A “no-regrets” policy for pandemic preparedness and response: A conversation with White House advisor Beth Cameron

One thing we know about the COVID-19 pandemic is that not one state or organisation was adequately prepared for a health crisis of this scale. So, what have we learnt in the last two years about pandemic preparedness? How can states and global health organisations put in place the capacities to respond quickly to a fast-moving threat, and to cooperate across government to be able to prevent, detect and respond swiftly? 

In our first episode of 2022 we talk to Beth Cameron, Senior Director for Global Health Security and Biodefense on the White House National Security Council. She was previously the Vice President, Global Biological Policy and Programs at Nuclear Threat Initiative and was instrumental in developing and launching the Global Health Security Agenda at the National Security Council during the Obama Administration.

We spoke to Beth just after America released its new pandemic plan – American Pandemic Preparedness: Transforming Our Capabilities. We talk about what this new plan entails and how global health security cooperation plays an important part of an effective pandemic response.

We hope you listen and join the conversation @CentreHealthSec.

Transcript

Dr Stephanie Williams  0:02  

Welcome to Contain This. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security and as we start a new year, we bring you an interview that will set the scene for an important debate in global health security in 2022. 

Robin Davies, the Head of the Indo-Pacific Centre for Health Security and I last year sat down with Beth Cameron, Senior Director for Global Health Security and Biodefense on the White House National Security Council. 

We sat down with Beth, not long after America released a new pandemic plan called American Pandemic Preparedness: Transforming capabilities into the future. Beth was previously the Nuclear Threat Initiatives Vice President for Global Biological Policy and Programs and during a previous stint with the United States National Security Council under the Obama Administration, she was instrumental in developing and launching the Global Health Security Agenda, which Australia strongly supports as an international partner.

2022 is shaping up to be a big year in global health. Global health reform to be debated at WHO, questions about how the world comes together to fund COVID response and pandemic preparedness into the future. 

So, the discussion that you're about to hear is very timely, because we talk about how Australia and America have worked together in the past, during COVID, and potentially into the future in health security, as well as best thoughts about global health security cooperation into the future. 

Welcome to Contain This. 

Beth, our Contain This listeners are a global bunch, but most are here in the Indo-Pacific and in Australia. Could you please share with us a snapshot of your current role at the National Security Council? And maybe a taste of your former roles at the nuclear threats initiative and on the Global Health Security Agenda?

Beth Cameron  1:57  

Thanks so much. I'm so excited to be here today. So my role at the National Security Council staff in the White House is really to re-establish our directorate on global health, security and biodefence. 

And the main role of this office, while we spend a lot of time obviously on the current pandemic, our role is really to ensure a "no regret" policy for the responding, preventing and detecting emerging biological threats. Including, obviously the current pandemic, but also any other emerging biological threats that might arise. 

We're looking at all emerging biological threats around the world - naturally occurring, deliberate or accidental. We've obviously made COVID-19, one of our top missions and the President from day one, when he re-established this directorate, made a commitment to biodefence and Pandemic readiness. He also, in addition to standing up this office reengaged with the World Health Organisation on his first day in office, and put forward a bold agenda that looks at strengthening our international response to COVID-19, as well as our response here at home, advancing global health security, and preventing, detecting and responding to future biological threats. 

In terms of my previous roles, I was involved here on the National Security Council staff from 2013 through 2017. In similar roles, first as a Director focused on biological threats and working on Ebola response, for example, from 2014 to 2015. And then I established this Directorate at the end of the Obama Administration. I then went on to the non-governmental sector, where I worked as a biological lead, the Vice President for Biological Program at the Nuclear Threat Initiative, where I did a lot of similar types of work outside of government focused a lot on biosafety and biosecurity and ensuring that we have the norms in place to deal with emerging biotechnology risks. 

So now that I'm back in government, I'm taking a lot of those lessons and continue to work really closely with allies around the world, including our strong work with Australia.

Dr Stephanie Williams  4:13  

So as you said, Beth, we're still very much in the thick of it in terms of domestic and international responses to COVID and providing international health security support. And I know that the you know, the finding of the Global Health Security Index Report from 2019 said no country in 2019 was fully prepared, but some were better prepared than others. 

In looking critically at the Indo Pacific and the COVID response, I just wonder if you could offer some reflections on how Southeast Asia and or the Pacific countries responded to COVID Indeed, are responding? Are there features that have really stood out to you from the Indo-Pacific region? 

