The editors of the Washington Post urge us to start thinking seriously about the next pandemic. Here’s what they would like done:
A high priority is to build the equivalent of national early warning radar for disease. Genomic sequencing makes it feasible to rapidly identify pathogens and send up a flare, as South Africa did with the emergence of omicron. A viral and bacterial surveillance network will provide a clear picture of threats and more time to respond properly.
Next, we must invest in people. Even before the pandemic, turnover was high among state public health officials, and once the crisis set in, state and local workforces became exhausted and burned out. Dr. Walensky said the workforce needs more than just money: “We need to train it. We need to make public health an attractive workforce to enter.” Public health workers have been at the front line of bitter political debates about vaccine and mask mandates, too often subject to toxic public threats and political interference. At the same time, they must redouble efforts to earn the public’s trust with clear, transparent communications and overcome the deleterious impact of misinformation and disinformation. The CDC needs to get out of its ivory tower and play a more direct and urgent role in addressing the public.
Data is the lifeblood of public health. The CDC and states have suffered for years with antiquated systems. In an unpredictable pandemic, this is a serious liability to decision-making. Dr. Walensky promised to make upgrades a priority. “The pipes have to connect,” she said.
I wish they would connect the dots for me. I don’t see how any of those measures, whether in isolation or together, would mitigate the risk of a future pandemic. COVID-19 was completely sequenced by the Chinese no later than January 10, 2020. Since then the virus has spread from China to every country in the world and killed more than 5 million people. In the case they cite sequencing the omicron variant did exactly nothing to halt its spread.
Invest in people? We’ve been investing in people for a half century or more. I suspect that issue is more that we’re investing in the wrong people. In most states public health officials are required to be medical doctors. As has been pointed out “thinking like doctors” is part of the problem rather than the solution. My experience has been that medical doctors are peculiarly unsuited to manage groups consisting of varied professionals. They’re not trained for it and the motivations that lead to med school generally don’t include a desire or the personal skills to manage physicians let alone non-physicians. Managing professionals is generally understood to be a tricky matter and med school doesn’t prepare you for it.
And then there’s data. Government organizations are peculiarly unsuited to applying cutting edge information technology. For one thing they are almost always standards-based and standards are inherently retrospective. You only need consider the federal government’s many information technology debacles of the last dozen years to recognize that.
I don’t have any advice for dealing with the next pandemic. All I can suggest is that the editors try again.