Moore and Goldring on “Pandemics, National Security & Re-Balancing Health Care”
Today’s guest essay is co-authored by Professor John Norton Moore and Dr. Steven R. Goldring who argue that the devastating impact of the COVID-19 pandemic requires a re-conceptualization of health care.
Among other things, this would include re-balancing the approach to provide greater emphasis on disease prevention. They also urge greater governmental action in a number of areas, and particularly for a major increase in funding for basic research – but also include public/private partnerships in their recommendations.
They introduce their article with a comparison of the pandemic to traditional national security threats. Lawfire® readers may note that historically I haven’t been too enthusiastic about bringing even serious national ills under the aegis of “national security” (e.g., here).
However, the authors take a more nuanced approach in that they are not calling for incorporating health care into the national security enterprise, per se. Instead , they are advocating for “some of the same commitment to deterrence and preparations for response as has been traditionally ascribed to national defense.” Lots to think about here!
Pandemics, National Security & Re-Balancing Health Care
John Norton Moore & Steven R. Goldring, MD
National Security has traditionally focused on wars, terrorism and the use of force. Natural pandemics have not traditionally been thought of as national security challenges.
Yet COVID-19 is a wake-up call that pandemics pose some of the same catastrophic consequences as war and, consequently, they require some of the same commitment to deterrence and preparations for response as has been traditionally ascribed to national defense.
COVID-19, and potential future viral pandemics, are as deadly as wars and impact the economy of America and the world, costing trillions of dollars and causing massive hardship and disruption. In addition, they hugely affect defense readiness and reduce the funds available to support our national defense.
In national defense we prepare for the risk of war and conflict; hoping to deter but, if necessary, assuring that we will prevail. As such, we maintain a high-level of expenditures on an army, navy and air-force; forces we hope will not be necessary to use.
An onset of more frequent viral pandemics
But we spend only a comparative pittance on pandemic risk. If pandemics only occur every 100 years, as is the time period between the 1918 “Spanish Flu” pandemic and the Covid-19 pandemic this may be the efficient strategy. But the relatively recent appearance of SARS, MERS and now COVID-19, all within the last eighteen years, suggests that the onset of viral pandemics may be more frequent than experienced in the past.
Indeed, we know that the continued spill-over of Corona viruses from animal sources is an inevitability, with more than 25,000 Corona viruses in the master data base. Greater animal to human interactions, a growing global population, and enhanced travel, among other factors, have set the stage for potentially more frequent, and possibly even more deadly, pandemics. We also know that COVID chaos in Europe and America has whetted the appetite of terrorist groups for bio-terrorism.
Re-conceptualize our thinking about health-care
Further, just as we can appropriately think of the risk of pandemics in national defense terms we also need to re-conceptualize our thinking about health-care. In recent years the national health care debate has focused on health care disparities and models of health care delivery and reimbursement.
Embedded within these debates there has been the issue of what portion of the health care budget should be focused on disease treatment versus disease prevention. This is a subject of longstanding debate and surprisingly there remains controversy, especially with respect to cost-effectiveness of particular disease prevention programs.
Nevertheless, there are multiple examples of disease prevention strategies that have been shown to be cost-effective and to save human lives. This is particularly the case with respect to viral illnesses where identification of disease carriers, immunizations, and anti-viral therapies have been shown to prevent disease expression and dissemination, and most importantly, to save lives.
Support of basic science research
COVID-19, with its tragic human and economic costs, clearly highlights the need for federal support of basic science research that can develop therapies that target viral disease prevention, treatment and cure and a comprehensive public health infrastructure that can act expeditiously and efficiently to deal with viral pandemics.
America is blessed with the finest pharmaceutical and medical device companies in the world; many of which are heroically stepping up to deal with the COVID-19 pandemic. But there are well-understood economic reasons why there is a major role for federal funding of a sustainable and effective public health infrastructure, clinical health care, and basic science research that can respond to a health care crisis such as the COVID-19 Pandemic.
Need for governmental action
Where markets will not produce adequately because the stream of benefits cannot be fully captured – referred to as an area of “positive externalities” — economists have long supported the need for governmental action. Support for basic science targeting the prevention, cure and amelioration of disease is one such area.
Failure adequately to fund basic research in such areas is as much “government failure” as failing to adequately prevent “negative externalities” from market failure. Indeed, dealing effectively with “positive externalities” is as much an issue of appropriate “rule-of-law” as a proper regulatory structure.
Where a substantial percentage of the US population is affected, where the total cost of a disease is high, where existing research funding has been relatively low, and where new biological and medical knowledge offers promise for reduction in the disease burden then there is a strong case for enhanced federal funding.
Enhanced research in such settings offers promise for cost savings which are potentially an order of magnitude greater than the research costs. Further, greater success in cures or treatments would mean that millions of Americans would no longer be condemned to an early death or a lifetime of pain and disability. Viral pandemics meet each and all of these conditions for enhanced federal funding.
A public/private sector “Apollo” type partnership
For now, of course, the focus must be on everything associated with defeating COVID-19. But when we have defeated COVID, America should lead the world in a public/private sector “Apollo” type partnership to work on prevention, treatment, and cures for viral outbreaks. The project would work on development of improved tests for rapid detection of viral infection and immunity, more effective anti-viral treatments, speeding up development and testing of vaccines, creation of a sustainable public health infrastructure for early disease detection and contact tracing, as well as enhanced hospital resources and protective gear for medical workers.
The effort would need to include a major increase in basic research – since 2003 the inflation adjusted NIH grant budget has declined nine percent. It would need to dramatically increase the Nation’s public health infrastructure — over the past decade the public health workforce has shrunk by 56,000 positions.
And it would need to include a legal mechanism for greater coordination in dealing with pandemics between the fifty states and the federal government — as now exists on homeland security. Coordination is particularly important in dealing with the inevitable tension between controlling a pandemic and supporting and sustaining the economy.
Need for international cooperation
As the research and pharmaceutical base is truly global, in this effort we should work cooperatively with other nations which are willing to contribute. International cooperation in dealing with global pandemics is important for better and faster development of anti-viral therapies and vaccines. But it is also important for humanitarian reasons, as well as for reducing reintroduction of the virus from other countries. Human ingenuity can and will beat COVID-19, but we must be better prepared for our next viral enemy.
John Norton Moore is a Professor of Law Emeritus at the University of Virginia and was a founder of the field of National Security Law. He has held six Presidential appointments under three American Presidents.
Dr. Steven R. Goldring, MD, is the former Richard L. Menschel Research Chair, and Chief Scientific Officer, of the Hospital for Special Surgery in New York. He is a former Professor of Medicine at Harvard Medical School and Weill Cornell Medical College.
The views expressed by guest authors do not necessarily reflect those of the Center on Law, Ethics and National Security, or Duke University.
Remember what we like to say on Lawfire®: gather the facts, examine the law, evaluate the arguments – and then decide for yourself!