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On May 5, President Donald Trump signed an executive order banning future federal funds going on gain-of-function research. This move comes as the nation begins to consider the broader failures in its response to the pandemic. This is a failure that extends to all aspects of public health policy, far beyond the lab.
As the acute phase of the Covid-19 pandemic fades into the rearview mirror, the US finds itself engaged in post-mortem engagement on closures, vaccines, school closures and public trust. But there is one obvious lesson the US has yet to fully absorb. Health strategies during a crisis cannot rely on one type of tool. A narrow binary response to Covid-19 costs money on lifespan. The country needs to do better next time.
During the pandemic, the public was often presented with a simple command: get vaccinated or take your chance. While most Americans should have actually been vaccinated, policymakers should have provided more room for nuance and variation. They ignored the core truths of medicine – there is no single solution that fits all individuals. The virus has evolved. Patients responded varied. However, the official toolkit did not adapt.
Former President Joe Biden and President Donald Trump (Getty Images)
What the US needed was a robust and flexible public health approach that supports a variety of modalities, including vaccines, yes, but antiviral agents, monoclonal antibodies (MABs), and emerging biology.
Trump's Health Care Orders Help Modify Health Care for Everyone
A resilient system is a system that can pivote quickly and a system that can match patients with the right intervention and adapt as science progresses.
Monoclonal antibodies provide a clear example of what went wrong. These treatments have been proven to reduce hospitalization and deaths in high-risk patients, and were widely distributed early in the pandemic and were successfully used by senior federal officials, including the president. However, between late 2021 and early 2022, federal authorities stopped distribution and cited a decline in effectiveness for new variants.
This was a mistake. MAB is a platform technology. They can be tailored to the variant and deployed quickly. They are especially important for people who don't respond well to vaccines. However, almost five years after the start of the pandemic, they have not fully received FDA approval for respiratory virus prevention, despite meeting the same safety and efficacy benchmarks used to quickly track other medical measures.
Meanwhile, the public was encouraged to rely on booster shots. Booster shots, although still additive, have lost their effectiveness as the pandemic continues. CDC data show that the bivalent booster only provides 37% protection for hospitalization in adults over the age of 65 years of age after a few months. In the case of immunodeficiency, protection was even lower. However, treatments that could have closed that gap have come off the table.
Trump is right to block research into “dangerous” gains of function
The United States has had to maintain all existing approaches to treatment, and its healthcare professionals were able to make patient recommendations on a case-by-case basis to ensure that the most vulnerable Americans receive appropriate protection.
More broadly, five years later, the US still lacks a proactive framework for deploying flexible, evidence-driven therapeutics in public health emergencies. The US needs a system that is not just dependent on the first market. We need something that actively supports a diverse portfolio of tools.
This means investing in organizations such as the Bureau of Advanced Biomedical Research and Development and the National Institutes of Health in adaptable measures, such as antibody platforms, extensive antiviral agents, rapid diagnosis, and therapeutic RNA technologies. It also means modernizing the FDA's approval pathway to reflect the pace of innovation. If real-world evidence indicates that treatment is lifesaving, regulators should have the flexibility to act.
Congress can help by approving funding flows that reward versatility, creating incentives for businesses to maintain and adapt all treatment approaches, ensuring that public-private partnerships are built for speed and scale. The law can establish a permanent procurement mechanism for vaccines as well as variant-specific updates.
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All of these will help alleviate the decline in public confidence in American health institutions, one of the biggest victims of the pandemic. This erosion stemmed from a sense that key decisions lacked transparency or could not explain the diverse needs of patients.
According to a 2022 Pew Research Center survey, only 29% of US adults said they had a great sense of confidence in their medical scientists, starting from 40% at the start of the pandemic. Trust in public health officials followed a similar decline.
A more transparent and inclusive approach in which policymakers communicate the rationale behind treatment change and openly assess real-world outcomes can help rebuild that trust. A better system emphasizes data sharing, clear communication, and respect physician judgment when adjusting care to fit the patient's needs.
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Covid-19 has exposed the limitations of the current US playbook. A more effective future calls for flexibility, pluralism and humility to recognize health policymakers.
But when regulators build the right systems – if they promote innovation, evaluate results in real time, and keep all safe and effective tools on the table, they don't need to learn this lesson again the hard way.
For more information about DR, click here. Tom Price
