Covid’s enduring lesson: The U.S. has no federal system to protect public health

June 26, 2024

By Linda Stamato

When disease prevention is done right, we don’t notice. When it isn’t, disease spreads, people get sick, and they die. Then, we pay close attention. After the threat passes, stock is taken, and, oddly enough, investment in public health declines.

Prevention is difficult to measure; it’s like trying to prove a negative. What we do know, though, is that an unprepared, under-supported and inadequately organized public health system presents a serious challenge to the nation.

Yet America has no such system.

Disease doesn’t stop at state borders. If states differ on their approaches in managing a health crisis, as they did when Covid-19 hit, disease can spread more easily. The impact, of course, can be consequential. Indeed, many lives were lost, as a failure to cooperate — impeded by different practices by state health systems — left the nation without a coordinated response.

When partisan politics entered the picture, the situation worsened. Certain religious beliefs that prevented trust in vaccines added fuel as well.

When science is denied, and treatment and prevention methods, notably vaccines, are questioned, disease spreads.

We weren’t prepared for Covid. In its wake, there is no excuse to be unprepared for the next pandemic, but we are. It could be upon us, as bird flu spreads to humans. A third case has just been added to the list of known human infections.

Cambodia has reported eleven people infected, more than anywhere in the world so far as we know, and five have died. The nation has an excellent tracking system that aided early detection and preventive interventions.

Neighboring nations, however, are not up to speed. And neither is the United States.

If we can’t detect bird flu — we don’t collect the data — we can’t prevent another pandemic.

Bird flu may be capturing the headlines, but we need to pay attention to the increase in communicable diseases that we had largely conquered and the concomitant undermining of public health, its scientists and other professionals that makes prevention efforts so challenging.

We are on a treacherous path.

♦ Polio, after three decades of eradication, is making a comeback.

♦ Mumps is on the rise. A dangerous disease, it can cause brain inflammation (encephalitis), deafness, or infertility later in life.

♦ And measles, once eliminated from the U.S., is spreading as vaccines are avoided. A highly contagious disease that can produce pneumonia, ear infections, and if it spreads to the brain, neurologic or brain complications, it also cripples the immune system. An unvaccinated person, if exposed, has nearly a 90 percent chance of contracting it.

The MMR vaccine — to prevent measles, mumps and rubella — is safe and about 97% effective. Yet the rate of parents opting out of the vaccination program has been increasing. In New Jersey, the number grew from 1,641 in the 2005-06 academic year to 8,977 during the 2013-14 year.

As more and more parents “free ride” off the community’s dwindling immunity, outbreaks of disease occur. These rising rates, if not reversed, will erase much of the nation’s public health progress as preventable diseases return.

This revival of resistance — and revisionist history — imperils public health.

The stubborn persistence of challenged beliefs needs to be understood and met with information that counters those beliefs—for the public good. It doesn’t promise to be easy.

Misinformation, whatever its source, has penetrated deeply, perhaps indelibly, into the public imagination, seemingly on its way to becoming less a matter of truth than a matter of personal and group identity. It’s a major challenge that can’t be ignored.

A federal approach to public health is essential. If we learn nothing else from our nation’s response to the Covid epidemic, it is this: The Founding Fathers got this one wrong.

Public health work is underfunded, undervalued, and misunderstood as a result, undermining the development and implementation of effective public health strategies. We need a sound data collection and distribution system. Without it, epidemiologists cannot identify communities that are particularly vulnerable, or detect the patterns and trends so that timely interventions can take place.

The CDC, by the way, can only make recommendations; it’s a weak substitute for a federal public health program.

With exceptionally good timing, PBS has produced a four-part Frontline program that exposes the limitations of our fifty-state approach and the consequences for the nation’s health. The series explores how public health has increased lifespans and saved countless lives from disease, and how underfunding and the skepticism of science and government place human health at risk.

Consider just one consequences of misinformation: In Florida, measles cases have spiked, partly because of the state’s surgeon general approving of parental defiance of health guidance, and unvaccinated kids exposed to measles being sent to school.

Amid all the challenges we are facing today, public health cannot be set aside for later. It must be an American priority – particularly in the Covid age — and adopting a federal approach is the path to take.

Linda Stamato is a Senior Policy Fellow at the New Jersey State Policy Lab and co-director for the Center for Negotiation and Conflict Resolution at the Edward J. Bloustein School.

Original article published on, June 26, 2024

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