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On February 28, the White House Bureau of Science and Technology Policy asked the National Academies of Science, Engineering and Medicine to create a new expert advisory committee – the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats— “serve as a focal point for discussions on how to integrate science into national decision-making for preparedness and response, to explore lessons learned and best practices from preparedness and previous response, and consider strategies to combat misinformation. “
This 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 in-depth expertise in medicine and in response to pandemics, with training in the public and private sectors.
So far, the NASEM committee has failed to realize its potential. In the 40 days since its creation, it held a public meeting and only responded publicly to eight requests from the White House. The most recent request was for the survival of the virus “in relation to temperature and humidity, and the potential for seasonal reduction and resurgence of cases”. The committee responded on April 7 with a five-page study of relevant documentation which was ultimately ambiguous in its conclusions. Other questions sent by the White House were about the survival of the virus on surfaces and the possible genetic mutation of the virus.
These rather modest demands on the NASEM committee reflect a huge missed opportunity.
This week there has been a public outcry over scientific evidence regarding the effectiveness of President Trump’s treatments. The dispute pitted Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and member of the White House Coronavirus Task Force, against Peter Navarro, director of trade and manufacturing policy for the White House. Navarro, an economist who is not a member of the working group, and Fauci, the only member of the working group who is not appointed by politicians, have reportedly discussed the effectiveness of the malaria drug hydroxychloroquine in treating COVID-19, a drug that Trump has touted as a “game changer”.
The dispute was quickly flagged as a matter of personalities and palace intrigue, which could fuel and amplify the already highly politicized response to the pandemic. It doesn’t have to be that way.
The Coronavirus Working Group is not an expert advisory body and should not be called upon to arbitrate complex technical or scientific matters. However, the committee of national academies is just such an advisory body. It would be both simple and appropriate for the White House to ask the committee to decide not only on the state of understanding of hydroxychloroquine, but on any other potential treatment currently under study.
That the White House has not asked for advice on the hydroxychloroquine dispute is disconcerting; that it has only consulted the committee of experts eight times since its creation. Given the speed at which the pandemic is evolving and the absolutely central role of data, models and the wide range of newly produced medical, social and political research, one might think that the administration would consider the committee as an essential resource for developing its strategy to fight the pandemic.
Remarkably, the White House projected up to 240,000 deaths from COVID-19, but did not share the scientific basis for the projection. According to a Washington Post article, “Almost all of the public’s knowledge of the death projection was presented on a single slide during a briefing on Tuesday from the White House Coronavirus task force. A White House official said the task force had not released the models it had designed out of respect for the privacy of model makers. “
The United States currently does not have a centralized agency or advisory body to assist decision makers in understanding the wide range of epidemiological models produced by state agencies, universities and consultants, domestically and internationally. ‘foreign. This means that policy is developed at the federal level and across states on the basis of a variety of presumably sophisticated but uncoordinated and often opaque models. As a former Obama administration official noted, “We don’t know exactly what the White House is doing on this front. As a result, each state tries to create its own models to anticipate its needs. “
It would be simple and appropriate for the White House to ask the committee of national academies to list available models and provide specific advice on their use, in particular on how federal and state officials could handle large uncertainties. and areas of ignorance. that evolve every day. Such a body of shared knowledge would facilitate coordination of policy and planning, and would also help build public confidence through transparency of methods and evidence and openness to the boundaries of knowledge.
Better use of the committee would also help separate boards from decision-making. Currently, it appears that the Coronavirus task force is selectively presenting evidence to justify or defend the proposals of the time. In a democracy, elected officials have every right to choose the evidence on which they rely, but democratic accountability always works best when the public can see the evidence base behind those choices.
The national academies committee must also improve its game. On March 21, the committee responded to a request from the White House on “the necessary data elements, data sources, gaps in collection and design suggestions.” and integrating data systems to improve modeling and decision-making for COVID-19 “with what was mostly vague generalities rather than specific directions relevant to policy. For example, the committee listed “eight basic viewpoints” such as “using existing databases and focusing on accessibility, usability, interoperability and scalability will lead more quickly to functional data systems than trying to build systems from scratch. ” This answer is so general that it is useless.
The White House’s request for the data would not have been difficult to respond with more precision. The committee should have identified the specific data needed to improve the modeling, exactly where this data could be found, what steps could be taken to collect the missing data and institutional alternatives for housing and data sharing. On the other hand, a pandemic modeling advisory committee of the British government published in 2018 a long list of variables for which data should be made available for pandemic modeling in real time. The United States also has many qualified experts who could assist the NAS committee in ensuring that its responses are directly relevant to current policy.
Over time, there will undoubtedly be numerous assessments of the use, misuse and non-use of scientific expertise during the pandemic. But for now, the White House should immediately make better use of the experts it has integrated who are ready to advise policy makers, and when invited, NASEM experts must provide advice directly useful to political needs current. So far, the role of expert advice in the US government’s response to the pandemic is far from its potential.
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