In the fall of 2016, in the aftermath of the slow, uncoordinated, and resource-intensive response to the Ebola crisis in West Africa, the White House NSC staff created the Global Health Security and Biodefense directorate. Designed to plan for and oversee rapid, efficient, government-wide responses to global health security threats, the directorate pooled NSC staff focused on domestic and international biodefense and health security issues. Led by a senior director, the directorate reported to the national security advisor and the deputy homeland security advisor, the latter of whom was designated as the lead for coordinating the U.S. response to a biological crisis. The White House also released a companion executive order in November 2016 advancing the GHSA. In the spring of 2018, the administration dissolved the NSC directorate for Global Health Security and Biodefense, and oversight of these issues was incorporated into the directorate for Weapons of Mass Destruction and Biodefense. In the fall of 2018, the White House released a National Biodefense Strategy designed to strengthen the country’s defenses against biological threats to health and safety. President Trump also signed a National Security Presidential Memorandum on Support for National Biodefense, which reaffirmed U.S. support for the GHSA, extending through 2024, and established a Biodefense Steering Committee chaired by the secretary of Health and Human Services and responsible for the monitoring, coordination, and implementation of the strategy. In May 2019, the White House released a Global Health Security Strategy, the first of its kind, which “defines the actions the Administration will take to prevent, detect, and respond to infectious disease threats, whether naturally occurring, accidental, or deliberate,” and which reiterated the administration’s support for the GHSA. The administration should be commended for advances in the national biodefense and global health security strategies.
However, critical leadership gaps remain. It remains unclear who would be in charge at the White House in the case of a grave pandemic threat or cross-border biological crisis, whether natural, accidental, or deliberate. Over the past year, the sluggish White House response to the Ebola outbreak in the DRC is but the latest example of this problem. And while the Biodefense Steering Committee plays an important role in implementing the National Biodefense Strategy, senior leadership in the White House is required to successfully coordinate the large number of government agencies and programs across health, security, development, and defense, as well as private-sector actors that would be involved in a response to an international public health threat. In the case of a health security emergency, White House leadership will also be critical in navigating challenging political issues like quarantines and travel bans and in communicating to and reassuring the American public. The authorities currently in place at HHS are insufficient to address these critical, complex, and often urgent interagency demands.In addition to coordinating the interagency process, a global health security and biodefense directorate at the NSC can reform fragmented programs and ensure higher efficiencies, strengthened accountability, and better spending of scarce resources. Together with the Office of Management and Budget (OMB), it can identify, rationalize, and align funding in the U.S. president’s budget across agencies.