HJAR May/Jun 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2021 37 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement the fire truck needs fuel, just as public health needs adequate funding. But the firefight- ers also need to keep the truck in running order and able to shift into a higher gear when necessary. The speedy development of COVID-19 vaccines was an example of public health successfully shifting into a high gear, but efforts to mitigate the spread of the disease fell short, with dire results. Modeling byAndrewAtkeson, an economics professor at the University of California, Los Angeles, suggests that more than 200,000 deaths in the U.S. could have been prevent- ed through better public health strategies. 2 Deborah Birx, who was the White House coronavirus response coordinator under the Trump administration, has said U.S. deaths could have been “decreased substantially” by a more effective public health response. We must be better prepared for the next threat, and that means learning the lessons of this one, including: • Public health leaders need to articulate the value of public health in a way that historically they have not been suc- cessful in doing. The pandemic has served as a potent reminder of the importance of public health, but that message must not be lost when the nation is no longer in a public health emergency. • Public health leaders need to improve their ability to communicate informa- tion to the public. They must be able to translate scientific knowledge into clear, consistent, logical communica- tion that effects positive changes in public behavior. • Trust in public health must be rebuilt. Increasingly, there is evidence that year 2019 to $850million in fiscal 2020. The same report noted that funding for the Hos- pital Preparedness Program, the only source of federal funding to help hospitals prepare for and respond to emergencies, has been cut by half since 2003. 1 Perhaps we should think about pub- lic health the way we think about the fire department. We support our local fire de- partment, because we know that someday we may need it in an emergency. We are reminded of that possibility every time we see a fire truck rushing somewhere with si- ren blaring and lights flashing — but public health has no shiny red fire truck to remind us how important it is. Before the pandemic, we cut funding for public health, because there was no fire, so to speak — and then we had a fire. We should have been better prepared for COVID-19. The U.S. has been through pandemics before, most recently with the novel influenza A (H1N1) virus that emerged in the U.S. in 2009 and ultimately spread across the globe. Public health sounded alarms over H1N1, and people were concerned. President Barack Obama declared a national emergency. But for a number of reasons, H1N1 turned out to be far less deadly than COVID-19: The CDC estimates that the H1N1 virus killed 12,469 people in the U.S. between April 2009 and April 2010, compared to the COVID-19 death toll of more than half a million Americans. One of the challenges for public health is that if you prepare for a threat, and the threat does not materialize to the extent expected or when expected, then support for public health erodes. To return to my fire department analogy, public health messaging during the COVID-19 pandemic was influenced, if not replaced, by political objectives. For the public to trust and to take ac- tion, that can never be allowed to hap- pen. Our public health agencies must have some degree of protection from political influence or the appearance of political influence. • We need local, state and national lead- ers — public and private — to build a true pandemic management plan based upon science, logic and what we have learned. We were caught flat- footed by COVID-19. Our pandemic plan was dusty on the shelf, and our pandemic teamwas dismantled. When the alarm was sounded, our response was inadequate. As our world continues to become more connected, travel continues to increase and commerce grows between continents, we must recognize the real potential for new infectious diseases to spread and spread quickly. With each of us as potential vectors of these new threats, we must learn fromour COVID-19 experiences and retain skills to keep each other safe. Our new public health efforts will need to include not only the CDC and our Department of Health, but more importantly each of us contributing and supporting efforts to be healthy and safe. n REFERENCES 1 Trust for America’s Health. The Impact of Chron- ic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2020. https://www.tfah.org/report-details/public healthfunding2020/ 2 Atkeson A. Behavior and the dynamic of epidem- ics. https://www.brookings.edu/bpea-articles/ behavior-and-the-dynamic-of-epidemics/