Before the COVID-19 pandemic began, leading health experts saw the United States as one of the countries best positioned to deal with an outbreak of infectious diseases. That 2019 Global Health Security Indexas the benchmark of each nation’s health security contingency, the United States ranked as the number one country out of 195. Now that the world is entering the third year of COVID-19, it is clear that the United States was in fact ill-prepared for a real pandemic.
The number of Americans reported to have died of COVID-19 is 63 percent higher than any other high-income country. USA death rate stands at 295 deaths per. 100,000 people, compared to 245 per. 100,000 in the UK, 152 pr. 100,000 in Germany and 99 per. 100,000 in Canada. There are many reasons for the faltering American reaction, which will be dissected in detail over the coming years. They range from communication challenges that have fueled an avalanche of misinformation, to a vaccine campaign that follows Australia, Canada and many European countries. The fragmented public health infrastructure in the United States was not built or resources to withstand or respond to large-scale public health emergencies. And then there are the challenges with the U.S. health care system itself, issues that existed long before COVID emerged: access to care, health inequalities, and the underlying health condition of Americans.
If one examines the world to see how different countries responded to the many waves of COVID-19 over the last two years, there are some practices that shine brighter than the rest. No country has had a perfect pandemic response. China’s zero-COVID policy, for example, has resulted in low morbidity and mortality rates in the first two years of the pandemic, but it has come at a high price. It involves social isolation, a continuous cycle of lockdowns and the curtailment of individual freedoms. And now, with the highly contagious Omicron variant – and all its descendants, including the more transferable BA.2 variant – it seems highly unlikely that this strategy will continue to work. Other regions that have successfully cured the virus over the first two years are now dealing with large numbers of cases and rising deaths, such as in South Korea and Hong Kong. While the United States can learn a great deal from COVID responses around the world, it should focus on a few key actions that it would be politically and legally possible for it to carry out, including addressing misinformation and improving science communications. confidence in government and improvement of the U.S. public health data infrastructure, to name a few.
SWABS AND SHOTS
In most of the pandemic, the United States did not test enough. But with the expansion of production and the increased distribution of rapid antigen tests, U.S. officials can now credibly claim that anyone who wants a test can get one. That was not the case in November, when the Omicron variant was gaining momentum in the US and demand rose sharply. This demand has since fallen, which has contributed to the abundance of tests now available. However, ubiquitous testing was available in most of Europe much earlier and often at minimal or no cost. The value of rapid testing as a public health tool was recognized much earlier in many European and Asian countries. It was used to identify infected people, cut down on infection chains and reduce quarantine periods for international travelers. This framework for testing, along with the removal of barriers such as cost and access, made rapid antigen testing as routine as brushing teeth in places like Germany, Slovakia and the UK. This culture of frequent testing allowed COVID-positive people to quickly limit their exposure to others. Had the United States incorporated frequent rapid antigen testing earlier in the pandemic and enabled a faster regulatory approval process for new tests, it could have been able to avert some of the nearly 80 million confirmed COVID-19 cases – which in turn would have prevented some of the 969,000 US COVID deaths.
Now the question is no longer availability or supply, it is whether the United States can maintain test capacity with ongoing funding levels – money that is now being chopped up in Congress. With vaccines, the United States has been ahead of the rest of the world in terms of supply. But even with three safe and effective COVID-19 vaccines, millions of eligible Americans remain unvaccinated. By March 21, approximately 18 percent of the population had not yet received a single dose.
The vaccination campaign has been fraught with challenges: hesitation with vaccines, misinformation and misinformation politicization public health and widespread anti-scientific attitudes. With 65 percent of the population fully vaccinated and only 29 percent updated with boosters, the United States is rows in 65 and 70 place in the world. The United Arab Emirates is 98 percent vaccinated and 50 percent boosted; Portugal is 92 percent and 61 percent; and Canada is 83 percent and 48 percent.
No country has had a perfect pandemic response.
In addition to barriers to entry, such as being free to be vaccinated or having to travel to get a dose, one major reason the United States is lagging behind in terms of vaccination rates, low government confidence, and lack of cohesion in society. One recently investigative analysis by COVID-19 National Preparedness Collaborators demonstrated the importance and impact of trust in government and trust in local communities, which correlated with high COVID-19 vaccine coverage among middle- and high-income countries.
