Preparing for the Next Pandemic
#Interventions
Infectious diseases expert David Relman, MD, took a sabbatical in 2024 to serve as a senior adviser to the Office of Pandemic Preparedness and Response Policy.
The federal government has two primary strategies for facing potential pandemics: prevent them from happening and prepare to respond when an outbreak does occur. Often, the government is doing both at once. It’s a balancing act, and the White House’s Office of Pandemic Preparedness and Response Policy (OPPR) is its center.
In 2024, infectious diseases expert David Relman, MD, the Thomas C. and Joan M. Merigan Professor in Medicine and professor of microbiology and immunology at Stanford, went on sabbatical to serve a six-month stint as a senior adviser to OPPR.
An Early Test of OPPR
OPPR was established by a bipartisan act of Congress in 2023 to advise the president and to drive interagency coordination and communication around preparedness and response to pandemics and biological threats.
“We’re still here. Humans do have the means of making this place a better world. We just have to put our minds to it and commit to the hard work.”
– David Relman, MD
According to OPPR Director Paul Friedrichs, MD, in a speech at Boston University in March 2024, OPPR’s staff does not look like “typical government people.” There are career policy makers and people from the Pentagon in the mix, but there are also physicians and career scientists, like Relman.
When Relman began working at OPPR in late April 2024, an outbreak of highly pathogenic avian influenza (HPAI) A (H5N1) was spreading in dairy cows in the United States. Humans come into close contact with dairy cows during the milking process, and the Centers for Disease Control and Prevention (CDC) has reported cases in humans exposed to infected cows.
The federal response to the H5N1 outbreak has included the Department of Agriculture (USDA), the Food and Drug Administration (FDA), the CDC, the National Institutes of Health, and other components of the Department of Health and Human Services. Resulting actions have included a USDA federal order that dictated livestock testing and reporting policies, USDA funding to identify and address cases of H5N1 in poultry and livestock, and an FDA program to test the commercial milk supply for the virus.
OPPR is deeply involved in the response to HPAI. In testimony to the Senate Appropriations Committee in May, FDA Commissioner Robert Califf, MD, credited OPPR for coordinating the response across agencies “at the highest level.”
Harmonizing the Interagency Response
Relman and his colleagues attend many meetings each day with the various parties involved. They discuss ongoing responses and long-term planning. They try to find common ground, establish priorities, and ensure that good policies result. At the very least, Relman says, they work to see that “there aren’t disparate and contradictory actions.”
The H5N1 outbreak embodies the balancing act of government. As multiple institutions respond in harmony to stop the spread of H5N1 in livestock and humans, they must also build a long-term plan.
Long-term planning includes asking educated what-if questions. Viruses mutate. Pandemic preparedness means anticipating possible mutations and developing countermeasures, such as tests, antivirals, and vaccines.
Relman’s task at OPPR is to provide the perspective of a career scientist and expert in infectious diseases and biological risk. In particular, he is personally most interested in the problem of anticipating future events, such as how viruses might evolve or how well-intentioned science might lead to consequential biological risk.
A Seasoned Expert in Advising the Government
Relman is no stranger to advising the U.S. government on future biological threats. He has an enduring commitment to national service. “I’ve always felt that’s just an important component of being a responsible scientist,” he says.
For more than two decades, that commitment has included serving on the Defense Science Board for the Department of Defense and as an inaugural member of the National Science Advisory Board for Biosecurity. He is also a member of the National Academy of Medicine, part of the National Academies of Science, Engineering and Medicine, which advises the U.S. government on pressing matters of health and science. Relman’s work for the National Academies in general has been substantial, including influential work in the realms of laboratory science, international security, and future biological threats.
Relman chaired a committee at the National Academies that provided advice to the U.S. State Department and co-chaired a panel for the U.S. intelligence community on Havana syndrome, a set of neurological symptoms and findings that was first reported in 2016 in U.S. government personnel based at the U.S. Embassy in Cuba. The origin of Havana syndrome and its national security implications continue to be a subject of debate, with Relman a prominent voice.
“It’s rare for professors with strong academic research portfolios to also have a practical sense of issues that are important to public policy,” says RAND Corporation President and CEO Jason Matheny, who has worked with Relman in previous roles related to policy, including serving together on the National Academies’ Intelligence Community Studies Board.
“I think there’s only a handful of people in this category of people who are as widely respected in the scientific community who spend a significant portion of their waking hours thinking about national security and public policy,” Matheny says. “Truly, I can only think of a few people who have committed as much as David has to these topics.”
A Different Kind of Sabbatical
Relman’s work in OPPR is his first time advising from within the government.
“I had never taken a sabbatical,” he says. “This seemed like a fun, interesting, and unusually important opportunity, even though I knew it would not be a relaxing six months. Which, it turns out, it isn’t.”
There is an urgency to OPPR’s work. Most people agree that it is not a question of if, but when the next pandemic will arise and under what circumstances.
But ultimately, he says, despite the challenges facing OPPR and humanity more broadly, “we’re still here. Humans do have the means of making this place a better world. We just have to put our minds to it and commit to the hard work.”
“Accountability and delivering for the American public is a very palpable thing here,” Relman says. “It adds to the pressure to get things done.”
Relman has advised the U.S. government on biological threats, in various capacities, for over two decades.
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