Investment

The U.S. needs greater investment in medical countermeasures

The U.S. government has warned that Russia could use chemical weapons against Ukraine. Russia’s president, Vladimir Putin, has threatened to use nuclear weapons under certain conditions. Russia’s secret police have used nerve agents to attack political opponents inside and outside Russia. And Russian forces have seized two of Ukraine’s nuclear power plants.

Russia is creating the possibility of a chemical, biological, radiological, and nuclear (CBRN) nightmare. Its aggression against Ukraine makes it clear that American investment in innovative medical countermeasures is long overdue. U.S. policymakers must ensure that this country is as ready as it can be before the worst comes calling.

The 9/11 terrorist attacks on the United States and the anthrax attacks on the U.S. Capitol complex a week later produced a patchwork of agencies and programs meant to improve U.S. preparedness for chemical, biological, radiological, and nuclear attacks.

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One such agency is the Biomedical Advanced Research and Development Authority, or BARDA. Created by Congress in 2006, one part of BARDA’s mission is to develop the medical countermeasures necessary to respond to the array of chemical, biological, radiological, and nuclear threats. BARDA manages Project BioShield, an initiative meant to promote private-sector investment in countermeasures essential to U.S. health security.

So far, the U.S. Food and Drug Administration has approved 62 different medical countermeasures resulting from Project BioShield. Some of the most exciting examples include sargramostim (Leukine), a treatment for acute radiation syndrome, and Silverlon, the first approved countermeasure for treating burns caused by mustard gas. Another is obiltoxaximab (Anthim), a monoclonal antibody used to treat anthrax infection. Even Moderna’s Covid-19 vaccine platform, Spikevax, was supported by BARDA.

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But despite these success stories, America’s CBRN readiness is a decidedly mixed bag. When it comes to responding to threats, the past few years have provided a worrisome case study. The Strategic National Stockpile (SNS) is an important source of essential medical supplies during a pandemic or CBRN attack. But just weeks after Covid-19 arrived in the United States, the pandemic depleted the stockpile’s inventories of ventilators, masks, and gowns. The country must not get caught short again.

Revamping U.S. medical countermeasure preparedness first requires recognizing that the market for these products is fundamentally different from that of the rest of the pharmaceutical and medical device industries. By and large, these industries produce products regularly used by some predictable portion of the general population, from cancer treatments to glucose monitors.

Countermeasures for CBRN threats, by contrast, have no commercial market and are used only in situations of dire emergency. The U.S. government is usually the only customer and, without government purchases in sufficient quantity, many of the companies making these lifesaving products would go out of business or abandon production of CBRN countermeasures in favor of products that are more commercially viable.

Neither of these attributes is conducive to strong private-sector investment. Federal officials need to craft policies that make public-private cooperation profitable for the private sector and cost effective for the government. Through Project BioShield, BARDA has provided funding directly to companies doing research on medical countermeasures. This federal support needs to grow alongside the growth in CBRN threats.

Even though chemical, biological, radiological, and nuclear weapons can put millions of lives at risk, the Project BioShield annual budget is about $780 million (equivalent to just 0.1% of yearly U.S. defense spending). And the Department of Health and Human Services’ fiscal 2023 budget request actually calls for a $10 million decrease in Project BioShield funding.

Funding for BARDA and the Strategic National Stockpile, meanwhile, lags behind national needs by hundreds of millions of dollars. The Biden administration itself acknowledges that BARDA needs $3 billion, yet it requested barely half that sum. Closing this funding gap for BARDA’s health security mission is an urgent priority for making Americans safer.

The HHS budget request proposes an additional $40 billion for “mandatory pandemic preparedness.” On the heels of Covid-19, that’s understandable. But U.S. policymakers and lawmakers need to broaden their vision to include preparing for human-generated chemical, biological, radiological, and nuclear threats as well. Preparedness requires robust government investment in private-sector innovation, starting now — before the unthinkable occurs.

Joe Lieberman is the co-chair of the Bipartisan Commission on Biodefense, and served in the U.S. Senate from 1989 to 2013 (D-Conn.). Michelle McMurry-Heath is a physician-scientist and president and CEO of the Biotechnology Innovation Organization.

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