[Has public health failed us? Or have we failed public health?]
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PANDEMIC YEAR 3: WHO’S GOT THE POWER?  
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Gregg Gonsalves
December 1, 2022
The Nation
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_ Has public health failed us? Or have we failed public health? _

President Joe Biden receives his updated Covd-19 booster at the White
House on October 25, 2022, in Washington, D.C. ,

 

Here comes our third year of living and dying with Covid-19.

We started this 2022 festive season on Thanksgiving with pediatric
intensive care beds gobbled up by a triple-demic
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SARS-CoV-2, influenza, and respiratory syncytial virus (RSV); a new
set of Covid-19 variants, BQ.1 and BQ.1.1
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hobbling the effectiveness of key treatments for the
immunocompromised; and only a third of Americans
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received a vaccine and the original boosters—and only about 10
percent
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up for the new “bivalent” boosters in the United States.

Meanwhile, administration officials continue to talk out of both sides
of their mouths, saying we shouldn’t worry
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Covid-19 this winter, that “we have the tools
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to handle the combined whammy of Covid-19, the flu, and RSV, while
simultaneously making desperate pleas
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more Covid-19 funding from Congress, seemingly baffled that after
months of their downplaying the seriousness of the pandemic, no one
seems to think Covid-19 is a problem anymore. A dozen Democrats joined
Republicans in the Senate in voting to rescind
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national emergency declared in response to the Covid-19 pandemic in
2020.

Yet we keep hearing that public health has failed us during this
pandemic. From right
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from print journalists to talking heads, the mess we’re in gets laid
at the feet of those of us working in the field—as if we have any
influence on the circus going on in Washington, D.C., or in
statehouses across the country, where quacks like Florida’s surgeon
general, Joe Ladapo, spout nonsense about vaccines
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Lynn Freedman, at the Columbia Mailman School of Public Health, who
was a senior adviser to the Millennium Project Task Force on Child
Health and Maternal Health, was also the lead author on the final
report of that group in 2015, “Who’s Got the Power: Transforming
Health Systems for Women and Children
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To paraphrase Dr. Freedman’s words, any serious strategy to change
the state of American health, in particular in regards to Covid-19,
needs to ask, answer, and confront a singular question: “Who’s got
the power?” In the United States, it’s not public health who has
the power. Not at all.

We came into this pandemic with a weak and feeble public health
system, understaffed, under-resourced—mostly by design, as the late
Elizabeth Fee and her colleague Theodore Brown have described
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which we mostly ignore public health, frantically try to mobilize in
the midst of crises, and then wonder why we end up doing so badly
again and again. It shouldn’t be surprising that, as Alyssa Bilinski
from Brown School of Public Health, along with Kathryn Thompson and
Zeke Emanuel, reported
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Journal of the American Medical Association_ this month, “the US
continued to experience significantly higher Covid-19 and excess
all-cause mortality compared with peer countries during 2021 and early
2022, a difference accounting for 150,000 to 470,000 deaths.”

It’s not public health that has failed us for the past three years.
Rather, American political leaders have been failing public health for
over a century. They pretended we could deal with public health one
person at a time, fixing them up in our hospital wards, emergency
rooms, and doctors’ office. As Hibbert Hill suggested in 1913
in_ The New Public Health
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treating a few thousand victims of disease is far cheaper than dealing
with the structural causes of ill health. Contemporary commentators
following Hill, like Josh Barro
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on any idea that more communitarian approaches to public health have
any role in an individualistic America, trashing public health experts
as tin-pot tyrants pushing a political agenda, rather than
acknowledging that it is communitarian solutions that gave him clean
water to drink and clean air to breathe, and that have
been fundamental
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health success since John Snow pushed local officials to take the
handle off the Broad Street pump
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in what Barro would probably decry as interference in the free
exercise of commerce and the private provision of water in
19th-century London. It’s this kind of libertarianism—the
you-do-you ethos of American culture that sees the “public” in
public health as anathema, clinging to a medical model
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risk and private cures—that dropped us down to the 40s in global
life expectancy rankings before the pandemic, and will land us below
the 60s by 2040
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“Give me liberty _and _give me death” is the reigning mantra of
America today.

Instead, I would harken back to one of Hibbert Hill’s
contemporaries, who had a more nuanced view
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freedom: “Real liberty for all could not exist under the operation
of a principle which recognizes the right of each individual person to
use his own, whether in respect of his person or his property,
regardless of the injury that may be done to others.” This was
Supreme Court Justice John Marshall Harlan, who wrote the opinion
in _Jacobson v. Massachusetts_ in 1905 upholding vaccine mandates.
Of course, nowadays the courts have become more hostile to public
health protections, overruling expert opinion again and again
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So remind me: Who’s got the power in 2022?

What might “public health” do if it had the power to influence
agendas, rather than have its best experts make post hoc
justifications for politicians they work for? Jeffrey Lazarus and 385
co-authors told us
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world’s premier scientific journals, _Nature_, in November (and
full disclosure, I was part of this process). Lazarus and his team
offer a road map, which will never be followed—but at least it will
show us the road not taken when we look back on this moment.

First, these authors state: “SARS-CoV-2 still moves among
us—despite some governments moving on—requiring continuing efforts
and resources to save lives.” Such a simple statement. No
downplaying the threat of variants with quips like “Omicron is mild
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or suggesting
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will equate to lower disease severity. Indeed, they warn against such
ideas, and make a clear appeal to take long Covid seriously as a
chronic condition. This all seems so obvious, but with the president
of the United States proclaiming that the pandemic is over, these
words are a tonic.

And while US officials refuse to stand up for a comprehensive approach
to the pandemic, these authors just come out and say it: “Vaccines
are an effective tool against Covid-19 but will not alone end Covid-19
as a public health threat.” Even in the midst of the triple-demic of
Covid-19, flu, and RSV, administration officials still refuse to talk
about much more than the need for vaccination—though millions of
Americans remain unvaccinated for Covid or the flu. In
November, another important scientific article
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in _The New England Journal of Medicine_ suggesting that the failure
to mask in schools in Massachusetts led to thousands of needless
infections. The authors in the _Nature_ article (unlike US
policy-makers) do not shy away from calling for the use of
masks—along with robust testing efforts, upgrading of ventilation
and air filtration, and financial support for those affected by
Covid-19. In fact, they call for a whole-of-society and
whole-of-government approach to the pandemic, even as our own leaders
are driving us toward a minimalist response, blaming Congress for
their failures, but with their own gaze clearly focused on
the political expediency
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putting the pandemic behind us.

_GREGG GONSALVES is The Nation's public health correspondent and
codirector of the Global Health Partnership and an associate professor
of epidemiology at the Yale School of Public Health.  A cofounder of
the Treatment Acton Group, he was the winner of a 2018 MacArthur
fellowship. _

_Copyright c 2022 THE NATION. Reprinted with permission. May not be
reprinted without permission
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Distributed by PARS International Corp
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Please support  progressive journalism. Get a digital subscription
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* public health
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* COVID-19
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* influenza
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* RSV
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* vaccines
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* pandemics
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