This post is the first article in a Health Affairs Forefront short series, “Meeting America’s Public Health Challenge.” This series includes articles that reflect on and are inspired by a report of the same name released in June 2022 by the Commonwealth Fund Commission on a National Public Health System. The series was developed and published with support from the Commonwealth Fund, a nonpartisan foundation. Health Affairs retained review and editing rights.
Americans are tired of talking about viruses and public health issues. As we enter another season with COVID-19 and other viral infections running rampant, the US may be headed into a winter of discontent. Early spikes in influenza A in the South and shocking levels of RSV infections in children in the mid-Atlantic and East Coast are creating crowding problems in hospitals and physician offices. Even so, as of December 1 just 12.1 percent of eligible people had gotten boosted with the latest bivariant formulation of the COVID-19 vaccine, according to the CDC. Other prevention measures, like wearing masks in crowded public places, seem to have also waned. Thirty-seven percent of those surveyed by Ipsos in September reported wearing masks in public, down from 71 percent last September.
Key issues like inflation, the economy, and crime remain top concerns of voters, but as we all adjust to post-pandemic life, we cannot lose focus on improving our public health system now, so we do not repeat the mistakes of the past.
Legislative And Regulatory Opportunities
Congress and the Biden Administration have upcoming opportunities to improve the public health system that should be embraced by both parties. With the close of the 117th Congress at the end of the year, all eyes are focused on policy priorities that can travel in the final end-of-year legislative package. Reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA) due next September is yet another opportunity. Both the end-of-year bill and PAHPA reauthorization should include new legislative directives and funding to support, modernize, and maintain our nation’s public health system so that Americans in rural Alaska, suburban Ohio, and downtown Atlanta can all count on receiving essential services and trusted information, to keep them healthy and protect their families and loved ones.
Finish The Job On COVID-19
First, the Biden Administration should accelerate its encouragement of booster uptake and Congress must allocate resources to meet this goal. Policymakers on both sides of the aisle need to dismantle the politicization of public health emergencies to help rebuild trust in a government-led response. A robust campaign that includes community partners such as the effort underway with monkeypox will help reach the vaccination goals necessary to prevent a winter surge and avoidable COVID-19 hospitalizations and deaths. Under improved scenarios, an aggressive booster vaccination campaign could prevent COVID-related deaths from exceeding 400 per day, while saving billions of dollars. Taxpayers could save $10 billion in Medicare and Medicaid through an accelerated booster campaign, even if the federal government paid for all costs of vaccination, according to the Commonwealth Fund.
Pass The PREVENT Pandemics Act
Second, Congress should improve and pass the Prepare for and Respond to Existing Viruses, Emerging New Threats and Pandemics Act (PREVENT Pandemics Act) as part of any end-of-the-year legislation. PREVENT cleared the Senate Health, Education, Labor & Pensions (HELP) Committee with overwhelming, bipartisan support this past March but has not yet been considered by the full Senate.
The HELP-passed bill includes several important improvements, including new requirements for data collection and sharing. Under the bill, CDC would be required to implement “a near real-time electronic nationwide public health situational awareness capability through an interoperability network of systems” to help prevent, manage, and control outbreaks. The bill would also require the CDC and others across HHS to revisit and redraft data use agreements among federal offices themselves as well as the agreements those offices have with state and local public health authorities (as under 42 U.S.C. §247d-4(C)(1)).
Other important pieces of PREVENT would improve data flow inside the government, ensuring that data flows from the government back to those on the ground. Closing the data loop is critical to knowing where resources need to be deployed and doing it transparently can help to build trust in the process.
The near real-time network that PREVENT would jump-start is not a new idea; it was originally passed into law in 2006 as part of PAHPA. PREVENT includes dedicated funding for this provision to add to the more than $1 billion Congress has specified for public health data modernization since the beginning of the public health emergency (PHE). Congress must hold the CDC accountable and ensure transparency with the public on its progress. There is already a movement to do so; Senator Mitt Romney (R-UT) has led a coalition of moderates who believe that no more COVID funding should be given to the CDC until a more thorough accounting of spending is shared with Congress. For PREVENT, Congress should provide ongoing funding that is stable, predictable, and adequate, but the CDC must outline how much money it needs to get the job done. The law should spell out parameters and a timeline for use of available funds to systematically build public health infrastructure, with an initial focus on workforce and data systems.
Provide Clear Federal Leadership
With PREVENT in the rearview mirror, Congress must then go further. Despite dozens of federal health agencies and nearly 3,000 state, local, tribal, and territorial health departments, there is no single person or office at the U.S. Department of Health and Human Services to lead and coordinate the nation’s public health efforts within the US Department of Health and Human Services (HHS) and with state, local, tribal, and territorial health officials. Creating leadership, purpose, and direction within the public health bureaucracy will be a crucial step in ensuring a more effective public health response to both major crises and everyday challenges. As recommended by the Commonwealth Fund Commission on a National Public Health System, Congress should establish a position, such as an undersecretary for public health at HHS, to oversee and coordinate the development of the national public health system—beginning with a focus on the key infrastructure elements of workforce, laboratories, and data.
Focus On Oversight, Accountability, And Accreditation
Finally, the next Congress should increase its focus on oversight and accountability and build it into PAHPA reauthorization. The Senate HELP Committee, which has oversight over public health activities, will likely be led on the Republican side by Sen. Bill Cassidy (R-LA), who has stated many times that he’s reluctant to send more money to the CDC until there’s more transparency and accountability.
Oversight of public health in the 118th Congress should focus on performance and continual communication between the branches of government. So far CDC’s data modernization initiative includes very little public information on how money is being used. Additionally, it is unclear how funding sent to states is being used to improve current systems as opposed to perpetuating the old way of doing things.
We must also require accountability from federal partners. As the Commonwealth Fund Commission outlined earlier this year, Congress should have experts in public health and the Public Health Accreditation Board establish streamlined, essential accreditation standards for state public health systems to ensure critical levels of functionality. While in the past Congress has been hesitant to tie state public health funding to performance, the 118th Congress should look at the PAHPA reauthorization as an opportunity to change that. Congress can tie continued support for public health infrastructure to the expectation that health departments become (re)accredited, just as the government expects hospitals and health centers it funds to be accredited. One provider organization recently shared with us that they spent a year working with a state to meet the various data reporting requirements specific to the state’s laws and technological capabilities only to have the state go dark when it came time for reporting. Providers are held accountable by federal health care programs and the funding that flows through them. The doctors, nurses, and other caregivers treating sick patients on the ground should not be stuck with funding cuts due to a lack of reporting channels at the state level. It is time states are held accountable for their funding.
Winter Is Coming, But It Doesn’t Have To Be Miserable
In the wake of election season and the beginning of a lame-duck Congress, it’s easy to get distracted. This Congress and the next should focus on the tremendous opportunities in front of them to make lasting changes to our public health system. By improving and passing the PREVENT Pandemics bill and working to include key reforms in next year’s PAHPA reauthorization, Republicans and Democrats alike can ensure that the lessons of COVID are not wasted. These actions, combined with a winter COVID-19 vaccination campaign embraced by both political parties and funded by Congress, could save thousands of lives. Every American is now acutely aware of how fragile our public health system is and yet how fundamentally necessary it is to our survival and functioning. To avoid a miserable winter now and in the future, policymakers on all sides must act now.