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 Consider how federal, state and local health departments were
unprepared for a threat that an expert government panel warned, in 2019, was
inevitable. Despite its enormous $11 billion budget, the 800-pound gorilla of
public health, the federal Centers for Disease Control and Prevention, had no
model for how a COVID-like virus would spread, nor how to target preventive
measures. Worse, it had not developed a protocol for testing to determine if
individuals were infected with a disease, and no plans existed to work with
private laboratories to produce test kits for widespread distribution, which,
during the onset of COVID, it resisted. These delays cost tens of thousands of
lives.
The CDC’s often-contradictory advice made Americans skeptical of preventive
guidance, from lockdowns to masking and, subsequently, of vaccine efficacy and
vaccine mandates. One might wonder if today’s CDC and local health departments
could rise to the occasion, as did their predecessors, to beat back cholera,
stop malaria, conquer polio or obliterate smallpox. Given the ability of
malevolent actors to manipulate the genetic codes of viruses, the threats ahead
are far greater.
If past is prologue, there is a every chance that the members of a highly
visible COVID Commission will be drawn from political and academic elites, will
earnestly go through the motions, and then will recommend significantly more
funding for the CDC, local health departments, and schools of public health.
This time, to break the pattern, Congress should direct a new COVID Commission
to make recommendations for bottom-up reform of our public health establishment.
Merely throwing more money at the existing system would be a mistake. The CDC’s
problem isn’t a lack of funds but a lack of focus. Enjoying the enhanced
visibility and status that the public health profession gained in the aftermath
of the HIV-AIDS epidemic, public health officials recklessly broadened the
definition of “epidemic.” Today, the CDC, state and local health departments,
egged on by ambitious academics, have taken ownership of “epidemics” including
racism, loneliness and gun violence – social ills for which experience in
controlling communicable diseases caused by microbes and viruses is irrelevant.
The primary objective of a COVID Commission should be clarifying the fundamental
expectations that our society requires from public health systems. Its work, and
its report, must urge public health officials to focus on disease. The CDC
should assume that we’ll face another pandemic – perhaps one even more lethal
than COVID – in the near future, and begin work to strengthen its capacities for
case finding, contact tracing, isolation and quarantine procedures, making them
more effective and relevant to a more dynamic and diverse U.S. population.
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To enhance these traditional tools, public health officials must boost their
statistical competency. The COVID Commission should examine the erratic
collection of data on COVID and determine the accuracy of the reported numbers
of infections, hospitalizations, and deaths. There is a big difference between
hospitalizations and deaths “with” COVID or “because of” COVID. Much of the
information that we have has been collected by different agencies, using
different standards and methods, and none of it has been processed in real time.
Next time, we will need accurate, consistent data – and we’ll need it fast.
A national commission on COVD also might observe that, if public health
officials want to diminish their collective credibility with the American
people, engaging in partisan advocacy is not a good place to start. The 1,200
public health officials who signed a letter endorsing the George Floyd protests
as “vital to the public health,” while calling for masking and social distancing
in every other walk of life, did more harm than good.
Finally, a COVID Commission should remind public health officials that theirs is
a global job. The old and now redeployed truism that “disease knows no borders”
reminds us that pathogens anywhere are a concern everywhere, particularly in the
era of rapid global travel. President Biden’s decision to halt traffic from
African countries where the Omicron variant has emerged was not racist or
xenophobic but done to prevent its broad introduction into the U.S.
That decision also reminds us that monitoring pathogens globally is critical to
America’s national security. Given that the WHO was slow to alert member
countries for fear of alienating China, a COVID Commission might recommend that
the U.S. should greatly improve its independent capacity to detect and analyze,
in real time, unrecognized and potentially malignant biological threats anywhere
in the world.
Public health experts may not be able to predict with certainty when the next
pandemic shows up, or what challenges it will bring. By focusing on their core
mission and constantly improving their methods and practices, however, they can
be more prepared when it arrives. A national COVID Commission that fails to call
the public health enterprise back to its principal mission preventing the spread
of communicable disease will not make a meaningful difference.
Carl Schramm is University Professor at Syracuse University, and is a senior
adviser to the COVID Commission Planning Group. His most recent book is “Burn
The Business Plan,” Simon and Schuster, 2018. |
