State funding for public health departments has dropped by 16 percent since 2010, and these same departments have lost a quarter of their workforce in the last decade.
How can the United States adequately prepare for the next pandemic when the public health infrastructure is woefully underfunded? U.S. Sen. Patty Murray (D-WA) asked this question during her opening remarks this week in a congressional hearing by the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP).
In “The Path Forward: Building on Lessons Learned from the COVID-19 Pandemic,” experts gave testimony outlining the ways in which the current pandemic exposed holes in our existing public health system and explained ways the United States could lead the world in biotechnology to prevent future pandemics.
Just as public health departments suffer from inadequate staffing, so do hospitals and clinics with shortages of nurses. According to the National Institutes of Health “the nursing profession continues to face shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution.” In testimony to the committee, David Janz, director of Medical Critical Care Services at University Medical Center New Orleans, said nurses have shouldered the heaviest load in COVID-19 response and are leaving the profession at high rates. In a report by Vivian Health, 43 percent of nurses are considering quitting the profession this year, while 72 percent report hospital morale has worsened during the pandemic.
“In my specialty of critical care medicine, 48 percent of ICU nurses are considering leaving health care,” Janz said.
The U.S. Bureau of Labor Statistics projects that 11 million additional nurses are needed to prevent a further shortage.
Studies of health care workers during the pandemic show they face a high risk of developing mental health problems comparable to that of other disasters such as the September 11th attacks or Hurricane Katrina, and one of the reasons they are leaving their professions, Janz added.
Whereas COVID-19 has pushed nursing and hospital systems to the brink, New Orleans experienced a bright spot regarding communication of medical needs during the pandemic. In March 2020, the coronavirus outbreak in New Orleans paralleled that of the Lombardy region of Italy, as both areas witnessed a rapid influx of patients and severely strained medical systems. However, real-time information out of Italy helped medical professionals in New Orleans in planning a response to a surge of patients, especially in forecasting ICU demands, Janz said.
Regarding communication in general, some senators questioned how equitable the current climate was for outreach. Although telehealth has undoubtably helped many Americans more conveniently see their physicians during the pandemic, U.S. Sen. Tim Scott (R-SC) told the committee that one in four people in rural South Carolina cannot connect to the internet, making outreach regarding COVID-19 vaccination difficult in those regions.
Health communication and technological hurdles were continued problems this past year in many communities across the United States. Some of the data systems in operation were built 20 to 40 years ago and are slow and not adaptable to today’s world.
“Our systems don’t talk to each other. Interoperability is the biggest challenge,” said Les Becker, Deputy Secretary of Innovation at the Washington State Department of Health. “It is critical that we operationalize rapidly configurable systems with the capacity to capture data quickly and share case data across states in a standardized way.”
He added that record-keeping should be moved to the “cloud” as Washington’s Department of Health has done.
Becker called for federal funding for electronic case reporting to initiate broad-scale, secure reporting from electronic health records in clinical care organizations to public health agencies across all jurisdictions and to the Centers for Disease Control and Prevention. He said supporting interoperable and intelligent real-time reporting from multiple sources and eliminating paper-based reporting is vital.
During the pandemic, some tribal communities in Washington were still using paper to report to state health agencies.
Where some systems are old and outdated, others are left to be desired. The United States has no centralized database to track outbreaks in schools, nor does the nation have real-time data to know when someone is infected or which coronavirus variant they are infected with. Congress has appropriated $1 billion for data modernization across the CARES Act and the American Rescue Plan, but it will take years for the country to update its public health data infrastructure, said Anita Cicero, Deputy Director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.
“What does a more proactive strategy for public health infrastructure look like? Given sufficient resources, people, and modern IT systems, public health agencies at the local and state levels could be seamlessly connected to health care providers and labs and collect more accurate, standardized, real‐time data. We need to leave the disjointed, local reporting systems behind and develop uniform systems for reporting on testing, positive cases, hospitalizations, and deaths,” Cicero said.
There is $500 million in the American Rescue Plan for the National Center for Epidemic Forecasting and Outbreak Analytics. The epidemic forecasting center should be included in annual appropriations, she added.
Innovation for Pandemic Realities
The United States may not know when the next pandemic will occur, but the panelists said the nation can ready itself for evolving threats.
“We should aim for creating a pandemic‐free future,” Cicero said. “Investing $30 billion over the next four years to improve pandemic preparedness, as called for in the American Jobs Plan, would get us on a more solid footing by bolstering our public health capabilities, innovation, and biomedical preparedness to better protect Americans.”
To accomplish this, Cicero proposed the creation of a “Disease X” Medical Countermeasures Initiative to combat the next unknown deadly virus through sustained federal funding of the Biomedical Advanced Research and Development Authority (BARDA), and in coordination with the U.S. Department of Defense. It is not possible to identify a specific virus that may be likely to cause the next pandemic. However, it is possible to identify viral families with high lethality and develop technologies and vaccine platforms at large scale to work against these groups.
There’s also opportunity to improve preventative tools such as developing superior masks that are reusable and better fitting for long stretches. When it comes to at-home diagnostics for infectious disease, the detection they provide could serve as an early warning surveillance for disease threats.
Such threats also include zoonotic diseases, or those diseases that can jump from animals to humans. Congress should improve CDC surveillance by expanding the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Division of Vector-Borne Diseases’ ArboNet system. This would improve ongoing data collection and analysis of vector-borne diseases, within our borders or from returning travelers into the United States.
Moving Funding Forward
Phyllis Arthur is vice president of Infectious Diseases and Diagnostics Policy at the Biotechnology Innovation Organization. BIO is the world’s largest trade association representing biotechnology companies, academic institutions, state biotechnology centers and related organizations in the United States and more than 30 nations, she said.
“We know that periodic threats, such as a 100-year pandemic like COVID-19, will occur but each individual threat has such a rare occurrence rate that commercial markets for such countermeasures do not exist,” Arthur said.
BARDA—whose mission is to develop 21st century medical countermeasures with industry partners— has a portfolio that’s grown to include 61 approved products, but funding levels for Health and Human Services Assistant Secretary for Preparedness and Response (ASPR) and BARDA initiatives have remained largely stagnant over the past decade, she added.
Despite the success of Operation Warp Speed and the current White House COVID-19 Taskforce, Arthur also questioned why the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) wasn’t utilized in developing and distributing vaccines.
“BIO believes a stronger PHEMCE could have accomplished similar goals without the delays of building new organizational structures,” she said.
Yet, funding for PHEMCE is lacking in President Joe Biden’s fiscal year 2022 budget, according to Arthur, who said that many products—including those for biological threats like smallpox and anthrax— have not been replenished in the Strategic National Stockpile (SNS). PHEMCE establishes an annual review for the SNS which provides guidance for budget creation and the procurement of medical countermeasures.
“That is why the U.S. Government, through BARDA, the Project BioShield Special Reserve Fund (SRF), and the Strategic National Stockpile (SNS), must invest in and procure the necessary MCMs to be ready for the next pandemic and other biological threats,” she said.