A Pandemic of Planning: Tears of planning did not help the United States during the pandemic.

• Author: Glock, Judge

The coronavirus pandemic intensified concerns that the United States was ill-prepared for disaster. Many bemoaned the absence of a plan for what seemed like a predictable crisis. A bipartisan bill now before the Senate, the PREVENT Pandemics Act, contains mandates and funds for new pandemic planning.

Yet, there is little evidence that America's failures in the pandemic came from a lack of planning. If anything, the crisis highlighted the incredible proliferation of federally mandated pandemic plans across all levels of government and the private sector. The abundance of these often-conflicting plans was both the result and symptom of the increasing number of government pandemic response authorities. The spread of both government planning and planning authorities inhibited a coherent response to the crisis.

PERVASIVE PLANNING

The federal government has been engaged in supporting, subsidizing, and mandating emergency planning since the Cold War. Pandemic planning emerged out of this tradition, but it only came into its own in the 21st century. In 2006, following the avian influenza scare, Congress passed the Pandemic and All-Hazards Preparedness Act, mandating federal planning for a future pandemic. The act led to the issuance of a White House Homeland Security Council National Strategy for Pandemic Influenza, and then a National Strategy for Pandemic Influenza Implementation Plan. These would be updated in 2009 and 2017.

The World Health Organization also began mandating the creation of pandemic plans for its member states. That, in turn, led to a U.S. Department of Health and Human Services Health Security National Action Plan. The United States also worked with Canada and Mexico to draft a North American Plan for Animal and Pandemic Influenza, which was created after a meeting of the three nations' leaders in 2012. The United States also has a National Biodefense Strategy, which emerged out of a congressional mandate in the National Defense Authorization Act of 2017. Then there is the HHS's National Health Security Strategy and a Homeland Security Biodefense for the 21st Century plan. And just months before the coronavirus outbreak, Congress passed the Pandemic Preparedness Act of 2019 to further encourage such work. Most of these plans do not note or reference the other pandemic plans.

All of these plans were supposed to align with the Federal Emergency Management Agency's National Response Framework plans, which are supposed to deal with all emergencies and which include a Biological Incident Annex to deal with pandemics in particular. And there are separate federal departments' Pandemic Workforce Protection Plans, which govern how the departments themselves would function in a pandemic. The Department of Homeland Security has its own Pandemic Workforce Protection Plan, and its eight component units each have one as well.

These plans are all in addition to state and local pandemic plans, which themselves are often mandated by the federal government. The 2006 Pandemic Preparedness Act and subsequent iterations require each state to create its own pandemic preparedness plan and submit it to the Centers for Disease Control and Prevention for approval. The CDC also offers state grants for Public Health Emergency Preparedness and supports what it calls Pre-Pandemic Planning Guidance for Pandemic Influenza These must be part of states' "all-hazards" emergency plans, which are also required by the federal government.

Before FEMA distributes aid to a state for any emergency, including a pandemic, a state must certify that its request for funds is in conformity with the state's general emergency plan. Congress has added more and more requirements to such plans. Following scenes of stranded cats and dogs after Hurricane Katrina, for instance, Congress passed the PETS Act in 2006, requiring that such emergency plans include details about how to rescue animals.

The government also has begun mandating and subsidizing private-sector plans. The Occupational Safety and Health Administration requires large employers to have "emergency action plans" for all hazards, including pandemics. The HHS offers grants for Hospital Preparedness Programs so that hospitals can engage in pandemic planning in particular. In 2016, HHS issued a new rule mandating emergency plans for health systems participating in Medicare and Medicaid, which encompasses most of the health care industry. It...