With Congress recently passing trillions of dollars of economic stimulus to keep the United States economy from imploding under the impacts of the COVID-19 pandemic, those of us who have worked in public health preparedness for decades are wondering why we ended up in a position where such an incredible sum is necessary. We have sounded the alarm on political leaders’ dangerous budget cuts to public health and preparedness for years now, and they have ignored the warning.
Now that pandemics finally have our collective attention, here are four steps that Congress must take to reduce our vulnerability to another pandemic like COVID-19.
Fund The Public Health Emergency Fund, and while we are at it, fund public health in general
There is no dedicated fund for public health emergency response like there is for other disasters. Although this kind of funding made a brief appearance in earlier versions of the stimulus bill, it is not in the final version. Outrageously, public health officials have had to transfer money from other programs while waiting on emergency supplemental funds from Congress.
This has played out for COVID-19 and prior public health emergencies, all while funding for public health preparedness is already stretched thin by cuts to as much as half prior levels. Overall public health funding levels have been inconsistent at best, with cuts leading to the elimination of more than 55,000 positions in local health departments between 2008 and 2017. All of this means that there is already little to reprogram into a pandemic response.
The reason money keeps coming up as a core issue among public health advocates is that cuts at the expense of public health and preparedness for more than a decade are the root cause of so many of the public health vulnerabilities we are now witnessing.
State and local health departments are understaffed, which means more delays in identifying the infected, tracing their contacts, and mitigating spread. Increased and stable funding is wholly necessary to prepare us for and to respond to infectious disease events. Funding the empty Public Health Emergency Fund — designed for quick response to infectious disease threats — should be a top priority.
Clarify disaster authorities to be more responsive to pandemics
The Stafford Act, the law that provides federal response authorities for disasters such as hurricanes and earthquakes, clearly allows for infectious diseases to trigger an emergency declaration.
However, it is not clear that infectious disease can trigger a major disaster declaration. This much more expansive definition opens up a much more extensive range of resources that are now being used for COVID-19. Governance is also a weak link: the pandemic response team at the White House created by President Obama, later to be consolidated, and arguably diluted, into another directorate under President Trump, was vulnerable to bureaucratic shuffling because such coordination is not sufficiently defined or required by statute. The lack of apparent authority for biodefense across agencies necessitates explicit White House coordination.
These are just two of the numerous authorities and coordination mechanisms that could be applied in a pandemic. Cleaning up existing disaster declaration authorities and establishing a more cohesive set of laws for biodefense leadership, expectations, and funding are all essential to avoid the confusion we’ve seen for COVID-19 that are costing time, money, and lives.
Establish more robust health care supply chains
The shortage of ventilators and other personal protective equipment is among the least surprising drivers of this current state of emergency. Experts have warned Congress for decades of the certainty of such shortages.
Leaving supply chains primarily to free-market forces that incentivize just-in-time inventories and disparate global supply chains has put all nations in peril, not just the United States. The stockpiles that exist through federal programs may prove emphatically insufficient for COVID-19 and similar pandemics.
Creating a strategic pipeline of production for these essential lines of defense should be given the same strategic consideration and resources afforded to all other elements of our national security, with more support for both emergency production and stockpiling of these essential supplies.
Increase access to health care and sick leave
Millions of Americans without access to health care means that people can’t easily seek care when they are sick, at once a moral and public health issue. It means more people suffer from undiagnosed or under-treated chronic conditions, making them more vulnerable to pandemics and the disruptions they cause.
People without sick leave are less likely to stay home when they are sick, and more likely to be adversely affected when they have no choice but to stay home. The absence of paid sick leave creates more opportunity for diseases to spread and dominoes into larger economic impacts on households and broader society.
Access to health care and paid sick leave is a national security issue. Creating universal access to healthcare and sick leave is no longer a debate about safety nets; it is about protecting us all.
Voters historically reward elected officials at the ballot box for relief rather than preparedness, even when preparedness can have enormous savings by reducing response and recovery costs. But eventually, people are going to get tired of losing jobs, livelihoods, and lives to the complacency of their representatives. They will start asking why so much relief funding — which will never be enough to save many of their jobs — is necessary. Congress has an opportunity to provide essential leadership in this direction. It can’t possibly make up for decades of insufficient action, but it can put us on better footing now for the next pandemic that is sure to come.
Jeff Schlegelmilch is deputy director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute, and the author of the book “Rethinking Readiness: A Brief Guide to Twenty-First-Century Megadisasters.”
Ellen P. Carlin is an assistant research professor at the Georgetown University Center for Global Health Science and Security and director of Georgetown’s Global Infectious Disease graduate program.