COVID data lapses are just one symptom of our ailing public health system

In early May, the Washington Post reported that the D.C. Health Department had, without explanation, failed to share data on new coronavirus cases or deaths with the Centers for Disease Control and Prevention (CDC) over a 12-day span. There was cause for concern, as neighboring communities in Maryland and Virginia were reporting the highest case rates in their respective states. The lack of data led to frustration among residents who rely on timely information to assess risk and plan precautions.

D.C.’s missing data — and other data system challenges from Texas, Washington state, and “virtually every other health department” — poignantly reveal the fragility of the nation’s public health data for tracking and monitoring diseases such as COVID-19. The CDC’s national disease surveillance system and COVID-19 community dashboards rely on data supplied by state and local public health departments, which are responsible for collecting information from health care providers and laboratories. Yet reports to the CDC often require that a health department staff member manually correct data imperfections and the workforce is stretched thin, having worked “over two years of 12+ hour workdays,” according to the director of D.C.’s Health Department.

Chronic underinvestment in the nation’s public health system, including in the data systems and workforce needed to ensure that these processes work smoothly, has left health departments throughout the United States in a tenuous situation like the district’s, battling COVID-19 for the past two years while attempting simultaneously to continue efforts to address other long-standing public health issues. Data systems are outdated and strained, often requiring manual workarounds to account for a lack of interface among various systems. The workforce is insufficient and shrinking. Most staff do not specialize in data science and informatics, and they often lack job supports such as modern technology and data systems for disease surveillance. 

Fortunately, there are several clear ways for federal policymakers to address this crisis in the short and long terms.

Lawmakers must invest sufficient and consistent funding in robust public health infrastructure, including improving data systems and supporting a diverse, well-trained workforce. Investment is urgently needed to modernize public health data capabilities that are flexible, dynamic and allow for a seamless flow of information. This investment must support improved and standardized public health data collection efforts, as well as systems that enable local data to be captured by state and federal systems, analyzed and understood and made available for community decision-making. Finally, this investment must support the development of a diverse, culturally competent and skilled workforce with training in strategic and systems thinking, data science, communication and policy evaluation, including training pathways and incentives for public health service. The bipartisan PREVENT Pandemics Act, sponsored by Sens. Patty Murray (D-Wash.) and Richard Burr (R-N.C.), is one avenue for Congress to pursue. The bill aims to strengthen the nation’s public health and medical preparedness and response systems, including infectious disease data collection as well as recruitment and retention of the front-line public health workforce, among other priorities. The White House FY 2023 budget proposal also includes over $10 billion in discretionary funding — $2.8 billion more than in 2021 — for the CDC and state and local health departments to improve public health infrastructure, including disease surveillance and forecasting, data modernization and workforce supports and career development.

Beyond these investments, lawmakers must also pass supplemental COVID-19 funding. With cases rising again in more than half of all states and predictions of a possible fall surge, it is critically important to continue investing in the tools and infrastructure that have thus far supported the U.S. response. The Biden administration’s original request of $22.5 billion in supplemental COVID-19 funding, later whittled down to $10 billion, is currently stalled in Congress. The impact is already being felt by uninsured individuals and community providers who have grappled with the elimination of the Uninsured Program, which paid for free testing, treatment and vaccinations. Without new funding, production and procurement of vaccines and treatments will wind down; some treatments are predicted to be gone by July. The United States will be unable to make advance purchase commitments, potentially losing its place in line for new vaccines and antiviral pills. As a result, the White House has warned that any new COVID vaccines that are developed to respond to future variants will need to be limited to individuals at high risk for severe disease.

Lawmakers must also not confuse the need for sustained public health investments with the need for pandemic emergency response efforts. They are different, and both are needed. During both times of emergencies and times of routine needs, our public health system requires greater long-term investments in order to be effective. Short-term funding infusions have been crucial to mitigate the impacts of COVID-19, but the public health system needs long-term support to ensure it is capable of addressing a range of existing and emerging public health threats, including the emergence of new infectious diseases. President Biden’s FY 2023 budget includes almost $82 billion over five years for long-term pandemic preparedness, including prevention, detection and response to biological threats. 

D.C.’s lack of data reporting was a symptom of a larger problem in America’s public health infrastructure — and it is a sign of what is to come should our lawmakers fail to make these necessary investments. Even with the knowledge that cases are underreported, most Americans want to be informed of current COVID case rates in their communities — and they deserve to know their public health system is prepared for future crises as well. 

To protect Americans’ health and safety, lawmakers must make these sustainable, robust investments in both our immediate COVID-19 response and our long-term health and prosperity.

Jill Rosenthal is the director of public health policy at the Center for American Progress.