She helped write the White House 'pandemic playbook.' Here's what keeps her up at night and her advice for Trump
Biologist Beth Cameron spent nearly two decades preparing for a biological threat like Covid-19.

Most notably, in 2016, Cameron, then the Obama Administration's director of countering biological threats, helped create a "pandemic playbook" to guide the White House in handling a pandemic.

They knew one was eventually coming.

"[W]e starting working on the playbook following the Ebola outbreak in West Africa," Cameron tells CNBC Make It. (The outbreak, from 2014 to 2016, was the largest Ebola outbreak in history, including 11 people who were treated in the U.S.)

The resulting 69-page document, completed in 2016, included a step by step list of priorities for federal officials to follow in the event of a pandemic. (You can read the document here.)

"The playbook is a decision-making tool intended to help the White House bring together all sectors of the federal government so that all capabilities, all expertise, all relevant science and technology can be brought to bear in anticipating needs, filling gaps and avoiding single points of failure," Cameron says.

In March 2017, Cameron left her job at the White House's pandemic readiness office after four years. A year later it was disbanded (whether by design or by reorganization) by incoming National Security Advisor John Bolton.

Now, Cameron is involved in the fight against Covid-19, as well as preparing the country for future biological threats, as vice president for Global Biological Policy and Programs at non-profit the Nuclear Threat Initiative.

Over two interviews with CNBC Make It, Cameron talked about the pandemic playbook, what keeps her up at night and her advice for President Donald Trump and other leaders as dozens of states see a spike in Covid-19 cases. The interviews have been edited together for length and clarity. The White House did not immediately respond to CNBC Make It's request for comment.

CNBC Make It: Would you say that the pandemic playbook was followed by the Trump Administration?

Beth Cameron: The questions in the playbook were not operationalized early enough. There are questions in the playbook about diagnostic capacity...about [stores of] personal protective equipment. Those rigorous questions really should have been asked ... in January and February.

The job at the White House is to ask questions about what's going to happen next, to try to get ahead and frankly, to ask what the points of failure might be so that you can have a backup plan or a backup plan to the backup plan, which we didn't have.

We're still not where we need to be with respect to a unified plan for things like contact tracing and testing as well as personal protective equipment, and understanding what our views might be over the next several months or years.

There is a lot of talk about a "second wave" of Covid-19 and there has been an uptick in cases in more than half the states in the U.S. as they reopen. As an expert, when you see what's happening now, what are your thoughts?

I'm nervous that we haven't gotten out of the first wave and I'm worried that we will continue to see a high number of cases moving into the fall, when people will start spending more time indoors and we'll see more transmission.

In that event, I worry that we'll see a larger increase and ... we won't have the contact tracing in place, the testing capacity in place or the isolation capability in place to manage that additional caseload.

I'm also worried about the fact that it doesn't appear that [the federal government has] come up with a unified national plan for personal protective equipment and supplies, which could place us and the rest of the world right back in the position that we were in March.

PPE shortage continues tweet

I feel like there is a sense of complacency in the federal government, and the White House in particular, right now about Covid-19. And I think when you look at our case counts and the rest of the world's case counts, we should not be complacent at all.

So if you had Trump's ear right now, what advice would you give him?

I would emphasize that unlike other natural disasters that we face, like hurricanes, for example, the pandemic is affecting all 50 states and the federal government has to lead a response. There will be no way to decrease our cases and beat the pandemic in the U.S. unless we have a concerted effort and a national plan for testing and contact tracing.

I think it's really important for the U.S. to be at the table with the World Health Organization and with our global partners to fight this disease. We can't do it alone and we're not going to beat Covid-19 here until we beat it everywhere.

Why is a federal plan and response so crucial?

We can't fight a pandemic state by state and country by country. This will always leave us in reaction mode rather than anticipating, which is where we need to be. A whole-of-government, whole-of-world, unified approach is still essential to surge needed testing, tracing and gear to all locations where the disease may seed and spread.

