Anticipating the greatest public health effort of our generation

Anticipating the greatest public health effort of our generation
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The COVID-19 pandemic is challenging us all in previously unimaginable ways. It is stretching our healthcare and public health systems like never before. It is spurring a new appreciation for the too-often invisible efforts of federal, state, and local public health agencies. And it requires us to create a surge of efforts that can be understood in three phases.  

First, is a necessary surge in a health care capacity. Second, is a surge in testing and contact tracing capacity, which is crucial to supporting the careful opening of certain sectors of society, and is currently underway. But it is the third phase — surging capacity to conduct a national COVID-19 vaccine response — that offers the true light at the end of this tunnel and the surest path to a full return to normalcy.

Although experts advise that a vaccine is many months away, it is not too soon to begin anticipating the challenges in carrying out what will likely be the greatest public health operation of our generation. We offer five considerations to help prepare for what lies ahead:


First, we must prioritize safety. Vaccines have been one of the greatest public health tools in preventing disease, suffering, and death throughout modern history. They are also among the safest and most tested medical products available. Although it grates against the urgency of the situation, we must all be patient and allow the government and manufacturers to ensure COIVD-19 vaccines are as safe and effective as possible. 

We are aware that small but vocal groups of citizens in the anti-vaccine movement are already raising questions to undermine any national effort. Public health leaders must be open to hearing from concerned communities, address them as best we can, and maintain our obligation to make policy decisions based on science.

Second, promote routine vaccines and prepare to enhance influenza vaccination this fall. With many states under stay-at-home orders, it is understandable why some children fall behind in their routine vaccinations. However, as we see all too clearly, the threat from infectious disease is real, and vaccines are our best tool for preventing spread. We join with partners at CDC and the American Academy of Pediatrics to remind parents that well-child care and routine vaccines are essential to prevent disease and that providers are adapting to continue seeing patients through this trying time safely. Call your pediatrician or usual source of care for more information.

As we approach the next flu season, it is also important that we reduce potential stress on the healthcare system by vaccinating all recommended groups for influenza as the vaccine becomes available. This effort will reduce preventable hospitalizations and healthcare utilization that will likely prove necessary, as COVID-19 is expected to continue circulating.

Third, build on what works. In 1993, Congress passed the Vaccines for Children (VFC) program, which provides vaccines at no cost to children who might not otherwise be vaccinated due to an inability to pay. When the H1N1 Flu Pandemic hit in 2009, the U.S. Department of Health and Human Service (HHS) utilized this existing vaccine purchase and distribution system created by VFC to deliver vaccines nationwide rapidly. Since then, states have regularly revised influenza pandemic plans to include provisions for mass vaccination if needed. 


CDC has decades of experience in partnering with state and local programs to assure high vaccination rates and therefore, must play a central role in any planning efforts for a national vaccine response. Building on the existing CDC vaccine distribution system and state plans for mass vaccination make sense. We need to avoid creating duplicative systems.

Fourth, assess and fill infrastructure gaps now. Despite thoughtful planning, several critical gaps in the nation's public health infrastructure must be addressed now to build capacity for large scale vaccination. First, our immunization surveillance and tracking systems need to be enhanced. Immunization information systems (IIS) must be ready to conduct several technical tasks, such as provider registration, vaccine distribution, inventory management, and tracking of doses administered

Fifth, communicate, communicate, communicate. Along with epidemiology, communication is one of the fundamental sciences of public health. There's an old saying that "No battle plan ever survives contact with the enemy." Indeed, there will be many challenges ahead, and frustrating delays or initial confusion over new guidelines and recommendations are likely inevitable.

Some of the most important lessons learned from past efforts include being willing to pause, evaluate, and adapt if needed; to always follow the science, and to communicate clearly and consistently with the American public every step of the way to share what we know as soon as we know it. Building on lessons learned, we have a solid understanding of what planning needs to happen now so that we are as prepared as possible for when a vaccine is available. As many leaders have noted, we are all in this together — and when we work together, we succeed.  

Michael Fraser has served as ASTHO's chief executive officer since August 2016. He received his doctorate and master's degrees in sociology from the University of Massachusetts at Amherst and a Master's of Science in Management with a concentration on management, strategy, and leadership from the Eli Broad School of Management at Michigan State University.

Claire Hannan has served as the executive director of AIM since 2004. She holds a Master's degree in Public Health from the Johns Hopkins Bloomberg School of Public Health.

Brent Ewig is a public health consultant with over two decades of experience working for leading public health associations. He holds a Master of Health Sciences in Health Policy degree from the Johns Hopkins Bloomberg School of Public Health.