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Last week President Joe Biden announced the end of the federal Public Health Emergency for COVID-19, first declared by the administration of President Donald Trump in early 2020.
Biden’s order – a Congressional mandate he signed into law in April – marks the beginning of a transition to regular health providers and insurance for COVID-19 tests, vaccines, and treatments.
The COVID pandemic has taken an unimaginable toll on public health. In the U.S. alone, 1.25 million people lost their lives. There were over 100 million reported cases, of which six million were hospitalized.
Some observers say it is premature to end the federal emergency. Few experts believe the nation’s public health system is prepared for a significantly different variant or a new pandemic. COVID continues to claim one thousand lives a week.
Nevertheless, the American people have moved on. Few wear masks at public gatherings. Thirty percent of the U.S. population are not fully vaccinated for COVID, and only 17% have received bivalent booster shots.
A new study, Lessons from the COVID War: An Investigative Report, assembled by a “Covid Crisis Group” of leaders, experts, and practitioners, reflects on how we got here and where we are going.
Intended as a substitute for a 9/11 Commission-style investigation of the COVID crisis that Congress failed to authorize, the report offers recommendations for handling the next pandemic when it arrives.
Though the study does not spare former President Donald Trump from harsh judgment, it makes clear that any president would have faced massive challenges dealing with a global pandemic.
Fragmented and underfunded, America’s public health infrastructure was ill-prepared for the coronavirus.
While federal agencies such as the Centers for Disease Control and Prevention (CDC) get most of the headlines when a public health crisis occurs, thousands of state, local, and tribal departments form the front line of disease prevention, detection, and mitigation.
Add to this the vast conglomeration of scientists and doctors working in hospitals and labs around the world, some backed by corporations and foundations while others operated independently.
Fortunately, according to the COVID Crisis Group report and the 2021 Michael Lewis book The Premonition, these informal networks, as well as state and local policy entrepreneurs, had a better handle on COVID-19 from the outset than did the U.S. government.
All the actors in the public health community looked to the White House for a national plan to track, combat, and defeat the virus.
However, Trump’s advisors in early 2020 were split on how dangerous the coronavirus was, the COVID report describes. National security staff warned a global pandemic was underway, while public health figures such as Robert Redfield, head of the CDC, and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, were not convinced.
To resolve the dispute, a White House Coronavirus Task Force was formed. Secretary of Health and Human Services (HHS) Alex Azar initially chaired the panel, but he was soon replaced by Vice President Mike Pence.
Blinded by politics and wishful thinking, Trump was privately concerned but publicly downplayed the threat.
Reality intervened when the coronavirus spread rapidly in mid-March 2020, forcing the president to order a national emergency, which led to a lockdown.
With the economy in freefall and the presidential election on the horizon, Trump decided to distance himself from his own government.
Just one week into the national shutdown, the president devolved responsibility for managing the pandemic to the states. This led to cutthroat competition among governors for ventilators and personal protective equipment.
Ironically, at the same time the president abandoned his leadership role, his administration launched Operation Warp Speed, the $30 billion project that produced anti-COVID vaccines by the end of 2020.
Leaders at HHS and the Defense Department, assisted by Trump son-in-law Jared Kushner at the White House, staked and fast-tracked drug trials by pharmaceutical companies racing to be the first to market a vaccine. Insulated from the politics and chaos associated with pandemic management, the undertaking succeeded.
Eventually, partisan divisions emerged on how to protect public health. Encouraged by Trump, Republicans argued for “returning to normal” as soon as possible, opposing closures, mandated masking, and other measures. Later in the pandemic, there was greater vaccine resistance in GOP-controlled states.
Alas, studies show higher COVID death rates among Republicans than among Democrats.
Though the report credits the Biden administration for promoting testing and vaccination, it notes that the U.S. still lacks a national biosurveillance network that provides real-time data on the emergence and spread of infectious diseases.
Furthermore, there is little continuity in public health planning from president to president.
Dealing with crises ranging from the post-9/11 anthrax scare to the Ebola outbreak in 2014, Presidents George W. Bush and Barack Obama made pandemic preparedness a responsibility of the National Security Council.
Regrettably, the Trump White House dismantled what was in place, in effect delegating public health monitoring and operational tasks to the federal bureaucracy. We now know the weaknesses of that arrangement.
Last fall the Biden administration launched a national biodefense strategy, which included large proposed increases in public health spending. Congress has yet to act.
What is needed, Lessons from the COVID War states, is more than just presidential leadership. There must be a “fundamental shift toward preparedness” across governmental, private, and non-profit institutions, nationally and globally.
Sorry to say, the next pandemic could be worse.
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