James Lawler, MD, MPH, a director at the Global Center for Health Security at the University of Nebraska Medical Center in Omaha, and a longtime biosecurity expert, has spent years advising on national pandemic preparedness. He has worked with Gerald Parker, DVM, PhD, who recently stepped down as head of the White House Office of Pandemic Preparedness and Response Policy, as reported by opens in a new tab or windowSTATopens in a new tab or window.

For Lawler, Parker's departure underscores a troubling trend: waning political will to prepare for the next pandemic.

In this MedPage Today interview, he warns that "pandemic fatigue" has left the U.S. more vulnerable than ever -- and that without White House–level coordination, the nation risks repeating the costly mistakes of COVID‑19.

Following is a transcript of the video:

It's unfortunate that pandemic preparedness is taking even more of a backseat than it has been.

I know Gerry Parker, I've worked with him for a long time. He was an excellent choice to lead that office. He has a lot of longstanding institutional knowledge inside and outside of government and was well-versed in our national health security enterprise and pandemic preparedness. I think it's just a reflection of the fact that this is not a high priority currently, and I think the experience of the last 5 to 10 years probably should indicate to us that it should be a priority.

Historically, the federal enterprise for biodefense and health security -- so protection against biological threats, deliberate or naturally evolving -- is spread over multiple departments and agencies. There's components of it within NIH and NIAID, so research entities that are doing the basic discovery and development of drugs and vaccines. There's a large proportion of it that exists at CDC, both in international and domestic work to prepare for emerging infectious disease and pandemic threats. There's some of it that exists in Department of Homeland Security in FEMA as the organizations that are involved in coordinating national response to emergencies. There is now the Administration for Strategic Preparedness and Response, or ASPR in HHS, which by statute actually has the lead for responding to health emergencies in the U.S. And then DOD has a large component of research and development for biological threats that kind of crosses over into the civilian space as well. And then other departments and agencies. The State Department has a role in evacuating biological casualties from overseas locations if they're American citizens. And it goes on and on.

So the fact that there are so many departments and agencies within the federal government that have a role, and it's such a complex and daunting task to begin with, to prepare for and respond to these types of threats, that it really does warrant White House-level coordination. It's the same reasoning behind the National Security Council. It was created to try and not only be a broker between all of the different departments and agencies that are involved in national security, but also a sensemaking tool for the president and the White House, so that you have experts who are able to gather information from the various departments and translate it to the president in a way that allows him to make decisions more efficiently.

And it's also its own advisory position of, again, giving their own assessments of security threats to the president to allow better management of the different departments and agencies. And so that same phenomenon exists for biological threats. And I would argue that it's equally important in terms of national security to have experts in the White House acting as liaisons and coordinators with the various parts of the federal government that are involved in preparing for and responding to these threats. But also to make sure that the president has an unvarnished assessment of what the landscape is and what our policy choices are.

This was an office that was created by Congress as a response to the COVID pandemic, but also I think in response to a variety of other health emergencies we've seen over the last 10 years from Ebola in 2014 to Monkeypox or Mpox that's emerged in the last several years to H5N1. I think Congress looked at how the federal government has responded so far to all of those events and has recognized the fact that there really needs to be a White House coordinating body. And so that was directed by Congress that that office should exist. And last time I read the Constitution, it does require the President to faithfully enact laws that are passed by Congress.

Unfortunately, I think pandemic fatigue is a diagnosis that the whole country could be given. It certainly seems that this administration really has no room for pandemic preparedness in its priorities. And I would say that based on what we're seeing really beyond fatigue, there's hostility towards any public health efforts addressing pandemic or other threats. But to be fair, in the Biden administration, it was clear they were done with pandemics as well. In fact, there are, and have been a number of reports about, that was a deliberate political decision, which I believe 100%, that this was not a decision based on science and the fact that the threat's gone. This was a decision that they did not feel that it was politically expedient to do more to address pandemic threats.

And unfortunately, that because of these political decisions, we are all less safe and the next pandemic, which absolutely will occur, and probably I anticipate will occur within our lifetimes. Certainly if we do not take a more serious approach to preparing for the next one, we stand to do even worse than we did with COVID.

And I think it's helpful to remind folks that we did lose 1.2 million American lives so far over the course of the COVID Pandemic, and we're still seeing COVID cases and deaths now. So it's not as if it's over. And we also spent trillions of dollars responding to the COVID pandemic, all of this because we were unprepared. And if we had reacted more quickly and more effectively, I think we could have easily had at least an outcome that was closer to what countries like Japan, Korea, Australia, and New Zealand experienced, which was many-fold fewer deaths. South Korea and Japan, five to six times fewer deaths per capita from COVID than we experienced. And again, these are populations that are skewed to the very old, as ours is, and have many of the same challenges we did.

So I think that's also a myth that people like to promote that, oh, we couldn't have done anything. We couldn't have done any better. That is false. We absolutely could have and should have. It is, from my perspective, unconscionable that the wealthiest and most advanced country in the world did so horribly protecting our citizens from the COVID pandemic.