British policymakers have begun weighing the future of Great Britain’s pandemic state, deciding which initiatives are worth keeping, which need revamping and which need scrapping altogether. We should be doing the same here in the United States.
Both the UK and the U.S. have had their fair share of troubles. But for all its early shortcomings, the UK is now arguably better placed than the U.S. to handle the pandemic and similar future crises.
For example, in the UK, large-scale genetic-sequencing was initially ridiculed as a “stamp-collecting” exercise but soon proved to be useful in keeping track of the myriad SARS-CoV-2 mutations and their effects on transmission. While other highly effective interventions, such as test-and-trace, are being downsized due to financial and political costs, there are still a host of other emergency policies and interventions that are now being absorbed into state infrastructure.
The UK Health Security Agency (UKHSA), a new executive agency formed during the pandemic to replace Public Health England (PHE), a much-criticized predecessor, plays a central role in this process. The aforementioned genetic sequencing and contact tracing efforts are set to become the responsibility of the UKHSA. The Joint Biosecurity Center, created to provide real-time data on the spread of COVID-19, and lauded by some as having been critical to the UK’s pandemic response, will now also reside within the UKHSA.
The U.S., in contrast, seems to still be playing catch-up, recently again snatching the global record for the highest number of new daily COVID-19 cases. It continuously fails to implement the most basic public health measures: testing of the infected, tracing them and their contacts, and isolating them as needed. Masking, another very basic pandemic control measure, is similarly sparse.
Although the U.S. surgeon general, under the Public Health Service Act and with permission from the secretary of the Department of Health and Human Services, has the authority to prevent the spread of disease between states and from other countries, most public health functions fall within the responsibility of the Centers for Disease Control and Prevention (CDC). Even so, experts at the CDC (in charge of hard science, data collection and disease surveillance) generally lack the means to enforce policy and ultimately depend on individual states to make their own public health decisions.
This means the COVID-19 response ends up being spread out across more than 2,000 state, local and tribal public health departments. As has been repeated many times, viruses have little respect for country, state or county lines. A scattered, decentralized pandemic response runs the risk of forgetting this and punishes those who act with the consequences of those who don’t.
In many ways, these failures hint at the limitations of a federalist system of governance when faced with a public health crisis such as this one. Lacking federal authority to enact nationwide policy, it is unsurprising that a period of immense political polarization, as we are witnessing today, leaves public health matters divided across party lines rather than scientific consensus.
The Biden administration’s move to enforce vaccine mandates for all federal employees, employees of larger businesses and most health care workers is a step in the right direction. As is its proposed pandemic preparedness plan, which would have the U.S. spend $65 billion to improve our ability to develop and manufacture vaccines, treatments and tests, and provide new money for early detection and warning systems. But these measures still don’t solve the root problem of enforcement.
In addition to these measures, we might strive to establish an independent public health agency that, during times of crisis, has the political authority to put the necessary policies in place. An independent agency would have the added benefit of being less vulnerable to political whims.
Recall that the CDC’s flagship Morbidity and Mortality Weekly Report, its main vehicle for sharing COVID-19-related developments, was subject to political influence in the midst of the pandemic. At a time of deep skepticism towards the state, these kinds of missteps only serve to further erode public trust, and with it the epistemic literacy so vital to an engaged pandemic response.
In contrast, the Federal Reserve Board managed to withstand political pressures similar to those directed at the CDC precisely because of its institutional grounding as an independent agency; long terms, budgetary independence and job protections mean the Fed’s governors can focus on what they are meant to, market fundamentals.
Slow start aside, the UK recognized an area of need in its pandemic response and acted accordingly. Now it has a new executive agency, the UKHSA, that is being given the necessary tools and funding to properly deal with this pandemic and any others to come.
Given the U.S.’s shortcomings in implementing the most basic of public health strategies, it’s clear that a similar area of need exists here. The difference? A noticeable lack of action. The result? Depending on your postal code, you may have been given coherent guidelines and mandates or left with a policy that actively stymies efforts in COVID control. Whether it’s revamping of the CDC and its legislative weakness or forming a new independent public health agency, the U.S. needs to act.
William A. Haseltine is president of ACCESS Health International. An infectious disease expert, Haseltine was formerly a Harvard Medical School professor and founder of the university’s cancer and HIV/AIDS research departments. His latest book is titled “Variants! The Shape-Shifting Challenge of Covid-19."