This memo is part of a series on policy responses to the COVID-19 crisis.
As the COVID-19 outbreak has shown, the United States needs to include public health in its national defense readiness planning. COVID-19 caught the country shorthanded on key medical devices and pharmaceutical supplies, and with a limited ability to track the spread of the virus in real time. A national security outlook should be applied to public health as the strength and place of the nation in the world literally depend on it. These four steps could quickly begin bringing this mindset to public health: secure supply chains, set sufficiently high reimbursement rates, perform health checks at ports of entry, and manufacture simple-to-use test kits for home use.
First, secure medical device and pharmaceutical supply chains. These supply chains are akin to the supply chains for military equipment, and similarly the national government must take steps to require more domestic medical device and pharmaceutical production and storage. The federal government should require any medical or pharmaceutical supply element that is to be produced abroad to go through the same kind of approval process that defense-relevant materials are subjected to, including licensure for export.
Second, reimbursement rates for pharmaceuticals, medical devices and labs must be set at a level that discourages outsourcing and encourages effective utilization. Having the ability to run a high volume of tests per day is vital to understanding if an outbreak is occurring and at what level in a given area.
Third, health checks should be performed at ports of entry. Persons entering from abroad should be asked on entry cards about recent health, be presented with nudging messages about health as they move to the immigration checkpoint, and temperature checks should be required as a part of the entry process. Travelers who report recent illnesses on their entry cards should be screened for signs of active illness by trained federal officials and given information about appropriate next steps after assessment.
Fourth, home use test infrastructure must be created that features cheap, easy-to-use testing kits. Access to these kits must be available for all, regardless of income level or physical location. Americans should know how to get and use a kit, as well as what actions to take in the event of a positive test. The ad-hoc public-private partnerships that developed to fight COVID-19 should be maintained as such relationships are in other important national security sectors.