such as for testing or treatment, may be prohibitive, especially for uninsured or underinsured individuals and families.

In the context of infectious disease outbreaks, should all testing be free? Why or why not, and if so, how should free testing be funded?

Follow-up: During the initial phase of future outbreaks, should everyone be tested, and not just those displaying disease symptoms? Please explain.

Follow-up: Would a US universal health care system improve our ability to confront a future pandemic?

Early on in the pandemic, World Health Organization officials believed “China was not sharing enough data to assess how effectively the virus spread between people or what risk it posed to the rest of the world, costing valuable time.”

How can countries be required or incentivized to be transparent with data about outbreaks of infectious disease? Should countries be held accountable for not being transparent? If so, how?

In order to both overcome COVID-19 and be prepared for the next pandemic, US research and development is key.

What are the keys to approaching how federal investments in both fundamental and translational emerging infectious disease research are made? Please also discuss the roles of broadly scoped and transnational work.

One of the reasons many infectious diseases originate in animals and spread to humans is because human populations encroach on wildlife habitats.

What role can the preservation of natural spaces, forest conservation, etc. play in reducing the spread of viruses from wild animals to humans?

COVID-19 is a respiratory illness and easily spreads from person to person. Some evidence suggests that air pollution is linked to higher coronavirus death rates.

While further studies are needed to draw a definitive conclusion, is there any downside to reducing air pollution? What is your understanding of how environmental impacts may worsen infectious diseases? Should reducing pollution be a part of preparing for the next pandemic?

The coronavirus can spread through the air when infected individuals expel droplets by coughing, sneezing, or talking. The coronavirus may also spread when people touch things that have the virus on them, and then breathe in the virus from their hands.

Is there enough emphasis on the development of technologies that can destroy disease-causing microbes in public spaces while at the same time not harming humans? How should these technologies be implemented effectively?

Congress has appropriated trillions of dollars for responding to COVID-19, and some top economists believe more spending is necessary.

How important is oversight over how the money for responding to the public health emergencies is spent? In your view, what are some best practices for oversight, and what should be improved for both COVID-19 and future pandemics? Please explain.

Are there cutting-edge biotechnologies that should be more widely deployed to defend against emerging pathogens reaching US citizens, and increase the speed at which the world responds to pandemics? How would you deploy them?

Follow-up: Vaccines work because they induce the production of pathogen-recognizing antibodies in people and provide lasting protection against the pathogens. However, it can take in the ballpark of 12 to 18 months to develop a vaccine against a novel pathogen, and additional time for distribution.

What role should developing therapeutic antibodies have in the response to COVID-19, and to the next pandemic? Could therapeutic antibodies be developed more rapidly than a vaccine?

Tragically, hundreds of Americans continue to die every day from the coronavirus. Close to 120,000 US lives, and counting. The Administration’s unsatisfactory response to the COVID-19 pandemic has contributed to avoidable deaths and other health impacts.

Holding responsible parties accountable could help prevent mistakes from being repeated. Should the Trump Administration be held accountable for deficiencies in responding to COVID-19? If yes, how so? Would this improve the federal response to future pandemics?

What should schools and daycare centers be doing now to be ready to safely reopen in the fall, and to know when to stay open in the face of potential new outbreaks during the school year? What have we learned from COVID-19 about the role of schools and daycares in both disease transmission and, and about how much families rely on schools and daycares?

Follow-up: What resources – financial, public health, etc. – are available to those schools and daycare centers? Are more resources needed? Please explain.

Science and fact and reason are the best tools to fight a pandemic. Has the US public health apparatus been funded appropriately? What are the broad strokes of an effective funding plan for public health in this country?

The White House coronavirus task force press briefings often sent mixed messages to the American public about how to care for one another, and the Centers for Disease Control and Prevention, staffed by premier public health and communications experts, only recently “held its first public press briefing in three months.”

Should the scientists, physicians, and public health experts at CDC have had the lead on communicating with the American people throughout the entire COVID-19 pandemic? What would a national public health communication model that gives consistent, clear messaging to the public look like?

Follow-up: Should the CDC be independent of the political system so it can operate purely based on science and medical facts, and not be subjected to political pressure?

Early in the pandemic, US public health officials did not recommend that the public wear masks. It turns out that wearing masks can help reduce COVID-19 transmission, and now, Americans should wear masks in public.

Should there be a public health campaign that promotes the uniform wearing of masks, both now and for a future pandemic?

Could uniformly high-quality public education about biology, insistence that political leaders get informed about infectious disease, or incentivizing more top experts to work in federal government have improved our response to COVID-19? Should these approaches play a role in preparing for the next pandemic?

Open data and open publication are very important for international COVID-19 scientific collaboration. They are also activities of a free press that includes respect for expert opinions. The free press is under threat in the US, and there are related declines in trust of experts. This can lead to poor decisions, such as not wearing masks, which, in turn, contributes to COVID-19 deaths, hospitalizations, and severe economic disruption.

Should policies be put in place to combat anti-scientific disinformation, attacks on scientists, attacks on think-tanks, and related attacks on the free press and evidence-based activities? Please explain.

Follow-up: Should greater oversight be conducted over current and future Administrations to reduce attacks on scientists and science that are hurting the US response to pandemics? Please explain.

Should Congress require the federal government to develop a thorough plan for coordinating an integrated national response to the next pandemic or national catastrophe, and what requirements should be placed upon Administration officials?