Are we prepared for the next health crisis? Maybe

In Fall 2017, the Johns Hopkins Bloomberg School of Public Health co-sponsored a symposium on the lessons from the 1918 influenza pandemic that asked the titular question: “When the Next Pandemic Hits, Will We Be Prepared?”

The answer from the assembled experts — which included none other than Anthony Fauci and many other leading public health authorities — was a resounding “no.” 

They were right. We were not prepared. As a result, the United States today has the most coronavirus cases and related deaths of any country — and the pandemic is far from over.

We will continue to suffer disproportionately because of the deficiencies in our public health system and our lack of commitment as a nation to prevention and to health as a human right. 

We will someday put this crisis behind us, but will we be any better prepared for the next one?

The answer is yes — but only if we learn from our lived experience and make the bold decision, once and for all, to invest in a public health system that protects the population’s health every day and serves us well in times of crisis. Investments in preparedness must go hand in hand with investments in disease prevention.

For too long, Americans have been left vulnerable to a pandemic scenario by public health systems that couldn’t pass a stress test. Now we are paying the price. 

It’s not surprising when you look at our threadbare and loose patchwork of local, state and federal health agencies with insufficient staffing, laboratories and disease tracking systems. Over the last decade, budget cuts have reduced the public health workforce by 56,000 positions.

What’s more, our population was remarkably sick even before COVID-19 ever breached our nation’s borders. Prior to the pandemic, we had the lowest life expectancy among all large, wealthy countries. Six in 10 Americans have an underlying disease such as diabetes, hypertension or cancer. Due to longstanding structural inequities and racism, people of color bear a higher burden of these diseases, most of which are preventable. Yet while the U.S. spends more on treating disease than any other nation, fewer than 3 percent of our health dollars are spent on preventing illnesses.

There is cause for optimism, however, given a better understanding of the value of public health strategies. People are seeing firsthand how protecting one’s individual health depends on protecting the health of the people around them. Progress to date in flattening the pandemic’s curve is not due to a medical discovery or new drug but to collective action to practice physical distancing, good hand hygiene and disinfection, combined with strategic testing, contact tracing and isolation. And if we find an effective vaccine in the coming months, the public health system will assure access to it and the community protection that comes with it.

We can seize this moment to modernize our public health capacity to deal with the realities of today’s interconnected global economy. It will require a sustained, coordinated and an accountable public health system designed for the spectrum of health challenges we face, from COVID-19 to cancer, anthrax to asthma, superbugs to suicide prevention.

Done right, we can eliminate health disparities, prepare for the next emergency and create sustainable, healthy jobs. 

Progress against these challenges remains far from assured. Our responses to the outbreaks of SARS in 2003, H1N1 in 2009, Ebola in 2014, and Zika in 2016 saw an infusion of resources for public health that did not last. 

We must invest now for the long term. In addition to brigades of contact tracers, we need brigades of public health workers to address other critical challenges. Rather than creating pop-up testing sites in low-income communities, let’s commit to more permanent community health workers and centers. Rather than temporary hotel housing for people experiencing homelessness, let’s build more affordable housing units. Our advocacy for these and other long-term solutions must be relentless. 

If we fail, we face the further erosion of trust and resources in public health agencies and organizations. We cannot allow a public health crisis to result in the devaluing of public health itself.

It’s time to build a real public health system in America. With over 140,000 lives lost, tens of millions of Americans newly unemployed and thousands of businesses struggling, the costs of our inaction have become painfully clear.

A strategic, long-term investment will help us respond, recover, and emerge a healthier and more resilient nation for all. 

Ellen J. MacKenzie is dean of the Johns Hopkins Bloomberg School of Public Health. Shelley Hearne is director of the Johns Hopkins Center for Public Health Advocacy at the Bloomberg School of Public Health and the inaugural Alfred Sommer and Michael Klag Decanal Professor of the Practice for Public Health Advocacy.