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We Can Put Out the Dumpster Fire of the U.S. COVID Response

— I see reason for public health optimism in 2023

MedpageToday
A photo of a Banksy mural of a dumpster fire next to a boy catching snowflakes with this tongue, titled: Seasons Greetings

More than once, the U.S. response to the COVID-19 pandemic has been called .

Early test development was , public health and undermined by , and hampered prompt responses to an evolving epidemic.

What's more, mask-wearing and other pandemic responses were drowned out by while we doubled down on tepid responses to that we worsened by .

In response, think the CDC and the country's elected leaders handled the pandemic poorly. And -- more telling than the twitchy court of public opinion -- life expectancy in the U.S. is more slowly from COVID-19 than in Europe.

Despite that grim news, the dumpster fire of U.S. public health contains more than flames. Peer carefully into those flames, and you will see miracles, heroes, and even some optimism within.

First, we should own responsibility for that fire.

The Chemical Formula of Gasoline

For decades, before COVID-19 became a household name, we repeatedly ignored calls for from public health experts.

In 2017, as Ebola was slipping out of the public eye, a blue-ribbon World Bank panel on pandemic preparedness for better resources:

"As the havoc caused by the last outbreak turns into a fading memory, we become complacent and relegate the case for investing in preparedness on a back burner, only to bring it to the forefront when the next outbreak occurs. The result is that the world remains scarily vulnerable."

It is a brutal irony to blame public health workers for lacking the tools they were repeatedly denied.

Compounding that , political gamesmanship also sabotaged the U.S. public health response, perhaps even to distract from that legacy of neglect.

Exactly when we needed trustworthy messaging about mask-wearing, vaccines, and evidence-based treatments, right-wing extremists , fueled against the nation's leading infectious diseases physician, about vaccine safety, and . The in COVID-19 mortality rates is but one symptom of that sad act of self-sabotage.

Even so, the triumphs of the U.S. public health response also warrant mention.

A Miracle, Under the Flames

In the greatest public health achievement of our lifetimes, lifesaving COVID-19 vaccines developed largely by U.S. scientists and companies were sped to your neighborhood and mine with astonishing speed, of lives.

With similar alacrity, clinicians treating high risk and severe COVID-19 now have a panoply of proven developed predominantly in the U.S.

Any assessment of the U.S. public health response to COVID-19 must include those historic successes, diluted though they were.

Not all successes involved new technology. Our grandmothers and uncles are alive today because a highly committed army of public health dweebs counted cases, conducted contact tracing, held vaccine drives, and wrote and re-wrote informational web pages while the rest of the country called them idiots on Twitter. Nobody clanged pots and pans every evening for public health workers, but our frontline public health workers are heroes, too.

Reasons for Optimism

In the of Rahm Emanuel, former chief of staff to President Obama, "You never want a serious crisis to go to waste. It's an opportunity to do things that you could not do before."

Emanuel repurposed his own 2008 quote to better funding for public health. He hoped the crisis of COVID-19 would bring new oxygen to our strangling public health system.

In that spirit, here are three reasons for optimism for public health in the U.S.

New Funding

The silver lining of the COVID-19 crisis is that the death toll appears to have shaken some shekels loose from the world's deepest pockets.

Leaders of the G20 recently announced the formation of a for pandemic preparedness. While more work remains to grow those funds and , better funding and multi-lateral collaboration on pandemic responses are welcome changes.

Closer to home, the Biden administration has called repeatedly for to the nation's public health budget.

If those long-overdue investments come to fruition, there will be real cause for optimism that our best weapon against the next pandemic won't be a dilapidated public health system.

New Leadership

Infectious diseases physician and HIV research powerhouse Rochelle Walensky, MD, MPH, took the helm of the CDC midway through a raging pandemic.

Walensky gets it. She , "To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications."

She has gone far beyond apology. Less than 2 years into her tenure, Walensky has ordered a of the CDC and appointed a to lead the charge.

That openness to critique, and willingness to make major change, will make new Congressional investments in a nimbler CDC more palatable -- and more likely to save lives.

New Ideas

As much as hope of better funding and structural reform at the CDC are welcome news, the flaws in the nation's public health response went well beyond that much-maligned agency.

To grapple with the wide-reaching inputs into the nation's public health failure, from political sabotage to the pernicious impact of pre-existing health inequities, a coalition of bipartisan senators has called for a to examine pandemic lessons learned.

Meant to emulate the bipartisan 9/11 Commission, this new COVID Commission could give political oomph to improved public health funding, including to fight the that COVID-19 brought to light and then made worse.

Don't Forget the Realism

Just as the American pandemic response was both a dumpster fire and a miracle, our optimism should be seasoned with some hard-nosed realism.

Biden's calls for better public health funding are not guaranteed to survive our fractious appropriations process. It is also far more difficult to redirect decades of institutional inertia at the CDC than to name the right new direction. The national COVID commission has been greenlit.

Still further, populist anti-public health sentiment remains. Republican presidential recently proposed an and Twitter's new Elon Musk recently put out a .

The million life question is thus: in response to the dumpster fire of the American COVID-19 response, will we use the fire extinguisher of new funding and , or the gasoline of demagoguery?

I choose hope for the fire extinguisher. Hope is the first step to transformation, and there are real miracles and real heroes worth saving from the fire.

is an infectious diseases physician and ethicist at the University of Vermont Medical Center, and a professor of medicine at the University of Vermont's Larner College of Medicine.