Attachment

Chapter 7 Page 176, para 2. Again, this is an issue of where lies PH sovereignty in the US. DHHS didn't have clear authority because our mechanism doesn't give it authority. And, as every PH worker in the US knows, or soon finds out, PH is grossly underfunded when there are no pandemics, and then when a pandemic appears, PH is blamed for not preventing it. PH workers live their whole careers caught in this Catch-22. Page 178, top para and elsewhere: the discussion of these exercises, which is excellent, brings to mind an issue raised earlier and also later, regarding the GERM idea. In the US we have an ICS (Incident Command Structure) for rapid responses to crises such as mass shootings and natural disasters. The public never sees it, but we all see the effects when we turn on the news and see a breaking incident like a shooting. Within an hour or so, there, on national TV behind a microphone, will be the governor, mayor, police chief, maybe the FBI, and various other local officials, all coordinating and reporting on the activities of their agencies, representing hundreds or even thousands of people getting on top of the problem. This happens because of long years of intensive planning, coordinating, exercises and drills, and a tight organizational chain of command in which everyone knows his or her roles and responsibilities. It also includes stockpiling and forward placement of equipment and supplies, designation of triage sites, medical facilities for casualties, and so on. In the US, this is one of the few governmental things that works REALLY WELL. With respect to the GERM idea, is it possible to do this on an international level? Page 182, para 2: the smallpox blanket story has never been proved. Some regarded it as probably true, or possibly true, while others regard it as apocryphal. Page 183, top para: actually, we DO know alot about these Soviet bioweapons. Through various programs including BTEP (Biotechnology Engagement Program) coordinated by the State Department, American scientists went to Russia and examined their bioweapons plants, including the notorious Vektor lab in Novosibirsk, which contains smallpox and once contained weaponized Marburg and other deadly agents (I was part of that team). We also brought some of the Soviet bioweapons scientists back to the US and gave them science jobs. (I now work with 2 of them in NIAID, NIH). While we need to always be aware of the potential for bioterrorism, we must at the same time recognize that Mother Nature is the ultimate bioterrorist. Page 187, bottom para: may be a good place to flesh out the GERM idea. How to make it happen? Who leads? What steps need to be taken and who takes them? Chapter 8 Page 189, para 1: as mentioned above, many would say our response to SARS was faster and more effective: whatever else one might say, we DID prevent a likely pandemic. Maybe we should study once more how we succeeded than but failed with COVID-19. Page 190, para 5: to many observers these things were not shocking at all, but completely and tragically expected. Has anything changed since we had HIV therapy but, for years, until PEPFAR and other programs, couldn't find a way to deliver these life-saving drugs to millions who needed it? Rather than being shocked, I think many more are just depressed by the "déjà vu all over again".