COVID response failure: Getting what we paid for with public health

We are in the midst of an unprecedented global health crisis that is laying bare serious shortcomings in the American health system. With one of the largest numbers of infected citizens of any nation, our public health defenses have been overrun and we have fallen back on our front-line healthcare staff, nurses, doctors and emergency providers working tirelessly to blunt the deadly impact of the COVID-19 pandemic while running short of essential equipment and facing overwhelming odds.

As a nation, we will spend a staggering $7.9 trillion in response to this epidemic and incur a similarly stunning loss in GDP. But history, common sense, and the examples of many other first-world nations make one thing crystal clear: it did not have to be like this. With a very small investment relative to other federal agencies and a tiny fraction of current spending on the pandemic response, we could have had a well-developed, evidence-based pandemic plan with experts trained and ready to execute it efficiently and effectively to save American lives.  

One reason we have struggled and suffered so much more than most of our first-world peers is we have lost sight of our national faith in public health. Breathing new life into our nation’s public health system is not just possible, it’s critical for making our country much better prepared for the next public health crisis.

In the days following the 9/11 attacks, President Bush turned to public health legend Dr. Donald A. Henderson to drive HHS and CDC bioterrorism preparedness. Dr. Henderson called on our team at that time to develop the CDC’s smallpox adverse reactions website and database, starting us on a decade-long journey that gave us a first-hand perspective on the inattention to public health and infectious disease preparedness.  

Dr. Henderson started his career in epidemiology and public health during the height of the polio epidemic. Later in the ’60s and ’70s, he led the WHO campaign to eliminate smallpox, the first complete eradication of the disease in the human population. By the time we started working with him and others in 2001, attitudes toward public health had shifted dramatically, and federal funding for public health was on life support. 

Over the course of our six-year public health initiative, we witnessed the level of resources going to the pharmaceutical industry soar, as faith and funding in public health plummeted. As of 2019, revenue from single psoriasis and arthritis drug was nearly 60 percent higher than the entire CDC budget for that same year.

Free-market capitalism often spurs creativity and has driven tremendous growth and innovation in every industry, including healthcare, but market forces do not always align with the public good. The successful government-led responses to polio, smallpox and other diseases showed that as a nation we could successfully invest to fill gaps where markets fail. Pharma will continue to play a major role in delivering therapeutics and vaccines, but our lack of pandemic preparedness demonstrates that profit motive alone does not always drive appropriate investment for meeting critical public needs.

This crisis is illuminating the failures of politicians and voters to prioritize public health. While spending tax dollars on government-led projects is often scrutinized and considered wasteful, it is possible to get very high-value returns for our tax dollars. The FAA’s sizeable budget, for example, is money well-spent given the undeniable safety of the U.S. aviation system and its criticality to U.S. commerce and leisure. For reference, last year’s FAA’s budget was $17.5B — 45 percent higher than that of the CDC. We have prioritized airline safety and have extremely safe air travel to show for it, but we have de-prioritized public health and due to COVID the daily death rates are averaging the equivalent of seven 737s crashing every day.  

The largest reveal in this crisis has been the folly of prioritizing individual medical treatments while ignoring the critical importance of population-based science and public health. We reward expensive medications and procedures while underfunding vaccine development, surveillance and prevention.

Imagine if we chose to spend as much on the CDC and public health preparedness as we do on airline safety. How many masks, ventilators, isolation wards, and more would that extra $5.4B have covered? Imagine the kind of robust public health surveillance and early containment that would be possible for high-risk infectious diseases and public health programs for vaccine research, nutrition, neonatal and infant health, addiction services, mental health, violence prevention, and more. 

Perhaps in the wake of COVID, public health will forever be connected to survival and death avoidance, but the fundamental shift in understanding and support for public health needs to come from us — the citizens, activists, and voters.

It is up to each of us to make our voices known by calling our representatives, voting for candidates who support public health and talking and writing every chance we get in support of this vital function. We have gotten what we paid for. We need to spend more, and we must do better.

Art Papier, M.D., is CEO of VisualDx, a University of Rochester affiliated medical informatics company. Paritosh Prasad, M.D., is an infectious disease and critical care medicine specialist, who leads the Strong Memorial Hospital ICU response to COVID-19.


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