Healthcare’s Neglected Stepchild

The current crisis should result in a renewed and sustained commitment to public health.

There’s nothing like a pandemic to point out the weaknesses in this country’s health care system. For example, those who previously supported single-payer health insurance have suggested that coronavirus raises the stakes on the need for Medicare for All, as proposed by Bernie Sanders.

What hasn’t been addressed is the way in which we have neglected the step-child of our health care system: public health. These days, most of that conversation has focused on the Strategic National Stockpile managed by the Department of Health and Human Services. But public health offices at the local and state level, as well as nationally, have a broad mandate.

While traditional health care providers treat individuals who are sick, public health professionals deal with the community conditions that affect our health. Here is how the American Public Health Association defines their work.

From conducting scientific research to educating about health, people in the field of public health work to assure the conditions in which people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease. Or educating people about the risks of alcohol and tobacco. Public health sets safety standards to protect workers and develops school nutrition programs to ensure kids have access to healthy food.

Public health works to track disease outbreaks, prevent injuries and shed light on why some of us are more likely to suffer from poor health than others. The many facets of public health include speaking out for laws that promote smoke-free indoor air and seatbelts, spreading the word about ways to stay healthy and giving science-based solutions to problems.

As you can see, dealing with infectious diseases is just one of the many community concerns addressed by public health professionals. In that particular arena, they are on the front lines of testing and tracking the spread of infectious diseases like coronavirus. I encourage you to check whether your city or county has a local public health department, because that could be a key factor in dealing with the current crisis.

When it comes to preparing our national public health system for pandemics, presidents have been both hot and cold on making it a priority. Bill Clinton is the president who created the Strategic National Stockpile. As the story goes, he read the novel The Cobra Event by Richard Preston, which was published in October 1997. As a result, he became deeply concerned about the prospect of bioterrorism, and included $51 million in the 1998 budget for “pharmaceutical and vaccine stockpiling activities at the Centers for Disease Control and Prevention.”

Following  9/11, bioterrorism continued to be the focus of concern, especially given the numerous anthrax attacks. But in the summer of 2005, then-Senator Barack Obama teamed up with Richard Lugar to write, “Grounding a Pandemic,” which was published in the New York Times.

When we think of the major threats to our national security, the first to come to mind are nuclear proliferation, rogue states and global terrorism. But another kind of threat lurks beyond our shores, one from nature, not humans—an avian flu pandemic. An outbreak could cause millions of deaths, destabilize Southeast Asia (its likely place of origin), and threaten the security of governments around the world.

Obama and Lugar went on to recommend a permanent framework for curtailing the spread of future infectious diseases that included the following.

Increasing international disease surveillance, response capacity and public education and coordination, especially in Southeast Asia.

Stockpiling enough antiviral doses to cover high-risk populations and essential workers.

Ensuring that, here at home, Health and Human Services and state governments put in place plans that address issues of surveillance, medical care, drug and vaccine distribution, communication, protection of the work force and maintenance of core public functions in case of a pandemic.

Accelerating research into avian flu vaccines and antiviral drugs.

Establishing incentives to encourage nations to report flu outbreaks quickly and fully.

That fall, members of the Bush administration report that, after reading John M. Barry’s The Great Influenza, the president created a national pandemic plan that included “diagrams for a global early warning system, funding to develop new, rapid vaccine technology, and a robust national stockpile of critical supplies, such as face masks and ventilators.”

Bush set out to spend $7 billion building out his plan. His cabinet secretaries urged their staffs to take preparations seriously. The government launched a website, www.pandemicflu.gov, that is still in use today. But as time passed, it became increasingly difficult to justify the continued funding, staffing and attention, Bossert said.

Barack Obama didn’t have to read a book to heighten his concern about a possible pandemic. The H1N1 flu became a reality not long after he was inaugurated. Over the course of his presidency, Obama also faced the Ebola crisis and an outbreak of the Zika virus.

In his ongoing attempts to find someone to blame for his own failures, Trump has often suggested that Obama left the reserves of the Strategic National Stockpile depleted. While his claim that the shelves were emptied is a massive exaggeration, there is some truth to his claims. During the H1N1 outbreak, the protective equipment in the stockpile was deployed and not replaced.

But as ProPublica documented, it was the Tea Party’s obsession with budget deficits and Obamacare—combined with the Republican focus on obstruction—that led Congress to deny the funding requested by the administration to restock the supplies. Eventually, public health officials had to make a difficult decision.

With limited resources, officials in charge of the stockpile tend to focus on buying lifesaving drugs from small biotechnology firms that would, in the absence of a government buyer, have no other market for their products, experts said. Masks and other protective equipment are in normal times widely available and thus may not have been prioritized for purchase, they said.

It was during the 2014 Ebola crisis that Obama made an argument for a bipartisan approach that would ensure America’s leadership role in fighting pandemics—the opposite of Trump’s “America first” approach.

By now, we all know that not only did Trump disband the pandemic response team established by Obama, the incoming administration ignored the exercise Obama’s team walked them through on responding to a pandemic and threw out the playbook they had developed for dealing with a pandemic.

The crisis we now face should result in a renewed and sustained commitment to public health at the global, national, and local level. We’ve learned the hard way that healthcare reform without that focus is simply a recipe for yet another disaster.

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Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly. Follow her on Twitter @Smartypants60.