Effective dissemination of evolving knowledge about a new communicable disease in a way that informs, inspires trust in the government and enables the public to take the necessary steps to protect families and communities has become one of the most complicated and difficult aspects of pandemic reaction. All countries have struggled with this, although some started with stronger confidence in the government. Other countries benefited from their previous experience with viral outbreaks. Understanding the danger COVID made them more willing to act quickly. What has been clear is that honest, regular communication with the public from trusted messengers has been critical. New Zealand and Germany have had particular success in their efforts to provide their public with reliable information based on science. With a crisis communication style rooted in empathy, honesty and openness, the messenger and message were well received. But just as important as this has been, crisis communication is still under-studied, and few public health officials are adequately trained in it, especially in how to deal with disinformation. Prioritization of communication must become a priority for all countries and should be an integral part of advanced education in any scientific, medical and public health discipline.
WARS OF INFORMATION
One of the biggest shortcomings of the U.S. pandemic response has been relying on other countries’ clinical and epidemiological data to make localized public health policy decisions, such as who should receive a booster dose. Vaccination data on booster demand from Israel, for example, has been leading as a test case for the United States. The lack of standardized data collection and real-time reporting and interpretation in the United States represents one of the country’s most serious pandemic shortcomings, and it has been known for decades. Former directors of the Centers for Disease Control and Prevention wrote earlier this month that “for far too long we have neglected our country’s public health data infrastructure, much of which is aging, outdated and insufficient to meet our needs … Progress was limited due to both lack of funds and lack of legal authority. ” The different ways in which public health authorities collect and store data combined with privatized healthcare creates challenges for integrating clinical and epidemiological data. Many public health and healthcare systems are not connected and there is limited interoperability to share critical data. In contrast, countries with nationalized healthcare, such as the United Kingdom, benefited greatly from their standardized procedures and their ability to conduct large clinical trials. Other countries, including Denmark, Israeland South Korea has also been at the forefront of sophisticated monitoring systems and real-time reporting. Efforts are underway in the United States to think about how to tackle this challenge, such as encouraging and improving data sharing and devising new strategies for large-scale clinical trials.
To follow virus as it develops has been a challenge for the United States. Mike Ryan, Executive Director of the Health Emergencies Program at the World Health Organization, said it best: “Speed trumps perfection. Perfection is the enemy of good when it comes to emergency preparedness.” The United States has often been too late to implement policy measures, including non-pharmaceutical interventions such as mandates. For example, the initial federal mask mandate for public transportation went into effect in February 2021, shortly after the Biden administration took office, a full year after the pandemic. It has also been slow to ease key pandemic products, such as the Food and Drug Administration’s sluggish approval of rapid home tests and its late recognition of their usefulness as a public health tool. At the same time, the United States has been quick to scale down other measures, such as lifting mask ordinances in certain states or reduction of monitoring tests. The U.S. bottom-up approach has led to an uncoordinated, uncooperative response, regardless of the federal government’s efforts to provide guidance. Instead, the United States has 50 epidemics – one different in each state.
Places that implemented rapid responses to COVID-19, such as Taiwan, Singapore, and Hong Kong, have previous experience dealing with pandemic threats, such as SARS 20 years ago and the continuing threat of bird flu. This previous outbreak experience built muscle memory on what to do when a pandemic strikes, enabling these countries to start with a robust level of trust from the population. One can only hope that the US experience with COVID-19 will similarly lead to better instincts the next time it faces a contagious disease threat.
THE NEXT CHAPTER
And now the United States is entering the third year of the COVID-19 pandemic and experiencing what is equivalent to a mass accident every day from COVID-19. Although many consider this current period a break, more than 1,000 deaths are still reported every day. Now is the time to prepare for future increases and stay on top of this virus. The Biden administration’s COVID-19 contingency plan does just that by focusing on four main objectives: protecting against and treating COVID-19, preparing for variants, preventing economic and educational shutdowns, and continuing to vaccinate the world. However promising this national plan may be, funding for it was removed from the US Government’s spending package, and it is not certain that an independent, supplementary bill will be passed. The consequences of Congress’ passivity for the American public can be serious.
There is a lot of work to be done in the United States, including revolutionizing and investing in public health infrastructure, bridging the gap between data integration from different health systems, and changing the country’s reactive approach. The necessary changes are frightening. It will require the restoration of a collective sense of community and the restoration of trust in government. It will also require a renewed commitment to public health and health workers, who are still embarking on two years of uninterrupted emergency preparedness with morale at an all-time low. All of this will require political leadership and resources. The United States’ chewing gum and Band-Aid approach to pandemics should end with this one.