March 09, 2020 David Wallinga, MD
The field of public health began more than 160 years ago when a physician named John Snow, who believed the epicenter of a London cholera outbreak was a contaminated public well on Broad Street, acted to change that environment. He took the handle off the Broad Street pump. With no pump, people stopped getting their water at that well. And the outbreak, which took 616 lives, soon ended.
Like Snow, I have pondered over the course of my career which public health actions and policies could help make our communities and nation healthier. As the new coronavirus outbreak unfolds, those questions have come to the fore. How effectively a nation’s leaders answer them is a matter of life and death, no less in the United States than elsewhere. So Congress and the White House should be paying closer attention to a few hard-earned public health lessons:
We need honest, accurate communication. Especially in a health emergency, what Americans deserve is concrete, consistent, science-based information. Leaders who offer less than that will risk losing the public trust that is so essential to mounting an effective response.
White House staff continue to make obviously false claims—for example, lowballing the actual number of confirmed coronavirus cases, stating that coronavirus is “very well under control in our country,” or asserting that the nation’s borders are sealed “pretty close to airtight” against the disease. Not being forthright about something so serious fuels fear and erodes public confidence.
Meanwhile, according to the New York Times, Dr. Anthony Fauci, the National Institutes of Health’s director of infectious diseases and one of the nation’s foremost experts on the subject, claims the White House has told him to say nothing further about the epidemic without clearance. Vice President Pence has now been put in charge of coordinating the administration’s communication around the epidemic. Hopefully he will respect and elevate the voices of public health experts rather than silence them.
Robust public health investment is critical. With the new coronavirus, we are painfully relearning the lesson that our natural world is in constant change and will often surprise us. To be ready for change, a great nation needs thoughtful, sustained investments in public health research, vaccine development and preparedness, and laboratory capacity, and it needs to hire and retain public health experts in government service. (There’s little or no profit motive for the private sector to invest in public health.) These investments are essential in order to properly prepare for and manage the environmental and infectious risks to our communities.
Less than a month ago, the president released his proposed budget for fiscal year 2021. It included more than $693 million in proposed cuts to the Centers for Disease Control and Prevention (CDC), signaling the goal of continued disinvestment from public health. If enacted by Congress, those CDC cuts would slice $85 million from the agency’s Emerging and Zoonotic Infectious Diseases program. That is especially ironic since the coronavirus outbreak, like the SARS and MERS outbreaks before it, is thought to have emerged from a wild animal (zoonotic) source, likely bats. Other CDC program cuts favored by the White House includes $25 million from the CDC’s Office of Public Health Preparedness and Response.* Besides preparedness, this office also manages the Strategic National Stockpile of emergency medical supplies—N95 respirator face masks, for example, which are in woefully short supply.
Perhaps insufficient preparedness has contributed to the testing boondoggle around coronavirus. European scientists began nearly two months ago to develop the first diagnostic tests to confirm who is or is not carrying coronavirus, a critical piece of information for containing its spread. By the end of February, the World Health Organization had deployed functioning tests to nearly 60 countries, and South Korea has performed about 10,000 daily tests since then. The CDC rejected the WHO test in order to develop its own and then stumbled in that task. Over the weekend, reporting said that fewer than 1,900 Americans had been tested thus far. The lack of such testing helps explain why a containment strategy has failed in the United States. Apparently, no one in the administration can or will explain how this fateful decision was made.
We must tackle threats so they never cause harm. Inherent in the word threat is the possibility, the hope, that nothing bad will ever happen. In fact, the best public health investments are not showy, and usually attract little notice, because nothing does happen. Instead, we were prepared: the new infection never spread; the refinery never blew; the children were never poisoned from drinking polluted tapwater. Writing in The Verge, Nicole Wetsman notes that the president’s latest budget did include a proposed increase of $50 million for the CDC’s Rapid Response Reserve Fund. However, those are funds to be spent only after a crisis develops; the previously mentioned cuts are all to preparedness programs that aim to prevent a crisis from happening in the first place.
As any schoolchild knows, an ounce of prevention is worth a pound of cure. And yet Harvard epidemiologist Marc Lipsitch describes the initial response of U.S. leadership to the outbreak of COVID-19 as “utterly inadequate.”
The administration’s approach to this latest emergency strikes me as painfully familiar, not unlike its response to many other threats facing the communities with which NRDC partners: urban and rural communities that are facing climate-related risks from drought, fire and flooding; a medical community facing a future where their antibiotics may no longer work, in part because they have been overused in industrial farming; and communities where municipal drinking water supplies could become contaminated with environmental lead and toxic “forever” chemicals, called PFAS.
After coronavirus wanes, or a vaccine is developed, these other community threats will remain. And so should our expectations for our nation’s leaders. Our country needs to be investing more—and investing earlier—to prevent and prepare for all of these sorts of challenges to community health. Early action that anticipates and heads off the worst possible outcomes or prevents problems altogether not only makes commonsense, but also makes smart financial sense. When our unprepared nation finally tallies the bill for this full-blown emergency, it's likely that we citizens will have shouldered the heaviest burden, not only the burden on our health but also in terms of the disaster relief dollars spent to pick up the pieces.