A View from the CT Foxhole: Lawrence Kerr, Former Director, Office of Pandemics and Emerging Treats, Office of Global Affairs, U.S. Department of Health and Human Services.

• Author: Cruickshank, Paul

Dr. Lawrence (Larry) D. Kerr is the Deputy Vice President for Global Health and Multilateral Affairs at PhRMA. From 2015 to early 2022, he served as the Director of the Office of Pandemics and Emerging Threats within the Office of Global Affairs at the U.S. Department of Health and Human Services where he led a broad policy portfolio including global health security, influenza preparedness, countering antimicrobial resistance (AMR), and infectious disease threats (COVID-19 and DRC Ebola responses). Dr. Kerr served as the Director for Medical Preparedness Policy at the White House National Security Council Staff as the principal staff member responsible for developing policies regarding public health and medical resilience for biological events and AMR, including his role on the Ebola Task Force. From 2006-2013, he was the Senior Bio Advisor within the Office of the Director of National Intelligence. Dr. Kerr completed his Ph.D. in Cell Biology from Vanderbilt University in 1990, and his post-doctoral work in virology and immunology at the Salk Institute in San Diego, CA.

Editor's Note: This interview was recorded in February 2022 before Dr. Kerr's retirement from government service.

CTC: For the last six years, you served as Director of the Office of Pandemics and Emerging Threats at the Office of Global Affairs in the Department of Health and Human Services, having held a variety of positions related to public health policy and preparedness over the last 20 years in the executive branch and the intelligence community. But firstly, you are a scientist. You began your career leading a research lab at Vanderbilt University. What drew you to public service?

Kerr: I originally thought that I was going to go the traditional medical school faculty route while at Vanderbilt. I really enjoyed research science, teaching, and working in an academic health center. I was very fortunate that I was given the chance to do a Robert Wood Johnson Health Science Policy Fellowship, which brought me to Washington, D.C., and I have to admit, I caught the policy bug or "Potomac fever," and found that when you had someone who had a science and medical background that was advising on making good policy, it was a critical skill set. After working on Capitol Hill, the opportunity to join the federal government arose, and by chance, I was working for Dr. Anthony Fauci at the NIH/NIAID when then President Clinton called to ask if he had anybody who had done policy work. I was sent to the Office of Science and Technology Policy, and that's where I kind of cut my teeth, if you will, on policy development and what launched my career. It was that sense of contributing one's scientific and medical skill sets to greater policy good for the public.

CTC: Could you explain the role that your office plays and its key focus areas?

Kerr: We are the one policy office within the Immediate Office of the Secretary of HHS that is focused completely internationally. Most people think of HHS and its domestic mission, or that the vast majority of HHS' budget is Medicare and Medicaid, but we are the office that focuses on international policy. So everything internationally focused that the Secretary does--whether engaging the World Health Organization (WHO) or ministers of health around the world or the United Nations--our office works on that. My team is the one that deal specifically with the global health security agenda, working with the International Health Regulations at the WHO; preparing for pandemic influenza, which is how the office actually got its initial funding start; antimicrobial resistance, looking at future threats; and then a team that's focused on emerging infectious diseases, which today means the COVID-19 response.

CTC: Looking back on your career in government, what aspect of your work are you most proud of?

Kerr: In the policy world, you're often thinking in three, five, sometimes 10 years out. And I've been fortunate, being in the government 23 years, to actually see the outcome and impact of some early policy work. When I was in the National Security Council (NSC) in 2005 and wrote the National Strategy for Avian and Pandemic Influenza and worked with OMB [Office of Management and Budget] and Congress, we got $6.9 billion devoted to implement that Strategy. At the time, we were worried about H5N1 influenza being the next pandemic, but low and behold, in 2009 the H1N1 influenza pandemic strain became the pandemic. And while moderate in disease severity at the time, we had already started to see some of the benefits of implementing that 2005 Strategy domestically and globally. But even then, in the 2014-2016 Ebola outbreak in West Africa and particularly then in the COVID-19 outbreak, we saw all of the programs that we had put in place across the public health systems--the detection systems across our public health laboratories that had been built from those initial investments starting back in 2006--actually come to fruition. It's been a very, very interesting look-back to see where those dollars are, the impact that they had, and then how they've impacted this pandemic.

CTC: Two years after the outbreak of the COVID-19 pandemic that has killed nearly a million Americans and a year after the rollout of the highly effective vaccines against it, what are the key lessons that you've learned or that you think we should be learning in preparing for the next pandemic?

Kerr: Whenever we go through tabletop exercises on pandemic preparedness, almost every single after-action review highlights communication and risk communication as top priorities to address during a pandemic. I would say, unfortunately, in this pandemic we saw a very deleterious politicization of the COVID-19 response arise early and continue in a way such that messaging around public health guidance, medical guidance, and simple personal measures to protect individuals, communities, states, and local governments just go down a route that I don't think we ever, ever envisioned in pandemic preparedness. It truly eats at the soul of a public health person when you know that we have what are some of the most safe and effective vaccines that we have against any pathogen, that we have therapeutics that save lives, and there are still individuals and groups who, for reasons that are not aligned along public health and medical guidance, just oppose their use. We know we can save more lives, and it's horrible not to be able to see that acceptance. I think it will be studied for decades, how the messaging and the communication went awry.

One aspect that really accelerated the development of those safe and effective vaccines/therapeutics was having the available resources to tap very quickly and to be able to really gather the breadth that the United States has in terms of basic science and innovation and to harness that to be able to get these countermeasures into people quickly. That availability of those resources, through Operation Warp Speed that then became the CAG (a) that is now H-CORE [HHS Coordination Operations and Response Element], really provided for groundbreaking vaccines in a time period that we've never seen before, and one we hope we'd be able to marshal once again if another pathogen comes to bear of epidemic or pandemic potential.

CTC: The COVID-19 pandemic caused unprecedented strain and stress on all healthcare systems. Certainly, we saw that here in the United States, but from your vantage point, looking across the globe, could you speak to the ways that public health systems can be improved ahead of a future pandemic?

Kerr: Unfortunately, in non-pandemic times, we often forget that the basis of our...