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The year since the first Covid-19 case was identified in the United States has been one of unthinkable losses and inexcusable failures. From the beginning, testing was marred by glitches, rigid rules, and delays. Public health experts were sidelined. And the risks of the disease were downplayed.

In the absence of federal leadership, states and municipalities were left to fend for themselves at every turn, from setting reopening guidelines to rolling out Covid-19 vaccines. Of the nearly 39 million doses that have been distributed nationwide, only about half have been administered. Meanwhile, the U.S. death toll is expected to surpass half a million by next month.

The Biden administration has announced its plan to triage the national pandemic response. It includes a range of commonsense but essential measures, from standing up thousands of new vaccination sites and mobilizing public health and medical personnel to staff them to implementing a mask mandate on federal property and potentially invoking the Defense Production Act to address vaccine, testing, and personal protective equipment supply issues.

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All of this will be essential to turning the corner in the battle against SARS-CoV-2 and ensuring that 2021 looks different than 2020.

But our ambition cannot end there. This crisis has illuminated a far broader set of challenges that have undermined public health for decades. Here are 10 ways we must begin addressing them now:

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Invest in public health. While the United States spends more per capita on health care than any country on earth, less than 3% of that spending goes to public health programs. That’s at least $4.5 billion less than we need to provide an adequate level of protection, prevention, and care. One option for closing that gap would be to make public health spending a mandatory entitlement program, with a blended federal and state financing system like the one for Medicaid.

Bolster coordination. In addition to fully funding agencies like the Centers for Disease Control and Prevention and the Food and Drug Administration, along with state, local, and tribal health departments, they need to work in concert. Covid-19 is showing us exactly what happens when they don’t: a disjointed response riddled with supply shortages, testing gaps, mixed messages, and inconsistent policies. Lack of coordination is why the virus was coming under control in some states even as it was ballooning in neighboring ones.

With that in mind, the country would benefit from the creation of an independent nongovernmental organization specially designed to meet the public health needs of the 21st century.

Enhance global engagement. The Covid-19 pandemic is the epitome of a global crisis and a stark reminder of the need for global health cooperation. In the short term, it’s encouraging to see the Biden administration reengage with the World Health Organization and commit to joining COVAX to ensure the equitable distribution of Covid-19 vaccines to countries around the world. In the long term, the administration must support a robust global health action agenda that includes doubling contributions to the WHO, supporting the reform of international health regulations, and increasing humanitarian aid.

Foster public-private partnerships. One thing this pandemic has made clear is that that public health cannot thrive without cooperation from the private sector and the private sector cannot thrive without public health. Throughout this crisis, we’ve seen unlikely partners come together to save lives, from producing and distributing personal protective equipment, ventilators, and other supplies to developing vaccines and diagnostic tests at record speed. Building on these public-private partnerships will help us bring innovation and efficiency to the public health challenges of the future.

Build crisis capacity. This pandemic has strained the U.S. health care system to its breaking point and underscored our need for sustainable surge capacity. That includes investing in vaccine research and development and continually replenishing the Strategic National Stockpile of medical supplies so we never again face dire shortages of personal protective equipment and other supplies. We must also alleviate the strain on hospital systems, particularly rural ones, which in many cases are already operating in the red and lack reserves for emergency scenarios.

Build a modern disease surveillance and reporting system. It is impossible to overstate the importance of robust data and the ability to access it quickly. But federal agencies today must consolidate information that comes in multiple formats — including via fax — to report national and regional statistics. That wastes time and increases the potential for error. It’s past time to build a 21st-century information-sharing system. In addition to tracking cases, the country also needs the ability to track resources like ventilators and ICU beds in real time and use that data to rectify disparities in access.

Address health care workforce shortages. The pandemic has underscored the urgency of recruiting and retaining physicians, nurses, and other first responders in the U.S. and around the globe. Even before this crisis, which has worsened burnout rates, the WHO estimated a shortfall of 18 million health care workers by 2030, with the vast majority of that gap affecting low- and middle-income countries. Investing in health employment will be critical to advancing well-being and protecting economic growth around the world.

Prioritize health promotion and disease prevention. Health care in the United States is actually more like sick care. Illness is treated with little attention to preventing it. This has led to unsustainable costs and poorer health outcomes. Roughly half of Americans today have been diagnosed with preventable chronic illnesses like heart disease, cancer, and diabetes — many of the same conditions that make Covid-19 so deadly.

The U.S. has a tremendous opportunity today to shift from a reactive system to proactive health and wellness model. Doing so would drastically reduce the country’s chronic disease burden, cut costs, and lead to longer, healthier lives.

Address the root causes of health inequity. The heartbreaking disparities in Covid-19 deaths reflect generations of discrimination and systemic inequality, not just in health care quality and access but across all facets of daily life. As much as 80% to 90% of a person’s overall health is determined by factors outside of clinical medical care such as the conditions in which we are born, live, work, and play, otherwise known as the social determinants of health. Addressing disparities in education, housing, air quality, and employment opportunities are all key to addressing health disparities.

