On Feb. 28, the White House Office of Science and Technology Policy asked the National Academies of Sciences, Engineering, and Medicine to create a new expert advisory committee—the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats—“to serve as a focal point for discussions on how to integrate science into national preparedness and response decision-making, to explore lessons learned and best practices from previous preparedness and response efforts, and to consider strategies for addressing misinformation.”
That new committee was organized quickly, and held its first (virtual) meeting on March 11. It is chaired by Harvey Fineberg, currently president of the Gordon and Betty Moore Foundation, and president of the Institute of Medicine (now the National Academy of Medicine) from 2002 to 2014. Fineberg is accompanied by 19 other experts with deep expertise in medicine and pandemic response, with backgrounds in the public and private sectors.
So far, the NASEM committee has not come close to fulfilling its potential. In the 40 days since its creation, it has held one public meeting and responded publicly to just eight requests from the White House. The most recent request asked about virus survival “in relation to temperature and humidity, and potential for seasonal reduction and resurgence of cases.” The committee responded April 7 with a five-page survey of relevant literature that was ultimately equivocal in its conclusions. Other questions sent from the White House focused on survival of the virus on surfaces and possible genetic mutation of the virus.
These rather modest demands on the NASEM committee reflect a huge missed opportunity.
Just this week, a dispute spilled into the public over scientific evidence involving the efficacy of treatments advocated by President Donald Trump. The dispute pitted Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and a member of the White House Coronavirus Task Force, against Peter Navarro, the White House director of trade and manufacturing policy. Navarro, an economist who is not on the task force, and Fauci, the only member of the task force who is not a political appointee, reportedly argued over the efficacy of the malaria drug hydroxychloroquine for treating COVID-19, a drug that Trump has touted as a “game changer.”
The dispute quickly became reported as a matter of personalities and palace intrigue, potentially feeding into and amplifying the already highly politicized response to the pandemic. It doesn’t have to be this way.
The Coronavirus Task Force is not an expert advisory body and should not be expected to arbitrate complex technical or scientific issues. However, the National Academies committee is just such an advisory body. It would be both straightforward and appropriate for the White House to ask the committee to render its judgment not only on the state of understanding related to hydroxychloroquine, but on every other potential treatment that is currently being researched.
That the White House has not asked for guidance on the hydroxychloroquine dispute is baffling; that it has consulted the expert committee only eight times since it was established even more so. Given how fast the pandemic is evolving, and the absolutely central role of data, models, and the wide range of newly produced medical, social, and policy research, one would think that the administration would view the committee as an essential resource in developing its strategy for fighting the pandemic.
Remarkably, the White House has projected as many as 240,000 deaths from COVID-19, but has not shared the scientific basis for the projection. According to a Washington Post article, “Almost the entirety of what the public knows about the death projection was presented on a single slide at a briefing Tuesday from the White House coronavirus task force. A White House representative said the task force has not publicly released the models it drew from out of respect for the confidentiality of the modelers.”
The United States presently lacks a centralized agency or advisory body to help policymakers understand the wide range of epidemiological models produced by state agencies, universities, and consultants, domestically and overseas. That means that policy is being made at the federal level and across the states based on a variety of no doubt sophisticated but uncoordinated and often opaque models. As a former official in the Obama administration observed, “It’s unclear exactly what the White House is doing on this front. As a result, you have every state trying to create their own models to anticipate their needs.”
It would be straightforward and appropriate for the White House to ask the National Academies committee to catalog available models and to offer specific guidance on their use, especially on how officials in the federal government and across states might deal with the large uncertainties and areas of ignorance that are evolving every day. Such a shared body of knowledge would facilitate coordinated policy and planning, and also help build public trust through transparency in methods and evidence and openness about the limitations of knowledge.
Making better use of the committee would also help separate advice from decision-making. Currently, it appears that the Coronavirus Task Force presents evidence selectively to justify or defend the proposals of the day. In a democracy, elected officials have every right to pick and choose what evidence they rely on, but democratic accountability always works better when the public can see the evidence base that informs those choices.
The National Academies committee needs to up its game too. On March 21, the committee responded to a White House request about “necessary data elements, sources of data, gaps in collection, and suggestions for data system design and integration to improve modeling and decision making for COVID-19” with what were mostly vague generalities rather than specific, policy-relevant guidance. For instance, the committee enumerated “eight basic points of perspective” such as “utilizing existing databases and focusing on accessibility, usability, interoperability and scalability will lead more rapidly to functional data systems than attempting to build systems from scratch.” That response is so general as to be useless.
The White House request on data would not have been difficult to answer with greater specificity. The committee should have identified specific data needed for improved modeling, exactly where that data could be found, what steps could be taken to collect missing data, and institutional alternatives for housing and sharing the data. In contrast, a British government pandemic modeling advisory committee in 2018 published a long list of variables for which data would need to be made available for real-time pandemic modeling. The United States also has many well-qualified experts who could assist the NAS committee to ensure that its answers are directly relevant to current policy.
In the fullness of time, there will no doubt be many evaluations of the use, misuse, and nonuse of scientific expertise during the pandemic. But for now, the White House should immediately better use the experts that it has impaneled who are standing ready to advise policymakers, and when called on the NASEM experts need to provide advice that is directly useful to current policy needs. So far the role of expert advice in the U.S. government’s response to the pandemic has fallen far short of its potential.
For more on the impact of the coronavirus, listen to this week’s episode of What Next: TBD.