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A drive-up COVID-19 testing site in Los Angeles in March 2020. The problems affecting the distribution of vaccines and other parts of the pandemic response reveal the consequences of a decade-long disinvestment of public health in the United States.

Public Health Systems Still Aren’t Ready for the Next Pandemic

By Michael Ollove and Christine Vestal | Feb. 1, 2021 | State Legislatures Magazine

Like public officials everywhere, Dr. Jeffrey Duchin marvels at the miraculous production of highly effective vaccines against COVID-19 in mere months.

But Duchin, head of public health in Seattle and King County, Wash., doesn’t dwell on the only triumph of the pandemic response. Instead, he quickly pivots to the huge deficiencies plaguing the rollout of those lifesaving injections.

The lack of planning and coordination. The insufficient workforce and training. The inadequate public messaging and outreach. And the failure to create a uniform database to track inventory and equitably distribute shots.

‘A Complete and Utter Failure’

“We’re seeing the consequences now of a complete and utter failure to ensure we have a full and robust vaccination system,” Duchin said.

The chaotic execution of state and local vaccination programs is only the latest in a series of missteps by public health departments during the worst pandemic in more than a century. They include lackluster testing, contact tracing and data collection, and the failure to protect minority communities, which have borne the brunt of this disease.

All of those blunders, Duchin and other public health officials say, are a direct result of a decade of neglect of the nation’s public health system by both the federal government and state and local governments.

As state legislatures reconvene, lawmakers in many states will address immediate pandemic demands, such as vaccinations, testing and contact tracing programs. And some will work on measures designed to reopen schools safely. But most states, hamstrung by tight budgets, won’t be able to make the long-term investments needed to shore up their public health infrastructures.

In his State of the State address this month, New York Governor Andrew Cuomo (D), vowed to create a state public health corps by working with Cornell University to train 1,000 public health fellows to assist in the immediate need to vaccinate state residents against COVID-19. California Governor Gavin Newsom (D) is proposing to spend $372 million in state funds to speed the delivery of COVID-19 vaccinations and $2 billion to ensure a safe return to K-12 in-person learning.

In Oregon, Governor Kate Brown (D) has proposed spending $30 million to modernize the state’s public health system. Next door in Washington state, Governor Jay Inslee (D) has proposed a budget that includes $397 million to pay for testing, personal protective equipment, lab costs, epidemiology work and vaccine distribution, and boost Washington’s public health system. And in Maine, Governor Janet Mills (D) wants to allocate $5 million to the Maine Center for Disease Control and Prevention for COVID-19 testing.

Budget Shortfalls Limit Option

Some of the proposals could help public health agencies prepare for the next pandemic. But experts at the National Conference of State Legislatures predict that budget shortfalls will limit the number of states able to invest in emergency coronavirus funding, much less long-term development of public health infrastructure.

That bleak outlook stems from a web of challenges. Public health agencies must fill empty positions in a politically fraught environment, carry out a massive vaccination program that’s off to a rocky start and continue to manage ongoing crises such as substance use disorders and chronic diseases.

“In this country, policymakers tend to pay attention to public health when there is a crisis or an emergency,” said Dr. Ronald Valdiserri, a professor of epidemiology at Emory University’s Rollins School of Public Health and a former high-ranking official at the federal Centers for Disease Control and Prevention. “It may be human nature that too few policymakers can see beyond the short run, but public health requires a long-term vision, not just the next year or two and then move on to something else.”

We’re now paying the price for that neglect, Valdiserri and others said.

Paying the Price

When the coronavirus reached U.S. shores a little more than a year ago, a decade of short-term thinking, declining investment and boom-or-bust financing had already taken its toll. The nation’s more than 3,000 public health agencies were ill-prepared to protect Americans from an infectious disease that could only have been contained by a sustained, coordinated and well-resourced response.

Understaffed and hobbled by data systems that relied on telephones and fax machines to manage an avalanche of testing and new patient information, many state, city and county public health agencies fumbled.

Data systems varied widely, making it impossible to compare outbreaks and analyze the course of the disease.

Michael Ollove and Christine Vestal are staff writers for Stateline, an initiative of The Pew Charitable Trusts. This article was reprinted with permission and is part three of Stateline’s “State of the States” series. It was originally published Jan. 27, 2021.

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