Public health is being undermined. These 10 actions can restore it

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.

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:

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.