Beth Cameron  4:56  

So, great question. I'll start by saying that I think it's really difficult to make blanket statements about how any region has responded to the pandemic. The Indo-Pacific, as you know, is an extraordinarily diverse region and if you look at current case rates and vaccination rates, there's a wide variation. But there's obviously a lot of geographic diversity and a lot of countries with large populations and also challenges with vaccination, including multi-island nations, and and countries that have a different types of governance structures. 

One of the things that we've learned from the Global Health Security Agenda and our long standing cooperation on it, is that there's a core set of capacities that you need to have in place to implement the International Health Regulations. And there's a lot of great work that went on in the Indo-Pacific, which was spearheaded by our governments and other governments working together. That work definitely lead to greater preparedness in some countries in the region and there's a few examples, I'll just just name a couple. The work that you see from our joint efforts in Vietnam, for example, the work that we've done together with Indonesia, with the Global Health Security Agenda, the work that we've done in multiple other countries in the region, I think, has definitely led to increase preparedness. 

But at the same time, as we've learned in our own country, the capacities that you have in place have to be leveraged quickly, in the face of in a fast moving emerging pandemic threats. And you have to have the cooperation across the whole of government to be able to prevent, detect and respond swiftly. And so what I would say, when looking at the Indo Pacific broadly, is that you see in it with each emerging waves of this pandemic, and with emerging viral variants, you see governments around the world continuing to struggle with making the pandemic the highest priority, with getting vaccinations out to the public with vaccine hesitancy, and with health care workforce.  

And I think this just reaffirms, for me, and I think for many of our colleagues working in health security, how important it is to have those foundational pandemic preparedness and epidemic preparedness capacities in place. But then on top of that, how we really need to have regional and global surge capacity and whole of government response available to be able to handle the the multiple challenges that we face, especially with a pandemic as it stretches on for many months.

Dr Stephanie Williams  7:45  

We agree that, that there was excellent preparedness in many places in many capacities in the region. At the same time, I think in all of the years that I've been working in health security, and recognising the likelihood of a pandemic, the idea we would have a sustained multi-year event, I think, is really adding a long term stressor to the systems. 

So the good quick fix responses in Southeast Asia that we saw in 2020, I think, as you say, the fundamentals are being challenged, the longer we go, and the harder it gets to manage multiple competing priorities, say for a vaccine rollout.

Beth Cameron  8:31  

No, I think that's absolutely the case. And I think that what we've learned through this long-standing pandemic and the multiple phases of it, is that we must have not only national capacity, but sustained regional and global capacity and financing, to be able to withstand a pandemic that lasts for many months, and in this case over a year, and has has different viral variants that come online as part of it. And we need to pay attention to regional surge capacity for medical countermeasures and personal protective equipment. We need global health security, financing and a dedicated financial intermediary fund. We need a global health threats council that has political leadership and can complement the strong leadership of the World Health Organisation and other regional regional bodies that are prepared preparing for and responding to this pandemic. We don't have everything that we need, and we need those things in addition to national capacities to prevent, detect and respond.

Robin Davies  9:41  

So Beth, Australia and the US have been working together increasingly closely on health security since at least 2017. That was when Australia established its health security initiative for the Indo-Pacific and that was when we started to work very closely with agencies like the US Centres for Disease Control, and the defence Threat Reduction Agency, Health and Human Services, State and USAID on a range of programmes in our region. And that was all pre-pandemic. 

So I'm interested to hear where you think Australia and the US working together can achieve even more than we can working individually in support of health security in the region.

Beth Cameron  10:24  

The US and Australia have a long standing partnership as you referenced Robin, and it's only growing stronger, in my view. I actually remember just as one personal note, in 2017, one of the last meetings that I did, before I left my my tour at the White House, the first time, was with the Government of Australia in as part of a consultation for setting up the Indo-Pacific Centre for Health Security. And I remember just how much thought went into that Centre in terms of considering a whole of government response, the role of Foreign Affairs, working closely with, with Health and with Centres for Disease Control. And so just watching the evolution of the Centre and the leadership that Australia is showing in the region, but also around the world has just been tremendous. 

