Much has changed since the start of the pandemic but the nation's public health system remains fractured.
As 2022 dawns, it’s starting to look a lot like March 2020 — so much so that President Joe Biden sought to reassure Americans they would not return to those dark days, instead promising a future made safer by vaccines and tests.
Those breakthroughs, along with genomic sequencing that can identify new variants and the promise of powerful antiviral pills, represent a revolutionary assault on the coronavirus. But biomedical advances are only half the battle, experts say.
“We have seen it isn’t enough to have testing and vaccines; you have to have a public health system that can deliver testing and vaccines,” said Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health.
The country is at a pivotal moment, Sharfstein said, full of opportunity if the lessons of the past two years lead to a new focus on getting shots in arms, swabs up noses and pills into mouths.
But some experts contend that the imbalance between the country’s scientific advances and its public health response is starker than ever, looking back in wonder on spring 2020 when a largely compliant population submitted to wide-ranging restrictions.
“We are going backward,” said Alfred Sommer, an epidemiologist and former dean at Hopkins.
“People are infinitely less responsive now,” said Sommer, who has tackled outbreaks of cholera and smallpox around the world. “This is different from anything that any public health person I know would have predicted in March 2020.”
When the most striking technological achievement of the pandemic — the mRNA vaccines — became available last winter, Sommer and others predicted the pandemic would be brought under control within months.
Instead, a year later, with little more than 60 percent of the U.S. population fully immunized with two mRNA shots or a single dose of the Johnson & Johnson product, the vaccines are providing huge benefits to individuals while failing to fulfill their public health potential of protecting the entire population.
For anybody who trusts science, this is “vastly different than March 2020,” said Francis S. Collins, who in December stepped down as director of the National Institutes of Health, the nation’s medical research agency. But those who don’t trust science and haven’t been vaccinated are in a vulnerable place, he said, endangering everyone around them.
“People should ask themselves which group they want to be in,” Collins said.
The United States has largely relied on legacy public health systems. One example: The Centers for Disease Control and Prevention’s external advisory board, the Advisory Committee on Immunization Practices, typically makes recommendations for routine vaccines that affect small portions of the population — often children — rather than responding to the minute-by-minute shifts of a worldwide outbreak.
The “processes are designed for a very different moment,” said Ashish K. Jha, a health policy researcher and dean of the Brown University School of Public Health. “They are not functioning well in a pandemic.”
The CDC did not respond to a request for comment.
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