Preparing For The Next Pandemic Needs To Start Now

IRA FLATOW: This is Science Friday. I’m Ira Flatow. For many of us, our first pandemic has been this COVID-19 one. But the US has a long history of public health crises. AIDS, measles, the flu, they’re all illnesses that left lasting impacts on the country.

You would think then that the country would be better prepared to deal with public health crises since they happen not infrequently. Well, you would be wrong. A new article in The Atlantic explores the country’s gaps in public health preparedness and why many experts saw the country’s mishandling of the pandemic coming a mile away. The article is called We’re Already Barreling Toward the Next Pandemic. It was written by my guest, Ed Yong, science reporter for The Atlantic, based in Washington. Ed won a Pulitzer Prize last year for his coverage of the COVID-19 pandemic.

Also joining me is Dr. Gregg Gonsalves, global health activist and epidemiologist at Yale in New Haven, Connecticut. Welcome to the show.

GREGG GONSALVES: My pleasure.

ED YONG: Thanks for having me.

IRA FLATOW: Ed, let me give you the first question here. A lot of people are going to be wondering why we’re already talking about the next pandemic when this one isn’t even over yet. Why did you decide to write about this now?

ED YONG: Well, I sympathize with those people. And I’m sure we all want to just never have to think about this again, and I certainly don’t. But I think that history tells us that if we take that attitude, we are doomed to making the same mistakes. For a very long time now, the US and the world at large has been trapped in the cycle of panic and neglect where a new epidemic hits, everyone pays attention, investments flow in, the right moves are made to make us a little better prepared the next time. But those moves eventually get eroded. People forget. Complacency settles in. And we enter these Sisyphean cycles where we never get any better at dealing with the next crisis.

And the next crisis is surely upon us. More epidemics are imminent. And there’s no guarantee that we’ll have the luxury of facing just one at a time. So sadly we have to walk and chew gum at the same time. We have to control this current pandemic while also trying to prepare ourselves for whatever is to come next.

IRA FLATOW: Can you give me an example of what you’re calling a Sisyphean cycle of panic and neglect.

ED YONG: Sure. So you look at just the recent history of the last decade or so. After the Ebola outbreak in West Africa, people paid huge attention to this idea of emerging diseases that could threaten us. A lot of investments were made. That money eventually was eroded. When Zika emerged and started causing problems, a lot of money that was devoted to Ebola was cannibalized for dealing with Zika.

And we don’t even have to think about past epidemics. We can look at what’s happened just this year. After the surge of the previous winter started abating and when cases started falling in the spring, America and many other parts of the world dropped their guard. Testing scaled back. The CDC announced that indoor masking was no longer necessary for vaccinated people, in many ways pitting two of our most effective defenses against each other. And President Biden, on several occasions, gave what were pretty close to victory speeches.

And then the Delta variant came out of other parts of the world and completely pummeled us. We didn’t even get out of this current pandemic before we entered into the neglect stage. And I think that, again, is why we need to start thinking about preparedness now. This cycle of panic and neglect spins so quickly that we’re are already heading towards the neglect phase even in the midst of this generation-defining disaster.

IRA FLATOW: Gregg, as an epidemiologist living through a global pandemic, when did you start thinking about the next public health crisis?

GREGG GONSALVES: So Ira, I’ve been living with another pandemic for 30 to 40 years, which is the AIDS epidemic. So I was always waiting for the shoe to drop with this one. And it finally arrived in 2020. And so it was clear, early on, as you watched the United States try to respond in its disheveled, chaotic, incompetent way last year, that we were singularly unprepared for what was happening and that the next pandemic was not going to treat us as kindly as even this one has, even with its sort of devastation that it’s caused so far. We’re weaker than we’ve ever been.

IRA FLATOW: So you’re saying, basically, the COVID pandemic and how it was treated is sort of a reflection on the total health, if I could put it that way, of the American health care system.

GREGG GONSALVES: Well, the health care system writ large, which includes public health, which is sort of the appendix of the body of American Health care. We spend pennies, $0.03 on every dollar, on public health in the United States. So yes, Ed talks about this in his piece at length. And if you look at the history of science and medicine, people like Elizabeth Fee, the late historian of science and medicine you know she discusses this at length. This is a century in the making.