Rebuild public trust in health agencies. Perhaps one of the most dangerous outcomes of the botched pandemic response has been the erosion of public trust in essential institutions. From the beginning, the Trump administration sought to discredit agencies like the CDC, FDA, and WHO. Basic preventive measures like mask wearing and social distancing became political acts. And lies, conspiracies, and scams impeded experts’ ability to get factual, lifesaving information to the public. Restoring public faith will be a long process, one that begins with centering scientists to provide transparent, apolitical information to people of all communities and backgrounds.

All of this is a tall order, but it could not be more urgent. Between climate change, antimicrobial resistance, aging populations, and the rise of noncommunicable diseases and mental illnesses, the next global health crises are already underway.

And so, as we work to halt this catastrophe, it is up to us to examine the many underlying issues that led to it and leverage the undivided focus on public health to address them.

When we do, we will improve well-being across the globe and save countless lives.

Michelle A. Williams is dean of the Harvard T.H. Chan School of Public Health in Boston.

  • I will reiterate a comment frequently made by Dr Michael Mina – that we should address the COVID-19 crisis using public health approaches, such as RAPID ANTIGEN TESTING, that may not satisfy the high standards required of medical diagnostics. By giving the general populace the inexpensive tool (particularly if the government supplies the tests) to determine whether or not they are infectious and allow them to make their own decision of how to act on that information, we can stop the rampant spread of the virus. This implicitly includes another public health approach, which is to give the public accurate information that health recommendations are based on and allow people to make their own decisions. An example in which this was not done is the early recommendation to not wear masks for fear that the public will purchase all of the N95 masks and create a shortage for health care workers. While this recommendation was later reversed, the initial contrary recommendation was cause for much mistrust and used by some officials as reason to not trust any information coming from our lead public health officials.

  • None of these articles ever them mention how operation warp speed brought a covid vaccine quicker than any expert in medicine or media said would happen. it was laughable to them , the discussions now would not exist wo the vacccine

  • The author states, “In the absence of federal leadership, states and municipalities were left to fend for themselves at every turn, from setting reopening guidelines to rolling out Covid-19 vaccines. Of the nearly 39 million doses that have been distributed nationwide, only about half have been administered. Meanwhile, the U.S. death toll is expected to surpass half a million by next month.”

    The “lack of federal leadership” is because of the 10th amendment to the Constitution, where powers not specifically given to the Federal government remain with the States….which is why Biden’s mask mandate is limited to Federal property. Thus, Governors insisted that they be responsible for much of the response to public health issues….some did this well, others (Cuomo) did not. The States license doctors, nurses, hospitals…not the Federal government. Thus unless you are proposing a Constitutional Amendment, any suggested improvements have to work within the existing system….not in a non-existent theoretical country.

    With regard to Federal agencies, the CDC and FDA are not respected because they failed when the very thing they were created for occurred. Creating an overly complex test for COVID illustrated that the CDC thought the virus would not be a threat to the U.S. Why….because if it thought there would be a pandemic, the test would have been simpler, less resource-intensive (such as the German test that existed at the time). Further, they would have practiced creating tests, and thus, avoided the ridiculous error of manufacturing tests in a lab where SARS-2 particles existed.

    Public policy experts would have advised mask-wearing – instead of saying it was of no benefit – only to change that advise at a subsequent time. Not being honest with the American people and subsequently explaining that they were trying to save the N95 masks for hospitals is disingenuous and certainly not a way to earn the trust of the American people.

    Further, while the U.S. is vulnerable to viruses, (large amount of obesity, inability to shut-off border or inter-state travel), it has fewer deaths than countries such as the UK, whose current death toll of 111,264 (worldometer) is equivalent to 542,759 when adjusted to the U.S. population (332.2 million/68.1 million). The current U.S. death toll is 469,373 (which is 73,386 fewer deaths than the UK when adjusted for population). While the U.S. can certainly do better, the notion that the U.S. response was the worst simply isn’t true.

    The point is, if you are going to make recommendations, start by admitting the inherent failures of the international organizations (WHO) and government organizations (CDC, FDA, etc.) and recognize the legal and cultural constraints that exist. Arguing for a non-governmental organization to manage a pandemic is simply not feasible….it will have to be a coordinated effort at the Federal, State, and Local level…

  • How about taking care of our own first before we start handing out billions of additional dollars around the world and be realistic about what we can do both in our own country and elsewhere?

    Some of what the author discusses makes sense (Such as maintaining the national stockpile) but….I do not believe that can EVER be large enough to cover a major nationwide pandemic or biological accident or attack. The cost of maintaining such as massive stockpile would be absurd. Money DOES matter since it comes largely from the taxpayer.

    I personally believe that preparedness starts both at home and in local areas. Each County and in some cases individual communities should be looking at their own level of preparedness rather than relying on State or Federal assistance because when the worst of the worst happens….That State and Federal assistance will be lacking and what does make it will take time to arrive. Local planning matters and should be prioritized.

    • While preparedness at home and in local areas is important, national and global preparedness is also very important. Global preparedness in terms of surveillance of potential viral and bacterial infections, and national preparedness in having a plan to deal with pandemics and a stockpile of resources to immediately draw on to initially address the problem. With respect to the coronavirus pandemic, it must be stopped globally to prevent it from coming back to our shores again and again in mutated forms. In this instance, we have to spend money to combat the virus throughout the world and the cost will be much less than the hit to the economy that we have incurred to date.

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