Details: What did Trump know, when did he know it?

More important: What was he advised to do?

In a prior post, we channeled an op-ed authored by members of a team that wrote a September 2019 White House report


Based on the report and its follow-up, the authors assert:

“The administration was well aware of the threat of a pandemic before the novel coronavirus emerged … and there was “immediate presidential action” to implement the reports recommendations.

Said differently:

The White House Was Prepared for a Pandemic: The September 2019 report laid the groundwork for Operation Warp Speed

Today, let’s drill down on the September 2019 White House report…


Among the report’s conclusions were:

> A likelihood of a viral pandemic was low (4%) but, if one were to occur, fatalities could exceed half a million people in the United States.

> Large-scale, immediate immunization is the most effective way to control the spread of pandemic viruses.

> The current vaccine development processes are far too slow and neither the government’s science community nor private companies are sufficiently motivated to rapidly develop and deploy high volumes of effective vaccines.

> Public-private partnerships along with preferential government purchases of vaccines prepared with newer, faster development processes and production technologies could provide adequate risk mitigation for pandemics.

Here’s some detail…


The Warning

In the last 100 years, there have been four major influenza pandemics leading to substantial deaths worldwide:

  • The 1918 pandemic, popularly known as the “Spanish Flu,” with more than 50 million dead;
  • The 1957 “Asian Influenza,” with more than 1 million dead;
  • The 1968 “Hong Kong Influenza,” with 1 million dead;
  • The 2009 “Swine Flu,” with 151,700 to 575,400 dead

This historical frequency suggests a 4% percent annual probability of a pandemic resulting from large and unpredictable genetic changes leading to an easily transmissible virus.

But, for such a virus much of the population would lack the residual immunity that results from prior virus exposures and vaccinations.

Easily transmissible viruses can spread rapidly from person to person, infecting a large fraction of the population in a short period during the early weeks of a pandemic.

Tens of millions of people could become ill, with many requiring hospitalization; and a significant number — especially among the vulnerable elderly population — could die.

Fatalities in the most serious scenario would exceed half a million people in the United States.

Millions more would be sick, with between approximately 670,000 to 4.3 million requiring hospitalization.


Immunization – Vaccination Programs

Large-scale, immediate immunization is the most effective way to control the spread of pandemic viruses.

But the impact of vaccines is limited by four factors:

  • The effectiveness of the vaccine in preventing infection
  • The percentage of the population that is vaccinated
  • The speed with which vaccines can be manufactured for emergent viruses
  • The number of doses that can be manufactured, distributed, and administered in a given period


Vaccine efficacy

As a benchmark, influenza vaccine effectiveness has ranged between 10% and 60%.


The rarity of pandemics makes it hard to determine vaccine effectiveness during pandemics,

The monovalent A(H1N1) vaccine created for the last pandemic, which occurred in 2009–10, was 62% effective in protecting people under age 65 years and 43% effective for those age 65 and older — the age group at highest risk of medical complications and death.


Vaccination Rates

About half of flu vaccines administered in the United States are to people covered by government health insurance.

Over the past eight seasonal flu seasons, the average population-wide vaccination rate for the seasonal flu was only 45%, but was higher for the most vulnerable groups, young children and older adults..


A recent survey found two categories of major reasons that people cite for not getting the seasonal flu vaccine: concerns about vaccine safety and concerns that the vaccines do not work well (i.e. efficacy).

In the 2009 pandemic, the percentage of people vaccinated with the monovalent vaccine varied by age group from 16% to 43% but was only 27% overall.

We believe that people would be more inclined to be vaccinated in a pandemic with high attack rates (i.e. likelihood of being infected) and high rates of complications (e.g. severe symptoms, death rates).

Moreover, multiple studies have demonstrated that there is high prevalence-elasticity of demand for vaccines for infectious diseases, meaning that as the prevalence of a virus rises in a pandemic, the demand for vaccine will also rise.

“We assume in our calculations that during a pandemic, demand for vaccine would be such that 80% percent of the U.S. population would be vaccinated.”


Vaccine Development & Deployment

Improving  vaccine efficacy and the speed of vaccine production and deployment are both important goals to mitigate pandemic risks.

Our analysis shows that innovation to increase the speed of vaccine production is key.

Unfortunately, the United States is unprepared to deliver a sufficient number of vaccine doses quickly enough to stop the rapid initial spread of a pandemic virus.

There is a key misalignment between the social and private returns from medical research and development (R&D) and capital investment in pandemic vaccines.

The social value of faster production and better vaccines is much larger than its private return to developers.

Given the underprovision of pandemic risk mitigation by the private sector, the public sector has a role in stimulating the development of, and demand for, newer vaccine technologies that are better able to provide pandemic preparedness.

Public-private partnerships created under a 2006 statute are key in the development of the newer vaccine production technologies that offer the prospect of accelerated timelines needed for improved pandemic preparedness.

Push incentives like public-private partnerships combined with pull incentives — such as the government’s preferential purchase of vaccines produced domestically with newer, faster technologies — that may create more efficacious vaccines that can lessen the impact of future pandemics, especially for older people.

Bottom line: Public-private partnerships along with preferential government purchases of vaccines prepared with newer, faster production technologies are essential provide adequate risk mitigation for pandemics.


Coming: So, what did Trump do about it?

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