And I'll just give a few examples of places where our joint engagement I think, is making a huge difference. So one is obviously shaping and advancing multilateral institutions like the World Health Organisation where it's critical that we work together to strengthen the organisation, and its leadership role. We're also extraordinarily active on the steering group of the global health security agenda, which was set up in 2014. To focus on preparing countries and and building capacity and providing resources, in line with the International Health Regulations so the countries have what they need to be ready for a high consequence, biological threat. 

Regionally, we're both very active in supporting partners in Southeast Asia and the Pacific, on areas through through and with the Global Health Security Agenda. And, of course, we're working incredibly closely through the Quad, which is United States, Australia, India, and Japan. And we are focused in that in on that effort on COVID-19, in particular, but increasingly also in discussing how preparedness for this pandemic can translate into the next. 

We've also worked closely through the Australian Ministerial or AUSMIN meetings with the US and Australia working together. And this is a partnership that since 2017, we've worked together really take stock of our health security cooperation, and work together to make commitments to the future. And a couple of examples of activities in that space, include convening other south security donors in Southeast Asia, working on capacity building projects in third countries, working across our government. And together, we held the first ever Military Health Security Summit that drew on participation from across the Indo-Pacific. And I'm really excited about our plans to host the next in that series in 2022. 

When we talk about our health security here in the United States, when we talk about the whole of government and the multi-sectoral approach, and we're really proud of the strong partnership we built with Australia across that rubric, and look forward to continuing to work together.

Robin Davies  13:24  

So for many agencies working in health security, this this has been really the dominant preoccupation since really about August, September last year. I was interested to get your perspective on some of the challenges in relation to sort of cooperation between those of us who are supplying vaccines to developing countries, and particularly areas in which you think the US and Australia and perhaps more broadly, the Quad partners can usefully work together as we try to support our partners' vaccine rollouts in the Indo-Pacific?

Beth Cameron  13:57  

This is a really timely question, Robin, as you know, we've been working together to coordinate our work on COVID-19 vaccination, particularly in the Indo-Pacific region, where we're both active and where Australia has so much work. 

And I'll just maybe start by commenting quickly, on the pandemic itself, and just saying that there are definitely places in the global response where we really need to continue to coordinate and are, including furthering global vaccination, and that includes delivery of vaccines, includes ensuring supply and manufacturing into the future. But also really importantly, and increasingly importantly, it includes getting vaccines into arms around the world. And that includes really making sure that we have the cold chain in place that we need to accept vaccines and combating vaccine hesitancy. And as we're finding in our own countries, it's not it's not an easy task, to get vaccination rates up to the highest percent possible just in terms of making sure that everyone has equitable access. And so that's an increasing priority globally as it is in our in our own countries.

We need to do all we can to make more doses available sooner, including by donating doses, including by procuring more doses, we're proud to have contributed 130 million doses to date and to have committed to 580 million and that includes from our own supply, but also our 500 million Pfizer purchase. Those doses are going primarily through COVAX and it's important that we continue to work together to support our international partners, including COVAX, to get as many vaccines out to low income and low and middle income countries as possible. 

Australia in the US are working extraordinarily closely together on all of those issues. But beyond the vaccine issues, we also have a lot to do, I think together on saving lives now through promoting oxygen supply testing kits, access to therapeutics and access to testing. Things that beyond vaccination will continue to save lives while we're working to increase vaccination rates around the world. And these aren't obviously these aren't just US and Australian actions. These are global actions that need to be collectively addressed. 

Our work through the quad, I might just take a minute to comment a little bit on how exciting our work through the Quad has been has been continues to be. At our first leaders meeting in March, we committed to taking shared actions to expand COVID-19 vaccine manufacturing for safe and effective vaccines. We've been working together as I mentioned on vaccine delivery through that partnership together as the US and Australia with our partners in India and Japan. We've worked together with the WHO, with COVAX and with CEPI, the Coalition for Epidemic Preparedness Innovation, which is working hand in glove with those organisations on vaccination and also on research and development and manufacturing for the next pandemic threat. In March, when we launched the Quad vaccine partnerships coming out of the Quad Summit, we looked at the need to increase production and distribution of vaccines. But we also really looked at how that work would continue and will will grow into the future as we look to expand our work together on global health security and on immunisation for COVID in the future, but for other disease threats that we face. So we're really excited about our continued work in this space and Australia's additional $100 million pledge that you made during the Quad and through the quad that was specific to last mile vaccination, which is exciting, and we really commend you for your leadership and supporting the  regional response. It's been extremely impressive to watch and we're looking forward to continuing to partner with you. 

