Lessons from past public health emergencies could have saved 2020
The last 11 months could have been so different. Imagine we had clear plans in place for last-mile vaccination, persuasive communications to explain its value and strategies to distribute these life-saving drugs equitably.
For me — for all public health emergency response professionals — the tragedy of COVID-19 is that this alternate reality was entirely possible. We have worked enough public health emergencies over the last 20 years to know that the lessons we are learning the hard way now, have been learned and forgotten over and over again.
How is it possible, you might ask, that our public health system has forgotten crucial information about managing pandemics? After all, airline accidents kill far fewer people, yet the National Transportation Safety Board is there to learn their lessons. Similar programs exist to lower crime rates, improve education and improve population health.
But unlike many in the developed world, the United States has no systemic way to study and learn from public health emergencies. A three-year National Academies of Medicine consensus study on which I served, led by Ned Calonge, concluded that science in this area was “seriously deficient…hampering the nation’s ability to respond to emergencies [and] save lives.”
We must resolve this problem immediately in the Biden administration’s latest relief package — before we miss our chance to learn the key lessons from COVID-19, also.
How big is the issue? Look at vaccination, the center of our hopes right now. A recent study showed that from 2008-2017, the federal government spent $16 billion to fund purely pharmaceutical research into health threats. Operation Warp Speed, the prior administration’s rapid vaccine push, was possible because of decades of studies driven by emergencies like SARS, H1N1 and Ebola.
Yet the same study showed we spent a tiny fraction — only $100,000 — to learn how to distribute the drugs to cure those health threats. That’s not an annual amount — that’s $100,000 total over ten years. In other words, the federal government invested more than 150,000 times as much to develop potential emergency medications and vaccines than it spent learning how to get them into people’s arms. No one should be surprised that we aren’t very good at this.
Distributing vaccines is just one of Centers for Disease Control and Prevention’s core preparedness capabilities. There are 14 others, covering public information to laboratory testing. We spent an average of $2.8 million annually from 2008 to 2017 to study all 15 capabilities combined — .002 percent of pharmaceutical research — while federal support for core health agency preparedness plummeted 31 percent.
Have you spent the last 11 months asking: “Why hasn’t lab testing met the need? Why can’t contact tracing keep up? Why doesn’t anyone seem to fully understand masking or social distancing? Why do the racial imbalances in care keep growing instead of shrinking?” Well, that’s your answer. We could have learned, but we didn’t. Right now, we are living and dying through the chaotic effects of this funding imbalance.
The way forward is clear. In fact, legislation from 2019 already called for the development of “evidence-based” standards for public health preparedness — although with no mechanism to achieve those standards. The Biden-Harris administration can address this gap by immediately calling for CDC to convene a multidisciplinary ‘lessons learned task force’ with researchers, local practitioners and decision-makers across the federal government, as called for in our National Academies’ report. This group should study health emergencies and translate their findings into equity-based practice recommendations.
How much would it cost? A pittance compared to designing medications. Some back-of-the-envelope math based on our example models and the historical costs of preparedness research makes us confident that around $22 million dollars annually (about one percent of the federal health preparedness budget) could meet the need. Long-term sustainment is the true key to success.
Can a system like this, alone, overcome the poisonous effects of politicizing public health? Of course not; few things can. But evidence still helps win arguments and the lack of evidence certainly allows misinformation to flourish. Building an evidence base won’t win the fight with COVID deniers. But it provides much-needed ammunition to fight the actual disease, along with all the public health emergencies yet to come. These are the wars that really count.
We’ve all heard, or said, “trust science” so much over the past year. But you can’t trust science that doesn’t exist. It’s not just medication that saves lives; public health practices do, too.
Whatever else happens in the aftermath of this pandemic — as we grieve and rebuild — we must establish a national system to study, catalog and learn from these public health emergencies. It’s such a small price to pay and every day we all mourn the supreme cost of its absence.
Mitch Stripling is the national director of Emergency Preparedness and Response for the Planned Parenthood Federation of America, as well as a member of the National Academies of Science, Engineering and Medicine (NASEM) committee on evidence-based practices for public health emergency preparedness and response. Formerly an assistant commissioner at the NYC Department of Health and Mental Hygiene, he’s responded to more than fifteen federally declared disasters and public health emergencies.