Why Public Health Needs the Private Sector

Every week, thousands of international travelers voluntarily stop at U.S. airport kiosks to offer a nasal swab for pooled testing, an important part of the country’s ongoing virus surveillance.

If there is a positive sample, a Boston-based biotech firm called Ginkgo Bioworks will sequence the viral strain. Like radar monitoring a storm, they’re scanning for new SARS-CoV-2 and influenza variants while also staying vigilant for signs of a novel virus.

“We do expect that if something scary is entering the U.S., we will be able to find it,” says Laura Bronner, the company’s biosecurity operations leader. “We are finding things sooner and earlier.”

As part of a partnership with the airport services company XpresCheck and the CDC called the Traveler Genomic Surveillance program, Ginkgo identified Omicron variants BA.2 and BA.3 weeks before they were spotted elsewhere.  

Some in public health are skeptical of such partnerships, citing cost and accountability concerns. But preparing for public health crises requires the private sector’s expertise, workforce, and resource capacities, says Tom Inglesby, MD, director of the Johns Hopkins Center for Health Security and professor in Environmental Health and Engineering.

“We need private sector partnerships to do critical things for the country,” he says. “The extent to which that wasn’t evident before the pandemic, it should be clear now.”

In February, Inglesby and CHS colleagues briefed Congress on the value of a national diagnostic action plan for quickly scaling up test development and testing capacity in future infectious disease emergencies. They’re hoping that that concept, as well as other public-private collaborations, will be integrated into sweeping legislation up for renewal this fall: the Pandemic All-Hazards Preparedness and Advancing Innovation Act, a 2019 law designed to improve the country’s medical emergency and response capabilities.

“People may disagree on the right level of funding, but there isn’t any alternative to having the private sector providing tests and testing services,” says Inglesby, who served as the senior adviser for testing on the White House COVID-19 Response Team. “This is a really important year to examine what the law did well and what things need to be amended to make us faster, sharper, and more effective.”

A Sobering Lesson

The early days of the COVID pandemic offer an unsettling story of what happens without having these partnerships in place. As the novel virus swept across the country, overwhelmed public health laboratories struggled to churn out test results. Hospitals ran out of ventilators, while health care workers reused the same soiled face masks.

In March 2020, the U.S.’s emergency stockpile held just 42 million N95 and surgical masks combined—roughly 1% of the projected 3.5 billion the country required for a pandemic.

Supply shortages plagued laboratories, too. Even as other countries ramped up testing efforts with tens of thousands of tests in February 2020, the U.S. was testing just dozens of people per day. 

In response to the growing crisis, private testing laboratories added capacity and improved sample turnaround time, says Susan Van Meter, MA, president of the American Clinical Laboratory Association, a group that co-authored the national diagnostic action plan. But they, too, struggled to source basic supplies like pipettes, reagents, and swabs. 

“It’s never good if you’re addressing a crisis as it’s unfolding,” Van Meter says. 

Planned Partnership

Although private sector collaborations offer many advantages, they are not a panacea, caution observers like Carter Casady, PhD, a research engineer in Stanford University’s Center for Sustainable Development and Global Competitiveness, who studies these arrangements. Effective partnerships don’t just happen, he says. Several factors must go into making sure they’re done right.

For example, the government needs staff with a sophisticated understanding of the project’s goals, complexities, and costs to ensure accountability when handling public funds.

“There’s this underlying citizen concern that the private sector is going to walk away with a bag of money at the expense of the public,” he explains.

Setting clear guidelines on expected outcomes can help address accountability concerns, says John Forrer, PhD, MPA, director of the Institute for Corporate Responsibility at George Washington University. For example, a vaccine distribution partnership might set goals for the number of people vaccinated and the desired rollout speed.

Ironing out those logistics in advance can pay off when a crisis arises, says Gigi Kwik Gronvall, PhD, a senior scholar at CHS and an associate professor in EHE.

“You don’t always need the fire department, but when you need it, you need it now, not in six months,” Gronvall says. “You need a long-term approach and long-term thinking and not a just-in-time approach.

Beyond a Pandemic

Stronger public-private partnerships will be a vital tool beyond the next pandemic, Gronvall says. For example, private sector technologies could be used to improve indoor air quality in public spaces like schools.

She points to BioMADE, a public-private-academic partnership that’s exploring ways to use natural materials like plant and animal cells or microbes to domestically source everything from building materials to critical medicines. One project is exploring the use of microbial fermentation and plant extraction to speed up coronavirus vaccine production.

Leaders at Ginkgo Bioworks, the company working with the CDC on airport testing, have expanded the government partnership to other areas, such as monitoring viral presence in municipal wastewater. In the next pandemic, this infrastructure could be used to pinpoint hot spots, allowing health officials to direct resources there. 

Mpox, respiratory syncytial virus, influenza, and bird flu provide disquieting reminders that infectious diseases aren’t going away. Evidence of the next pandemic could be lurking in one of those airport swabs.

“While we don’t know the name of the next risk, we know the next epidemic will occur, and it will occur soon,” Inglesby said.