Robin Davies  18:07  

Can I just ask a follow up about our cooperation in vaccine supply and one of the more challenging contexts in the Indo-Pacific Papua New Guinea. So Australia in the US are both supplying vaccines AstraZeneca and Johnson and Johnson, respectively. The rates of that vaccine uptake at present are quite low. And both of our governments are providing delivery support in various forms. Do you see scope for us to increase cooperation not only on vaccine supply, but on delivery support in some of the more challenging environments such as PNG? 

Beth Cameron  18:42  

Yeah, Robin, I'm glad you raised this. I think vaccine delivery is a place where we should continue to build and grow our partnership. And we have obviously ongoing work together and through our USAID and CDC partners in the United States. But I think determining some of the barriers that we're facing in different contexts, and especially challenging environments, is a place where we can work together to share our lessons in countries like Papua New Guinea, but also really apply those lessons to other countries around the world as we're working to increase vaccination rates everywhere. 

So in a nutshell, yes, and I really look forward to continuing to share work between our experts and to get to a place where we have a better understanding of how to overcome some of these really persistent barriers to vaccination, which are are challenging around the world in all of our regions.

Robin Davies  19:37  

Beth, I wanted to ask you about the pandemic preparedness plan, which was launched by the US government just last week. So this is a major initiative. I think the costing is 65 billion US dollars over over a number of years. And it does have a significant international component. Can you just tell us about the more internationally oriented parts of the plan, and I guess how they differ from or extend the plan that you worked on in the previous administration when you were last at the National Security Council? 

Beth Cameron  20:11  

So thanks, Robin, we're really excited about the American Pandemic Preparedness Plan, which we rolled out, as you mentioned, last week, here with our Office of Science and Technology Policy and our Science Adviser Eric Lander and the National Security Council staff. 

And this plan, as you mentioned, is a plan that's focused on pandemic readiness and preparedness within the United States, but also has a significant global component which complements existing global health security programmes and plans that the United States has in place and also existing funding that we have for CDC, USAID and other elements of our government that are focused on building capacity around the world. 

This plan really recognises that COVID-19 has killed at least 642,000 Americans and millions of people around the world. And this plan is intended to build the capabilities that we need globally and to really transform our scientific ability capabilities for vaccines, for therapeutics, for diagnostics, for early warning, and disease surveillance, and for our public health systems. These advances that we need to be more prepared for pandemics will strengthen our systems for biological threats in the future. But they're also going to be valuable for everyday public health and medical care in the United States and around the world. In short, this is going to help public health every day for everyone. 

The component of this plan, that's focused globally has a couple of component parts. So one of the pieces of this plan is focused on building capacities and really complementing the work that we've done through the Global Health Security Agenda. And so that includes providing preparedness funding, and we hope that that funding will complement what we are looking towards establishing with the international community with countries and organisations around the world. And that's a financial intermediary fund for health security, which is envisioned by the G20 and the High Level Independent Panel Report that came out earlier this year as being located at the World Bank, and being able to provide support over the long term for countries and for regional organisations that need to be able to be prepared, including capacities for disease surveillance, including workforce training, including immunisations on the ground. But also importantly, including building the capacity that we need for our pandemic early warning and what what we've been calling the pandemic radar that we need to be able to detect early and emerging infectious disease threat anywhere. It also will provide support, this financial intermediary fund that we want to support, will provide support for medical countermeasures, and also for regulatory networks and for clinical trials that we need to be able to test medical countermeasures early.  

In short, we have the ability now to be able to provide countermeasures in shorter order than we ever have, at any time, for any emerging infectious disease threat, but we need to significantly shorten that timeframe. So we're able to provide medical countermeasures more quickly when an emerging infectious disease threat arises. 

So a critical piece of our American Pandemic Preparedness Plan is to put together a mission, what we're calling Mission Control. So in recognition that in the United States, the Apollo programme is what ultimately took the United States to the moon, Mission Control in this case, is what we hope will ultimately provide pandemic readiness for any viral family in the future. And so Mission Control is a single unified programme unit within the United States Government that has the mission for achieving all the capabilities outlined in this plan. It'll have strong White House Oversight, it will have multiple departments and agencies working together. And ultimately, we hope will provide us with a more centralised approach to pandemic readiness and biodefence funding so that we can achieve these capabilities in short order.

