Although there will hopefully be some sort of respite between the end of COVID and the start of the next global health crisis, over the past two decades we've seen a remarkable number of new disease threats emerge each year (see HAIRS timeline above), and the pace appears to be accelerating.
Avian H5N1 remains at the top of our worry list, but we could just as easily be blindsided by another novel (swine or avian) influenza virus, a henipavirus like Nipah, Hendra, or Langya, a new coronavirus variant, or something from out of left field.
Coming off the deadliest pandemic in a century, there are natural concerns over the identity of the next disease threat, but natural disasters (earthquakes, hurricanes, drought, solar storms, etc.) can also test our preparedness.
Once a year TFAH.org (the Trust for America's Health) issues a detailed report on the readiness of America's public health system to respond to a variety of threats (see here, here, and here), and today they released their 20th review.
This 76-page report not only ranks each state in terms of their ability to respond to a public health emergency, it provides recommendations on what steps are needed to improve the nation's response.
This year’s report ranks 19 states and DC in top tier, 16 states in the middle tier, and 15 states in the low tier.
The press release for this TFAH report follows. I'll have a postscript when you return.
Strengthen the Nation’s Public Health System
Sustained Investment in Public Health Infrastructure and Preparedness is Needed to Protect Lives During Disease Outbreaks and Natural Disasters
(Washington, DC – March 23, 2023) – As infectious disease outbreaks and extreme weather events threaten the health of more Americans, a new report shows the need for strengthened national and state public health emergency preparedness.
Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, measures states’ readiness to respond to a spectrum of health emergencies and to provide ongoing public health services. The report gives federal and state health officials and policymakers actionable data and recommends policies to improve the nation’s emergency preparedness at a time when health emergencies are increasing. During 2022, the U.S. surpassed 1 million deaths due to COVID-19 and saw decreasing rates of routine vaccinations and increasing prevalence of health misinformation. In addition, the past year was the eighth consecutive year the U.S. experienced 10 or more billion-dollar weather-related disasters.
The report tiers states and the District of Columbia into three performance levels for health emergency preparedness: high, middle, and low. This year’s report placed 19 states and DC in the high-performance tier, 16 states in the middle performance tier, and 15 states in the low performance tier.
High Tier – 19 states & DC
CO, CT, DC, DE, FL, GA, KS, ME, MD, MA, MS, NJ, NC, OH, PA, UT, VT, VA, WA, WI
Middle Tier – 16 states
AK, AL, AR, CA, IA, ID, IL, IN, MO, ND, NE, NH, NY, RI, SC, TX
Low Tier – 15 states
AZ, HI, KY, LA, MI, MN, MT, NM, NV, OK, OR, SD, TN, WV, WY
“Increased and sustained investment in public health infrastructure, emergency preparedness, and health equity will save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Federal, state, and local officials as well as leaders in the healthcare and business sectors should use our findings to identify and address gaps in public health preparedness. Neglecting to do so will mean that the country will not be as prepared as it needs to be for the next public health emergency.”
The report’s findings showed both areas of strength within the nation’s public health system and areas that need attention.
Areas of strong performance include:Areas that need attention include:
- A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency.
- Most states are accredited in the areas of public health or emergency management. Some states are accredited in both.
- Most U.S. residents who received their household water through a community water system had access to safe water. However recent water system failures in Jackson, Mississippi and Newark, New Jersey demonstrate the importance of continued attention to the integrity of municipal water systems.
The report contains recommendations for policy actions that would create a stronger public health system at all levels, including:
- Too few people were vaccinated against seasonal flu last year despite significant improvement in flu vaccination rates in recent years. During the 2021-2022 flu season, 51 percent of Americans ages 6 months or older received a flu vaccine, well short of the 70 percent goal established by Healthy People 2030.
- Only half the U.S. population is served by a comprehensive public health system. Comprehensive public health systems ensure that necessary health services are available to all residents.
- Only 26 percent of hospitals in states, on average, earned a top-quality patient safety grade in 2022. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention.
Read the full report
- The Administration, Congress, and state lawmakers should modernize public health infrastructure, including by investing $4.5 billion annually to support foundational public health capabilities. In addition, Congress should continue to increase funding for the Public Health Emergency Preparedness cooperative agreement and public health data modernization to allow for earlier and more accurate detection of emerging health threats.
- Policymakers at all levels should act to protect and strengthen public health authorities and should prioritize rebuilding trust in public health agencies and leaders.
- Congress and state legislatures should invest in effective public health communications, including countering misinformation.
- Congress and states should ensure first-dollar coverage for all recommended vaccines under commercial insurance and for uninsured people. States should minimize vaccine exemptions for school children, and healthcare facilities should increase rates of vaccination for healthcare workers.
- Congress and states should provide job-protected paid leave for employees due to illness or family caregiving demands.
- Congress and states should invest in policies and capacity to address the social determinants of health such as secure housing, access to transportation, and access to healthy food.
- Congress should fund the entire medical countermeasures (MCM) enterprise, including the distribution and dispensing of MCMs. Congress should also create incentives for new products to prevent and fight antibiotic-resistant infections.
- Congress and states should strengthen readiness for climate change, extreme weather, and environmental health threats.
Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.
While there is still plenty for governments, agencies, and even the private sector to do to prepare for the next public health crisis, the biggest obstacle may lie in a pandemic weary, and increasingly skeptical public, many of whom now favor conspiracy theories over vaccines.
Fewer than 18% of the American public opted to get the new COVID booster released last fall, and the uptake of this year's flu vaccine (as of Feb.) was 2.3% less than in 2021.
While some of this mistrust has been rightfully earned (see When Scientists Behave Badly), much of it is has been stoked by the echo chamber of social media, whose primary interest appears to be fomenting outrage to get more monetized clicks.
Regardless of any progress that has been made, restoring the public's faith in the system may be the biggest pandemic challenge of all.
