NAS Members Say US Was Prepared for Pandemic but Lacked Leadership

WASHINGTON — The National Academies of Sciences, Engineering, and Medicine hosted a two-day workshop this week, during which academy members examined the future of the public health emergency enterprise and what exactly went wrong with the U.S. public health response during the initial days of the COVID-19 pandemic. 

“In the room, right behind me, in 2009, we were convened … to address the questions of what should the standards of care be if [we] were to face a catastrophic health emergency,” said Ali Khan, dean of the College of Public Health at the University of Nebraska Medical Center, and a former assistant surgeon general with the U.S. Public Health Service, as he stood in front of two wooden doors located inside the NAS Building.

“We developed a systems framework for catastrophic health care response that is better known as Crisis Standards of Care, which became a critical component of the response over the last two years,” continued Khan.

The question that Khan said has come up is, “What happened to the plans?”

According to Khan, there were plenty of pandemic preparedness plans that existed 20 years before the COVID-19 pandemic outbreak— from the Biologic Annex, the 2018 Pandemic Crisis Action Plan, or the Presidential Playbook for Early Response to High-Consequence Emerging Infectious Diseases.  

“[It] wasn’t for the lack of plans. Those existed …what didn’t exist, what we were missing — was more imagination, better leadership that was focused on this issue. We were missing centralized authority and responsibility across this broad enterprise of preparedness … and that put us where we were in January 2020,” said Khan.

According to Khan there was a 15 to 20% decline in the public health workforce nationally, state and locally in 2020.

Many scientists attending the NAS event said the failures in supporting the public health workforce can be referred to as the “boom and bust cycle” of the U.S. public health system during the COVID-19 response — where emergency funding supported an already underfunded public health system in a series of one-time boosts, but left the system dry of funding for responding to future pandemics. 

“This year we had wild fluctuations because of the states providing short-term funding for the COVID response. You saw some states with over 100% increase, and that’s a problem,” said Dara Lieberman, director of Government Relations Trust for America’s Health, during the NAS workshop.

“You’re neglecting that system every year, and then all of a sudden, providing short-term funding and thinking that the problem is solved,” said Lieberman.

Lieberman said there are about 80,000 full time equivalent workers needed in public health to provide basic and foundational public health services.

“That’s not something that can be solved with short-term funding,” said Lieberman.

“We’re continuing to receive these comments in Congress as we go to talk about public health funding and not just emergency funding right now, but the basics of what we need to be supporting public health to … prevent chronic disease, to prevent the opioid crisis, and to try to save lives across a range of different threats,” said Lieberman.

“[Congress] thinks that because there has been short-term COVID money available, then you don’t really need to fund public health anymore … public health isn’t the answer to all of it, but it certainly needs to be part of the solution, and starving it for many decades has not helped,” continued Lieberman.

Alexa can be reached at [email protected]