Congress currently is considering eight proposals to establish a national COVID Commission. Such commissions routinely follow massively disruptive events in our nation’s life. Unfortunately, such congressionally chartered efforts seldom make much of an imprint on the future, which is their common mandate. This time perhaps that could change, if whichever bill wins out includes a roadmap for meaningful reform of our public health enterprise that, in so many ways, failed as COVID engulfed us.
Consider how federal, state, and local health departments were unprepared for a threat that an expert government panel warned, in 2019, was inevitable. Despite its enormous $11 billion budget, the 800-pound gorilla of public health, the federal Centers for Disease Control and Prevention, had no model for how a COVID-like virus would spread, nor how to target preventive measures. Worse, it had not developed a protocol for testing to determine if individuals were infected with a disease, and no plans existed to work with private laboratories to produce test kits for widespread distribution, which, during the onset of COVID, it resisted. These delays cost tens of thousands of lives.
The CDC’s often-contradictory advice made Americans skeptical of preventive guidance, from lockdowns to masking and, subsequently, of vaccine efficacy and vaccine mandates. One might wonder if today’s CDC and local health departments could rise to the occasion, as did their predecessors, to beat back cholera, stop malaria, conquer polio or obliterate smallpox. Given the ability of malevolent actors to manipulate the genetic codes of viruses, the threats ahead are far greater.
If past is prologue, there is every chance that the members of a highly visible COVID Commission will be drawn from political and academic elites, will earnestly go through the motions, and then will recommend significantly more funding for the CDC, local health departments, and schools of public health. This time, to break the pattern, Congress should direct a new COVID Commission to make recommendations for bottom-up reform of our public health establishment.
Merely throwing more money at the existing system would be a mistake. The CDC’s problem isn’t a lack of funds but a lack of focus. Enjoying the enhanced visibility and status that the public health profession gained in the aftermath of the HIV-AIDS epidemic, public health officials recklessly broadened the definition of “epidemic.” Today, the CDC, state and local health departments, egged on by ambitious academics, have taken ownership of “epidemics” including racism, loneliness and gun violence—social ills for which experience in controlling communicable diseases caused by microbes and viruses is irrelevant.
The primary objective of a COVID Commission should be clarifying the fundamental expectations that our society requires from public health systems. Its work, and its report, must urge public health officials to focus on disease. The CDC should assume that we’ll face another pandemic—perhaps one even more lethal than COVID—in the near future, and begin work to strengthen its capacities for case finding, contact tracing, isolation and quarantine procedures, making them more effective and relevant to a more dynamic and diverse U.S. population.
To enhance these traditional tools, public health officials must boost their statistical competency. The COVID Commission should examine the erratic collection of data on COVID and determine the accuracy of the reported numbers of infections, hospitalizations, and deaths. There is a big difference between hospitalizations and deaths “with” COVID or “because of” COVID. Much of the information that we have has been collected by different agencies, using different standards and methods, and none of it has been processed in real time. Next time, we will need accurate, consistent data—and we’ll need it fast.
A national commission on COVID also might observe that, if public health officials want to diminish their collective credibility with the American people, engaging in partisan advocacy is not a good place to start. The 1,200 public health officials who signed a letter endorsing the George Floyd protests as “vital to the public health,” while calling for masking and social distancing in every other walk of life, did more harm than good.
Finally, a COVID Commission should remind public health officials that theirs is a global job. The old and now redeployed truism that “disease knows no borders” reminds us that pathogens anywhere are a concern everywhere, particularly in the era of rapid global travel. Joe Biden’s decision to halt traffic from African countries where the Omicron variant has emerged was not racist or xenophobic but done to prevent its broad introduction into the United States.
That decision also reminds us that monitoring pathogens globally is critical to America’s national security. Given that the WHO was slow to alert member countries for fear of alienating China, a COVID Commission might recommend that the United States should greatly improve its independent capacity to detect and analyze, in real time, unrecognized and potentially malignant biological threats anywhere in the world.
Public health experts may not be able to predict with certainty when the next pandemic shows up, or what challenges it will bring. By focusing on their core mission and constantly improving their methods and practices, however, they can be more prepared when it arrives. A national COVID Commission that fails to call the public health enterprise back to its principal mission of preventing the spread of communicable disease will not make a meaningful difference.
Editor’s Note: A version of this article originally appeared at The Hill.