Recently, Mark Horn, Director at The FlexPro Group, had the opportunity to interview Dr. Tammy Spain.
Dr. Tammy Spain is a Yale Ph.D. graduate in molecular biophysics and biochemistry who also works as an Associate Director of Project Management at FlexPro, Network Partners Group's pharmaceutical division. She has more than two decades of experience as a leader in the fields of biological defense technologies and pharmaceuticals. In this Q&A, she shares her insights into serving on the United States National Biodefense Science Board (NBSB) before and during the COVID-19 pandemic.
When and how did you come to be a member of the NBSB?
In 2013, I saw a call for applications for the National Biodefense Science Board. At the time, I was working at Draper Laboratory in defense technologies, mostly in the chem/bio defense space, and we had technologies that we were putting in front of the Assistant Secretary for Preparedness and Response (ASPR).
From that standpoint, I was already engaged in providing technology solutions to problems that the ASPR was facing and I thought it would just be an extension of that role in a broader sense, not just in types of technologies but in policies and types of risks/threats. So I applied and was selected to be a voting member of the board. I was sworn into federal service in 2014 by the ASPR at the time, Nicole Lurie.
What does the NBSB do? How often does it meet?
First, I must clarify that the views I express here are my own and do not necessarily reflect the views of the U.S. Department of Health and Human Services (HHS).
The board provides recommendations, advice, and guidance to the U.S. Department of Health and Human Services (HHS) Secretary, currently Xavier Becerra, and the ASPR, currently Dawn O’Connell. The NBSB includes 13 voting members from academia, industry, and government. Non-voting members include ex-officio members from various agencies in the HHS as well as other government organizations, including the Department of Defense (DoD), National Aeronautics and Space Administration (NASA), and state and local offices and territories.
We meet every month virtually and usually twice a year in person at the HHS offices in Washington, D.C. We are usually writing recommendations either on asks from the ASPR or HHS Secretary or on topics that the board considers important or relevant to current events.
All of our recommendations are publicly available on the NBSB website. The board’s remit, as detailed on the website, is very broad and includes everything from naturally occurring infectious diseases to chemical, biological, radiological, and nuclear agents.
Who sets the agenda for the board’s work? How are the issues prioritized?
The charter is very broad. The office of the ASPR and the NBSB started as a way for President George W. Bush to address weapons of mass destruction (WMD) threats after 9/11 with the Pandemic All-Hazards Preparedness Act (PAHPA). Since then, the act has been reauthorized several times and the scope of the board has increased beyond intentional WMD attacks to any medical emergency that the nation will face either intentionally or by natural causes.
Sometimes we get very specific asks from the Secretary or the ASPR. Some topics have been things that the Secretary or ASPR needed to research. Another time they needed verbiage to provide to the president on a particular health-related topic, and yet another time they needed help framing a particular issue so they know where they should focus.
The board can also provide recommendations on its own, bringing forth issues that we feel the government should work on. In general, whether the asks come from leadership or the board internally, HHS leaders want a problem examined by people outside of the government so that they know what is happening with their community partners in addressing health issues.
The board members serve as types of partners to the government who work to address health needs in their day jobs. For example, members are medical doctors, nurses, pharmaceutical manufacturers, and public health officials.
HHS uses the board members’ perspectives to try to keep government activities relevant. Priorities are set by the board in public meetings and we hold votes on priorities and recommendations at least quarterly.
You served on a working group focused on the prevention of infectious disease epidemics, which published a whitepaper in May of 2020 just after the start of the COVID-19 pandemic. What was it like to see a major pandemic emerge at that time?
That whitepaper was in the works for a very long time, long before the pandemic hit. We had attempted to complete and publish the whitepaper at the end of 2019 and it was dragging on. When word started coming down about the SARS-like illnesses causing deaths in January, we quickly worked to complete the paper but still did not complete it until May 2020.
Before the pandemic outbreak, we were debating heavily on the ability to rapidly develop and deploy a therapeutic. A lot of our discussions centered around activities that eventually were solved during the COVID pandemic.
