Public-private partnership is essential to prepare for future outbreaks of special pathogens



Editor’s Note: This Health affairs The blog post is one of a set of supported articles on a national system of care for special pathogens to be published in the coming months. Health affairs received support for the series from the National Emerging Special Pathogens Training and Education Center. All messages are submitted to Health affairsselection and editorial process.

The response to the COVID-19 pandemic has been a stark reminder of the limits of the existing network of special pathogen care delivery in the United States. The fields of healthcare, life sciences and public health have experienced critical gaps and inefficiencies in communication and coordination. There has been a lack of clarity on the roles and responsibilities of various stakeholders and organizations in health care delivery systems, the federal government, state and local public health departments, intervention providers in emergency and professional associations. This was the case before SARS-CoV-2 was detected, as the pathogen was actively spreading and the premises came out of a state of response. Failures in these three phases – commonly referred to as preparation, response, and recovery – highlighted a lack of trust among stakeholders and an inability to facilitate communication and collaboration between them.

The COVID-19 pandemic has exposed weaknesses both in the largely private U.S. health care system and in the government’s public health enterprise. This has created an urgency to adopt new ways for public and private health care leaders to work together to better prepare for future epidemics.

A coordination entity

The Office of the Assistant Secretary of Preparedness and Response (ASPR) at the US Department of Health and Human Services (HHS) recognized these issues and, in March 2020, appealed to the National Emerging Special Pathogens Training and Education Center. (NETEC), a consortium of three university physicians. health centers, to develop a national system of special pathogens (NSPS) care strategy. Among the main areas of focus of this strategy are: improving the coordination and management of the various public and private actors necessary for an epidemic response; implement the guidelines of professional organizations and the Centers for Disease Control and Prevention (CDC); and data collection to enable research. With the aim of garnering feedback and buy-in from these various stakeholders, during the winter and spring of 2021, NETEC consulted over 70 leading experts from over 20 organizations ranging from companies to professionals in the health care and insurance executives, to frontline nurses running special pathogens. units. These leaders recognized the value of public and private stakeholders contributing to epidemic preparedness and management. But, the missing piece, these leaders determined, was an effective and cohesive mechanism to coordinate diverse, unconnected and naturally competitive stakeholders to elicit a unified response.

As discussed in a previous blog in this series, a key part of the NSPS care system strategy is to build a care delivery network on top of the existing infrastructure initially established to address the epidemic of Ebola. This network will include establishments stratified by levels according to the capacity and the capacity to provide specialized care. Managing this network while ensuring coordination between stakeholder groups requires a strong and organized public-private partnership (referred to here as a “coordinating body” to move forward).

We believe the coordinating body will enable healthcare staff and administrators to deliver agile, high-quality care across the continuum of care delivery, performing six main functions:

  • strategy and supervision of executive management,
  • monitoring and evaluation,
  • standards and directives,
  • research and data,
  • communication and coordination, and
  • durability.

For these purposes, the coordinating body should engage relevant stakeholders to provide advice and expertise while actively participating in implementation. With the support of these stakeholders, the coordinating body should establish standard operating procedures and guidelines for each of the functions. This work will require the coordinating body to organize and model its governance on similar healthcare leadership structures that underpin foundations, nonprofits, and other public-private partnerships that enable many partners to participate and collaborate.

An agile response

The coordinating body must remain agile, as the different scenarios of special pathogens vary greatly depending on factors such as precaution / spread, lethality, geography, population movements and demographics. For example, there are significant differences between the following scenarios: 1) isolated cases of a special pathogen – such as Ebola; 2) spread of medium-sized special pathogens – such as a one-time annual influenza outbreak in a nursing home; 3) early stage outbreaks or epidemics such as – a regional outbreak of an unusual foodborne pathogen; and 4) a system-wide pandemic – such as COVID-19. Each scenario requires unique capacities and the coordinating entity will need to activate the participation of different stakeholders depending on the scenario.

We have learned from COVID-19 that future preparedness and response requires flexibility and collaboration. It also requires an entity comprising both public and private leaders with the authority to facilitate coordination and bring in all relevant stakeholders. Ultimately, the success of this coordinating body will depend on its ability to develop and maintain partnerships with federal, state and local government agencies, specialist and professional corporations, health systems, investors and others. And once established, the coordinating body will move the health system forward in close collaboration with government leadership to facilitate a stronger and more coordinated response to future epidemics.



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