Robin Davies  24:40  

So Beth, can I ask you a follow up question about the Global Health Threats Fund, which is the financial intermediary fund that you refer to, is the purpose of the fund to increase the level of resources available for global health security in aggregate? Because some people might fear that there are trade offs there. Or is the purpose to do business in a different way to, to perhaps allocate resources in a different way between other funds and programmes? I've heard it said that this fund might be a fund of funds that would be a feeder for other existing funds and programmes. If you could just elaborate on that, please.

Beth Cameron  25:16  

Absolutely. So look, in terms of the question about whether this fund is intended to provide additional resources for health security, absolutely. We just are in the middle of a global pandemic that's cost millions of lives and trillions of dollars in, in global economic resources. And if not now, to provide a dedicated set of resources that enable countries and regional organisations to be prepared, then when are we going to create this, this fund? And the opportunity, the opportunity here is to be able to not only create a sustainable financing mechanism for health security, it's also to be able to bolster existing resources. And so you mentioned the concept, which I think is outlined well, in the G20 High Level Independent Panel Report, which is that in essence, part of the reason for this fund will be to help be a fund of funds.  

So what does that mean? That means that there needs to be an aggregator that is dedicated to building capacity for high consequence, biological threats. That aggregator doesn't exist, and there isn't one a one stop place to take not only public sector, official development assistance, but also private sector funding, which as you know, Robin has been a challenge with the Global Health Security Agenda and the private sector portion of that, it's been very hard to provide a place for the private sector to dock in, to be engaged and to be engaged in a way that's, that's measurable. And so that's, that's a big component of this. 

But it also will be able to, to allocate funds to implementers that already exist. And so rather than create a large operational infrastructure, the idea of creating a financial intermediary fund is to draw on the implementing capabilities of an organisation like the World Bank, to be able to pair up with existing implementers that exists in the global health infrastructure. But recognising that those institutions that already exist have different types of roles to play in health security and there needs to be a centralised place, to track progress, to have targets, to be building on the joint external evaluations that already exist for health security and to be able to leverage country commitments to be able to build their own capacity. 

And so I really like to see and this is not yet built out in the in the programme for the Financial Intermediary Fund, and it's something that we're discussing actively with a number of countries, we'd like to be able to see a challenge element where countries and regional organisations that participate are able to actually leverage their own their own resources, such that we can incentivize countries to put funding into their own budget for health security in order to achieve new capabilities and resources coming out of this fund.

Robin Davies  28:28  

So Beth, you were obviously instrumental in establishing the Global Health Security Agenda in which Australia, the US and some 70 or 80 other countries are involved. The US and Australia are both on the the steering committee of the GHSA. The GHSA played a very important role in, I suppose you could say influencing the World Health Organisation to adopt a much more rigorous process for assessing health security capacities involving regular peer reviews and that was a very important addition to the the monitoring framework for the International Health Regulations. And the GHSA has also promoted a lot of very useful practical conversation among its members in a whole range of areas described as action packages. Now, I'm curious to know how you see the future of the GHSA, particularly now that there are a lot of proposals around for new international structures, such as the Global Health Threats Council, the Global Health Threats Board and so forth?

Beth Cameron  29:40  

Thanks, I think the Global Health Security Agenda is more relevant than ever. And one of the things that has always been a hallmark of the of the GHSA has been focused on building capacity for the future and on targets, measurable targets and so some of the areas where GHSA is really making impact during this pandemic and looking to the next emerging biological threats, is making continued drive for countries to commit to health security including mobilising their own resources, but also working towards pandemic preparedness financing, as we've been previously discussing, continuing to refine metrics to be able to show how countries are becoming more prepared and looking at the metrics that we have and making sure that we actually understand what it takes to be prepared for different types of biological threats to include high consequence outbreaks localised in one country localised in a region, or pandemic threats like the one that we're obviously facing now as COVID-19. 

Dr Stephanie Williams   

You’ve been listening to Beth Cameron, Senior Director for Global Health Security and Biodefense on the White House National Security Council. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security and along with Robin Davies, Head of the Centre for Health Security, we spoke to Beth last year for a Contain This episode, just after the launch of the plan, American Pandemic Preparedness, the United States new domestic and global approach to transforming pandemic preparedness.