We knew emergency use authorizations (EUAs) would be needed, for example, but we could not define what that process would look like until it actually happened. We knew that a rapid therapeutic would likely be nucleic acid-based but could not imagine that it would be approved in time until it had to happen during the pandemic.
We completely missed the run on toilet paper. We did call supply issues with gloves as a potential issue. We missed the importance of masks and the supply of masks. It was bizarre and amazing to see what happened after we had kicked so many related issues around for so long.
Now, I think we are more energized to continue the conversation and try to be more prepared for the next event by looking at the next layer of problems - a big one being healthcare inequity and using technology to even the playing field for underserved people.
Your NBSB bio shows that you led teams in the development of three biological detection systems field tested at the Dugway Proving Ground in Utah. Could you tell us more about that?
Yes! I was the lead scientist in the development of three different biosensors designed to detect biological weapons agents in air sample solutions, in the environment, and in clinical samples.
The first system, for air sample detection, was designed to be incorporated into the DoD’s main biodetection device called the Joint Biological Point Detection System (JBPDS). The DoD was looking at technologies to improve the JBPDS’s detection system. This was tested with bioweapons simulants collected from the air by the JBPDS aerosol collection device.
The second system, the Field Sentry, was an integrated air collector of our design, the detection system, and the readout device as a standalone integrated system. We had a prototype built and placed it on a grid with other systems from other companies and the DoD testers released biological simulants by line release off of a truck driving by, by an explosion from a bomblet, and in a cloud from an airplane.
In the third system, a clinical system, we tested for bioweapons simulants in blood and urine.
What are the most surprising things you’ve learned from serving on the NBSB?
One of the things I have learned that is surprising is that policies and procedures that are developed in preparation for health emergencies can get sidelined if there is a lot of public attention paid to them. Any big splashy events like the Ebola outbreak or the COVID outbreak tend to get overrun by the president or other political figureheads.
For example, less publicized events, though very significant like the swine flu pandemic in 2009, went as planned, including school closures in parts of the U.S., and hardly anyone outside of public health even remembers it. Yet from 2009 to 2018, the 2009 H1N1 flu strain has been in circulation in the U.S. and was usually included in the flu vaccines of these years.
Now in my third administration (Obama, Trump, Biden) on the board, I am that person in our meetings that says, ‘How do we make sure that the plans we make will not be sidelined by politics?’ We still struggle for an answer to this question.
What have you most enjoyed or appreciated about participating in the work of the NBSB?
I have enjoyed the teamwork and the genuine interest all of us have for other sectors of the public health community. Being an industry partner, I tend to be less philosophical and I have enjoyed learning that health policy is incredibly philosophical and is more about dealing with human nature than technology.
The Board has 13 voting members and you are one of four representing the private sector. Does being from the private sector lead you to look at things differently than colleagues from other sectors?
Absolutely! As I said, we in the pharmaceutical industry on the board have tended to be less philosophical and more data-driven and pragmatic.
There are a lot of blue-sky, aspirational discussions about new technologies, for example, medicines that can be designed in a week or telemedicine capabilities set up in extremely rural areas by Starlink. These discussions tend to gloss over more boring things like the time needed to qualify inactive ingredients when manufacturing drugs, the reluctance of regulatory agencies to adopt new technologies or the fact that if you deal with drug supply for one disease by taking supplies from another drug, the other disease is now not able to be treated.
Those of us in the private sector tend to be the ones that bring up these less interesting but very real problems. I like to think it balances us out as a board.
What is your proudest accomplishment as a board member?
My proudest accomplishment as a board member is that I chaired a working group tasked with addressing ways we might be able to leverage youth and youth organizations to help in public health emergencies. It was not an easy topic to approach but the ASPR at that time, Nicole Lurie, wanted to examine this segment of the community as a resource that is often overlooked and uniquely able to reach large parts of our community.
I co-chaired the working group with a member of the National Advisory Committee on Children and Disasters, and our working group consisted of members from their advisory committee and ours. We recommended, among other things, that schools be examined in their abilities to help spread information about disaster preparation and response through children who can take messages home and reach across cultural and language barriers in ways other segments of our society cannot. I believe children in underprivileged communities may be able to help address the healthcare inequities and disaster prevention inequities we have seen in the U.S.
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