There’s a book on Katrina that came out a few years ago. It’s called Katrina– A History, 1915 to 2015. The idea here is that the catastrophe of Hurricane Katrina was avoidable as well. But the policy decisions that were made over the course of a century in that city led to the devastation and the lack of preparedness for that natural disaster. And the same thing has happened here. We’ve seen millions of infections in the US by public policy, by choices we made last year and the year before that.

IRA FLATOW: You know, this pandemic began during the Trump presidency. And a lot of people put the blame on that administration’s flawed handling of it for how bad things went in the early days. But you say things would still have been bad even without Trump. Is that your reflection, again, on the whole state of health care?

GREGG GONSALVES: Trump made things inarguably worse. It was just a fiasco of incompetence, malfeasance, and, I think, a little bit of malign intent. And so yes, last year could have been better. But I think we should temper our expectations about what we could have achieved last year, even with President Biden at the helm of the country. The point is you get what you pay for. And we have a crumbling public health infrastructure. You look at the maps of COVID-19 right now or three weeks ago, and then superimpose it with diabetes, maternal health, infant mortality, life expectancy. And you start seeing maps that look eerily familiar, the catastrophe of COVID-19 in our towns and cities across the US, which we capitulated in a smaller form by chronic infectious diseases going back generations.

IRA FLATOW: Ed, looking forward, what types of mechanisms do you think we need to put in place to make sure the US is better equipped to deal with public health crises?

ED YONG: So I think there’s a couple of things. Gregg and others have spoken about the need for the high sustained level of public health funding that, crucially, cannot be eroded for other purposes. That pot of money needs to be immune to the vagaries of electoral cycles and whatever Congress decides to do in each round of appropriation. Public health departments need to be able to rely on a stable and substantial amount of funding if they are to actually rebuild. There’s so much to do in terms of basic infrastructure, in terms of data, in terms of hiring people. There’s no use giving a department emergency funds to hire someone who might then lose their job in two years.

And I would also argue that, aside from that, aside from shoring up the public health departments, I think the US really needs to think about shoring up all of society, and especially its most vulnerable sectors. The country has shredded its social safety net for many decades now, from the Reagan administration to the ones that came after. The country is therefore weak. Those weaknesses affect everything from the maternal and infant mortality to the opioid crisis. And they’ve manifested over the course of the COVID pandemic.

And those weaknesses are fundamental. It means that many people are living on the edge. They struggle to provide enough food for their families. They struggle to earn a living wage. And when you have a novel virus that hits such a society, you get very predictable inequities and very predictable losses of health and lives. It’s completely predictable that a lot of the essential workers couldn’t take actions to protect themselves, couldn’t isolate or take the time off to get vaccines or tests because they work low-income, hourly-wage jobs without any paid sick leave.

We have a system where millions and millions of people have no access to health care, have no access to a trusted primary health provider, have no access to trusted sources of health information. So it’s no wonder that even if you release incredibly efficient vaccines into that population that you’ll get uptake plateauing very quickly.

The US was 38th in the world in terms of vaccination rates, which is ridiculous given how much of a central role the country played in the development of those vaccines. But vaccines are great, but vaccinations are what matters. And you don’t get vaccinations if you have a society that is so vulnerable and so inequal.

IRA FLATOW: Do you have confidence, though, that the US government will be better prepared from now on to deal with the next pandemic?

GREGG GONSALVES: In part, Eric Lander, who’s the president’s science advisor, has created a whole sort of new pandemic preparedness plan. But again, it’s really focused on big science and the shiny toys. And there’s not very much mention of the sort of basic public health which Ed talks about in his article in The Atlantic and that we’ve been talking about here.

We need a massive investment in public health in the United States. You don’t build a castle on a weak foundation. And so the big-science, the big-technology approach to protecting us against the next pandemic is all well and good. But if we don’t have a local infrastructure from small cities and towns in the US to big metropolises, we’re in trouble. We fight diseases community by community, block by block. And we can see that when you look at ZIP-code maps or census-tract maps of how COVID has wreaked havoc in our communities.

And so I don’t think President Biden– and to be fair, presidents before him– really understand the fundamental problems in American public health and what has been sort of a catastrophic failure to invest in public health. Because remember, when public health succeeds, you don’t see it.

