Table 2.

Key failure themes of the COVID-19 pandemic

Accountable Leadership	• Science was packaged for partisan goals • HHS/ASPR preparedness and response efforts were inadequate • White House’s early denial of the pandemic, active propagation of misinformation about mask-wearing and treatments, and incoherent leadership harmed the United States
Statutory Authorities and Policies	• Crimson Contagion After Action Report noted that existing authorities and policies making HHS the lead of the federal government’s response in addition to ASPR’s role were insufficient and unclear • ASPR’s coordination role was ill-defined when the President transitioned authority of the response from the HHS Secretary to the Vice President, • After the national emergency declaration on March 13, 2020, ASPR’s role was subsumed by FEMA.
Inter-agency Coordination	• ASPR did not serve as a subject matter expert to FEMA or fully and effectively integrate with FEMA’s national and regional offices and preparedness activities. • ASPR’s limited regional presence and interaction with FEMA and state emergency management and public health authorities contributed to failures in response
Coherent Data System for Situational Awareness	• Federal entities could provide a coherent, comprehensive common operating picture with health departments across the federal state, local, tribal and territorial governments. • Trump administration ordered hospitals to stop sending data to the Centers for Disease Control and Prevention, and instead send it to a private data firm under contract with the DHHS, whose secretary reports directly to the White House
Strategic National Stockpile and Supply Chain	• SNS and commercial PPE inventory was inadequate needs • Weaknesses in FEMA’s resource request system and allocation processes. • WebEOC, the system FEMA used to process PPE and ventilator resource requests, contained unreliable data to inform allocation decisions and ensure requests were addressed • Officials within the White House coronavirus task force often circumvented FEMA’s decision-making to award contracts for PPE and other equipment to preferred states and companies • U.S. sent masks to China and then had to buy back at a deficit in order to fulfill the demand in country • Project Airbridge placed states against the federal government and the private sector
Testing and surveillance	• Inability to create a robust testing infrastructure left the country unable to track the rapidly unfolding outbreak • FDA regulatory hurdles, part of the federal government’s declaration of the public health emergency, stopped both public health and private sector labs from quickly deploying start-up tests of their own • The federal government consistently underestimated the need for urgency around testing for this virus; included strict testing guidelines that only tested based on travel and known positive contacts until end of February, missing community transmission • N3 assay which was designed to evaluate any coronavirus contaminated CDC tests delaying results. Under Emergency Use Authorization, labs were not permitted to remove this part of the assay • German-made, WHO distributed test was not utilized by U.S. and FDA did not approve individual lab made tests • President Trump verbalized the desire to slow down testing
Health Care System Surge Capacity and Resilience	• Local, regional, and national health care systems were stressed, lacking adequate bed capacity, sufficient staffing, and limited medical supplies
Federal Funds	• HHS Secretary transferred funds to make $52 million available to ASPR for procurement of PPE and BARDA’s initial investments in medical countermeasures • Sufficient funds only became available when Congress passed the first COVID-19 emergency supplemental funding bill (provided $3.1 billion on March 6, 2020 for the ASPR)