April 11, 2023
World Health Day
United States President Joe Biden has announced to Congress that his administration will officially end the national emergencies declared to address the global COVID-19 pandemic on May 11 this year. This announcement will drastically restructure the federal response to the virus and strip Americans from the protection they received these last three years.
Despite the USA’s wealth and advancements in technology and health, COVID-19 had devastating effects on the country. The Centers for Disease Control and Prevention (CDC) has recorded 1.13 million COVID deaths in the US since 2020. Fortunately the death rate has dropped drastically since vaccines became available. At the start of the pandemic, it became abundantly clear that the USA was ill-prepared to react to a fast-spreading outbreak. There were widespread reports of shortages in PPE, ventilators, hospital beds as well as overburdened healthcare professionals.
The annulment of the COVID-19 national emergency would mean that free at-home COVID tests will no longer be available, nor will hospitals get extra payments for treating patients. It will also shift the development of vaccines and treatments away from the federal government, back into private hands. Furthermore, as the government stops buying vaccines on behalf of the population, the cost of vaccination will skyrocket. Pfizer has announced that it plans to charge around $130 per dose, although only 15% of the US population have received the recommended booster dose.
The World Health Organization (WHO) has stated that the coronavirus remains a global health emergency. Although it is true that COVID-19 deaths are drastically reduced and immunity is up, the threat remains that a new strain or outbreak may emerge.
With Biden’s announcement about ending the national response to the COVID-19 pandemic, it’s important to ask ourselves two key questions: what did we learn from this pandemic and are we prepared for future outbreaks, whether it is related to coronavirus or something else entirely?
COVID-19 highlighted the disparities within the healthcare system, with elderly, low-income, marginalized and vulnerable populations facing the worst health outcomes. Over the course of this pandemic, infection and mortality rates have been highest among nursing home residents as well as black, indigenous, and latinx communities.
Black Americans make up 13.4% of the US population, but in July 2020, accounted for 23% of deaths from COVID-19. Black counties had a mortality rate 6 times higher than white ones. In New Mexico, Native Americans accounted for 32% of COVID-19 cases, although they only make up 11% of the population.
Transmission rates were also higher among essential workers: health care, food service, and public transportation. Nursing homes, prisons, meatpacking plants, homeless shelters, and psychiatric or developmental care facilities saw significantly higher rates of infection. In 2020, more than 400,000 residents and employees had been infected in nursing and long-term care facilities, leading to more than 68,000 fatalities—more than 40 % of the total deaths from the virus in the USA.
COVID-19 highlighted the general disorganization in public health offices. As the outbreak began to escalate, it was evident to see how badly fragmented the pandemic response was among different states and localities. Some fought against the various restrictions that were supported by the CDC, while others battled against each other for diagnostic tests, medicine and medical supplies.
The Commonwealth Fund released a scorecard ranking states responses to the pandemic. Hawaii and Massachusetts got the top scores, based on the measures they took to improve healthcare access and quality, service use and cost, as well as addressing health disparities. Meanwhile, the states with the worst scores included Mississippi and Oklahoma. The outcomes are significant: Hawaii had an excess death rate of fewer than 200 deaths per 100,000 people, while Mississippi experienced a rate of 500 deaths per 100,000 people.
This difference is based on a wide-range of factors but it is clear that access to affordable care was a dominant factor: states with lowest scores included those that had not yet expanded Medicaid eligibility under the Affordable Care Act as of 2020: Texas, Oklahoma, and Mississippi. Meanwhile, Massachusetts reported the nation’s lowest adult uninsured rate, 3.6%.
The United States and the international community have been receiving warnings from scientists of the inevitability of a pandemic for decades. Globalization, growing populations, climate change, and the increased interactions between animals and men have drastically increased the risk of an outbreak. This coupled with the overuse of existing drugs and underinvestment in producing new ones have seriously exposed the world to a devastating pandemic. COVID-19 has shown that the world desperately needs to improve its Pandemic Preparedness, yet the International Federation of Red Cross (IFRC) states that many countries remain ‘dangerously unprepared’ for the next pandemic, and the USA is no exception.
The Commonwealth Fund (CWF) has published a report reviewing the USAs pandemic preparedness and has highlighted several areas that must be improved. One of the primary issues is simply funding The IFRC recommends countries increase domestic health finance by 1% of their GDP and global health finance by at least $15bn per year. While the figure may seem like a lot, it is much less costly to prevent a pandemic than it is to respond to one: the COVID-19 pandemic cost the USA $4.5 trillion. Emerging health threats have now claimed more lives than terrorism, but receive a tiny fraction of funding (both within the US and globally) that counterterrorism efforts do. The US 2023 budget has approved $858 billion for defense. Meanwhile, only $81.7 billion has been allocated to the CDC, NIH, FDA and the Office of Pandemic Preparedness for the next 5 years. Not only do we need to ramp up our funding for our national health program, we must also contribute more to funding towards global health security. With globalization, disease is no longer limited by geographical barriers. Supporting countries that lack the finances to prepare for health emergencies will further bolster our national health security.
The CWF has also called for creating a national public health system in order to create more order when it comes to handling national health emergencies. According to them, “a national public health system would help ensure state and local health departments gain basic capabilities and resources to protect their communities, however different.” This office could further create national health policies that can begin to address the inequities that are often experienced in healthcare. Along with improving a coordinated-national response, the United States must work on regaining the public trust when it comes to health issues. During the pandemic, many questioned pandemic measures and refused to get vaccinated. Rebuilding trust is crucial to improve future pandemic responses.
As we use technology to create early warning systems for extreme weather, like earthquakes, the same should be done for infectious disease. By advancing bioinformatics, a trip wire can be created for infectious disease. Along with developing an early detection system, the USA should also bolster its ability to create and manufacture vaccines. The development of the COVID-19 shows that this can be done. We should not take it apart, as will be done in May, but ensure that we further develop the vaccine for coronavirus as well as other infectious diseases.
© Ignacio Marín/Medicos del Mundo
© Marie Monsieur
© Layla Aerts/MdM Belgium