IRA FLATOW: When you say invest in public health, are you talking about first responders, having enough hospitals ready, I mean, like gearing up for a war, where you keep stuff stockpiled until you need it?

GREGG GONSALVES: Look, let’s think about maternal mortality in Georgia, the state of Georgia– terrible, right? Is that about the wonderful obstetric care you might get at any of Emory hospitals? No, it’s about what we’ve done in communities around Georgia to ensure that women are healthy before pregnancy, during pregnancy, and after pregnancy. So we need to build up frontline public health to make people less vulnerable, communities less vulnerable. Yes, we should have more first responders. We should have better protocols in hospitals. We should figure out how to deal with the shortages of key commodities.

But keep going backwards to the very place where health happens– in homes, in communities, on blocks, and realize that a lot of risk happens there.

IRA FLATOW: This is Science Friday from WNYC Studios. And to mitigate that risk, we should be doing what?

GREGG GONSALVES: Look, since 2008, we lost 50,000 to 60,000 frontline public health care workers. They never came back. And the public health associations around the country suggest the deficit in frontline public health care workers is in the hundreds of thousands. Again, we spend $0.03 on every dollar on public health in comparison to health care.

I talk to health departments around the country. They’re doing vaccines now. They can’t do testing and vaccines, so this week it’s vaccines. The understaffing is incredible. Also the physical infrastructure of some of these public health departments, the data systems of some of these public health departments, we do not have a robust, strong, 21st-century public health infrastructure in the US from physical infrastructure, data infrastructure, and human resources.

IRA FLATOW: And you’re saying this is not by accident.

GREGG GONSALVES: It’s not by accident. We make choices about what we think is important in our society. And as Ed said in his article, when quoting Elizabeth Fee, public health always gets the short end of the stick when it comes to making public policy decisions.

IRA FLATOW: Gregg touched on this earlier, but last month, the Biden administration released a $65 billion pandemic preparedness plan. Is this plan going to address the deficiencies that you talk about, Ed?

ED YONG: I don’t think it is, for two reasons. $65 billion sounds like a lot, but it’s actually much less than what others have suggested is necessary to truly bolster the country against pandemics. And at least 2/3 of that pot goes towards things like vaccines, therapeutics, diagnostics, the kind of biomedical countermeasures that we think of as being crucial to pandemic preparedness.

Now, I’m not saying that we don’t need vaccines. Obviously those are great, good to have, they’re important. But if you devote 2/3 of a preparedness plan to them now, after everything we’ve learned over the last two years, that suggests to me that we’ve not actually learned the right lessons.

Like I said, we developed vaccines at incredible pace. And we now are 38th in the world in vaccination rates. The deaths per capita from COVID are higher in the US after the point when all adults became eligible for vaccines than in 100-plus other countries before vaccines were available. That’s a shocking statistic which should made us think hard about what actually it means to be ready or to be strong against an infectious disease.

I do think that if people are looking at the last two years and thinking, well, what we really need is just to do the same thing but hard, to get a vaccine but faster, I just think that’s the wrong lesson. Like if anything, it might be counterproductive. Like a lot of vaccine hesitancy stems from this idea that the vaccine development process was rushed, that corners were cut, and adequate safety tests weren’t done. I don’t think that rationale is correct. But it does exist. And it does explain why a lot of people have been reluctant to get vaccinations.

Now, you look at that situation and you think, well, we’ll just make vaccines quicker? I just don’t think that’s the right strategy. We need to start coming to grips with actually how vulnerable and weak a lot of sectors of American society were and how those weaknesses cannot simply be addressed by throwing more biomedical countermeasures more quickly at the problem. You need to fix the weak foundations rather than just layering more technological plaster on top of them.

IRA FLATOW: We have run out of time, gentlemen. So much to talk about. Such interesting stuff you have to say. I want to thank both of you for taking time to be with us today. Ed Yong, science reporter for The Atlantic, based in Washington. Ed won a Pulitzer Prize last year for his coverage of the COVID-19 pandemic. And Dr. Gregg Gonsalves, global health activist and epidemiologist at Yale, based in New Haven, Connecticut. Thank you both for taking time to be with us today.

GREGG GONSALVES: Thanks, Ira.

ED YONG: Thanks for having me.

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