This is part of a series on preparing for future outbreaks. Sign up for our newsletter, the Next Pandemic.
The coronavirus pandemic is here to stay, but the national and global emergencies it set off are, by all official accounts, over. Last week, the World Health Organization declared an end to its “public health emergency of international concern,” and on Thursday, the public health emergency designation in the United States will also expire. It’s a good time for the country to absorb the many lessons of the crisis. Instead, we seem to be actively forgetting them.
Despite the United States’ many failures — to develop coronavirus tests or deploy vaccines or communicate effectively about the pandemic and our response to it — it still got several things right. Lawmakers beefed up the social safety net with expanded tax credits, more generous unemployment benefits, a federal paid sick leave policy and stimulus checks that together kept millions fed and housed even as the economy plummeted. They also poured billions into Medicaid and suspended policies by which people are routinely purged from its rolls — a critical move during a health crisis.
Health departments rallied as well. Decimated by decades of funding cuts, understaffed and working with woefully inadequate technology, they still managed to gather and share reams of data about where and how the virus was spreading, which academics then worked heroically to analyze and publish. And even amid a rash of protests over shutdowns, a silent majority of citizens donned masks and obeyed social distancing edicts.
Perhaps most striking of all: Scientists developed a new and highly effective coronavirus vaccine with unprecedented speed. And yet. Vaccine hesitancy has reached a high.
The reprieve that kept people on Medicaid has expired, and the 15 million or so Americans who benefited from it are expected to find themselves among the uninsured in the coming months. More than five million of them will be children. A disproportionate number will be Black or Latin American — the exact groups that proved most vulnerable to Covid.
Other safety net expansions have also ended, and whatever lessons leaders learned about the importance of public health appear to have been forgotten: Lawmakers in at least 30 states have moved to limit — rather than expand — the power of public health authorities. A surprising number of health experts say that they would opt to do less in the next crisis, even if it involved a more deadly virus. And in the face of low pay and constant harassment and with resources once again dwindling, those doing public health work are now leaving the field in droves.
Such sweeping reversals of progress and policy are sure to leave us as woefully unprepared for the next health crisis as we were for this one. But there is still time to change course.
A strong social safety net is crucial in a pandemic. The expansion of social benefit programs like unemployment, food stamps, Medicaid and paid sick leave was one of the great triumphs of the pandemic response. It not only helped more people stay fed and housed during the pandemic and its attendant economic crisis; it also helped the economy rebound quickly once the crisis passed.
Rather than cut these programs now, Congress should be doing everything in its power to maintain the ground that has been gained. As experience tells us, and study after study shows, pathogens thrive in the gaps between a society’s haves and have-nots, and a nation bereft of food security, health care access and other social supports will be that much more vulnerable to the next potential pandemic that arrives.
Border policies need to truly account for viruses. The current administration has erred almost as badly as the previous one in its continued use of Title 42, an emergency order that allows the federal government to turn away migrants during a pandemic. The stated goal of this policy is to prevent the spread of disease.
But that rationale defies all logic. Forcing people into overcrowded detention centers where they are denied basic preventive health care (including vaccination) is a recipe for ensuring viral spread, not preventing it. President Biden is wise to finally end this policy (it will expire with the public health emergency). But much more work remains: Only a fully modern immigration system can balance the demands of border security, human rights and pandemic preparedness.
Public health is at least as important as clinical medicine. The United States has a long history of granting primacy to private medicine and neglecting public health. In the years preceding the pandemic, less than 3 percent of the country’s $3.6 trillion total annual health care bill was spent on public health; a vast majority of the rest goes to clinical medicine.
We need to correct this imbalance. Public health agencies need modern computer systems and equipment, more and better-trained staff, and the resources to conduct urgently needed research: How well did mask wearing, social distancing, school closures and quarantine protocols work? When and where and why did they fail? The nation cannot prepare for the next pandemic unless its scientists and public health experts answer these questions.
Likewise, curbing public health powers and cutting funds for community health workers, as state and federal officials are now doing, are shortsighted moves that the nation will come to regret.
Smarter partnerships would play to the country’s strengths. Strong collaborations and clear agreements between government, industry, academia and nonprofits are the key to ensuring that the nation is prepared to develop and deploy tests, vaccines and new drugs; that its national stockpile is adequately stocked; and that some semblance of equity is maintained between wealthy nations and their less wealthy neighbors.
To that end, lawmakers should review — and ideally, amend — the agreements they made with vaccine makers and test developers, especially. As a recent report on the U.S. response to the Covid pandemic makes clear, deaths could have been avoided, and companies could have profited even more than they did, with better, stronger policies for collaboration.
Public health requires public trust. If the pandemic taught us anything, it’s that the most advanced technology in the world is no match for the suspicions of the fearful or the skepticism of the misinformed. Several studies indicate that the communities most mired in this kind of mistrust were among those with the worst pandemic outcomes. That’s not surprising, but rebuilding trust between the government and its constituents will take time, effort and a careful rethinking of what it means to follow the science in a time of crisis.
Promises of science free from politics will always ring hollow because decision-making always reflects a society’s values, culture and politics as much as hard evidence. Instead, proponents of sound public health should promote the import of collective action and shared sacrifice in a crisis. To be better prepared for the next pandemic, we will have to think critically about what we expect from one another, and about what kind of society we want to live in.
With fresh viral threats looming, it’s clear that the world will not get another century to make these course corrections. The coronavirus pandemic has cost millions of lives and trillions of dollars, has upended the economy, and has exposed and aggravated a grim roster of disparities and societal fissures. Though it’s hard to imagine, the next pandemic could do far worse. We have the tools to prevent that from happening, but we have to start putting the lessons of the past three years to use now.