Given that a comprehensive federal plan has not been implemented, what is the best thing people or leaders can do now?

Local leaders need a "playbook," too. That's why we designed COVID-Local.org, a partnership between the Nuclear Threat Initiative, the Georgetown Center for Global Health Science and Security, the Center for Global Development, and Talus Analytics. They need decision-making tools, as well as clear metrics to track progress, clearly communicate progress to their constituents and understand policies that are in place and whether they are working.

At NTI, you do work to combat various kinds of catastrophic biological risk. In that context, what keeps you up at night?

One is just the risk that the current [Covid-19] crisis will continue and impact the U.S. and the world longer than it has to because we're not functioning as a unified government or a unified world. Some mortality associated with this disease could have been avoided with better collaboration with partners that have been able to get their cases down. There's just a lot more that can be done to more effectively fight this virus.

The other thing that keeps me up at night is the possibility of an even more catastrophic biological event. Covid-19 has demonstrated the havoc that a biological event can cause. For people like me, who have spent a career worried about biological terrorism and deliberate biological threats, I worry that it will lead to ... an even greater emphasis on biological threats in the future. I hope that will cause the United States and the world to spend more time and resources on preventing it from happening and being able to quickly respond to those threats.

Are we as unprepared for a bio attack as we were for the pandemic?

Yes, and potentially even more so, because there are major gaps in global capability for bringing together security, health and humanitarian leaders to share information, investigate and attribute to identify perpetrators and reduce the likelihood of a second attack.

[Some of the gaps are outlined here.]

In addition to things like mask use, social distancing and washing your hands, what have you learned actually works with regards to navigating Covid-19?

In terms of tips...that public health experts provided to me, know how to access diagnostic testing in your area so that if you are in a situation where you feel that you have been put at risk, you can quickly get a test. ... [And] just knowing to the extent that you can, who you have come in contact with

To suppress Covid-19, it's vital to rapidly trace contacts for those who test positive and for their close contacts to be quickly quarantined and tested. This is how you break the cycle of transmission — by identifying those who may have been exposed as quickly as possible and preventing them from spreading it to others.

Also, know your stats and use the great information that's out there. There are several sources like Covid Act Now, Covid Exit Strategy ... that [use] the Johns Hopkins dashboard [a map of confirmed Covid-19 cases by country/region/sovereignty]. Some have really great data, even down to the county level. And course, your local health department.

It's important to know how COVID-19 is being managed in your community. ... With clear information about whether their community is meeting metrics for suppressing the disease, people will make more well-informed choices about behavior.

There should also be ways for local businesses that are encouraging mask use, that have good policies for encouraging social distancing, that are looking out for people who are at risk, like seniors, to be recognized for that. I'd like to see that developed at the local level so that we can use a good practice model for encouraging additional practices in local businesses.

Those things can really help ... while we're in this period where we don't have a vaccine.

How are you personally navigating the pandemic?

One thing that has really helped me, is trying to change my scenery. I've been teleworking so I don't just work in one place, like going outside in my yard or on my porch. I've also been trying to restart my yoga, and having a dog has really helped. A pet has been very comforting right now — to be at home with my husband with a pet.

I've also made a concerted effort to eat better. My husband has been excellent about cooking things like vegetables. I'm just trying to stay as healthy as possible so that I'm able to keep working, keep mentally fit and also to be able to fight the disease if I have to.

In addition to focusing on Covid-19, what are you working on now at NTI?

Our main efficiency is combating globally catastrophic biological risk. We have a site called Covid Local that provides decision making guidance for U.S. and global leaders.

Then globally, we produce a global health security index in concert with partners at Johns Hopkins University and The Economist. And we are preparing for the next round of that index and building on some of the lessons that are already starting to come out of the Covid-19 response.

We're also looking at future risks, including deliberate and accidental release of biological agents and how we can be prepared for something that could be worse than Covid-19.

Correction: This story has been corrected to reflect that Cameron left her job at the White House in 2017, started working on the playbook in 2016 and her department was later disbanded by Bolton.

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