Post by Nadica (She/Her) on Aug 8, 2024 20:08:15 GMT
Déjà Vu All Over Again — Refusing to Learn the Lessons of Covid-19 - Published July 24, 2024
Audio interview available through the link!
The spread of H5N1 avian influenza among cattle and other farm animals as well as to agricultural workers in the United States has raised concerns about the potential for an influenza pandemic. Although the threat of pandemic H5N1 doesn’t appear to be imminent — this variant has yet to show the potential to be transmitted from human to human — the federal government’s initial response suggests that, rather than heeding the lessons from Covid-19, elected officials and other key decision makers may be relying on a dangerous type of revisionism that could lead to more deaths, should H5N1 cause a pandemic.
The prospect of an H5N1 pandemic has been a source of concern ever since the virus was isolated from humans in Hong Kong in 1997. In response, the U.S. government began developing pandemic-preparedness plans. A series of reports from the Institute of Medicine (now the National Academy of Medicine) and the National Academies of Sciences, Engineering, and Medicine has emphasized the need for the stockpiling of personal protective equipment, resilient supply chains, and greater coordination between agencies and various levels of government.1 Yet despite these plans and warnings, and despite being ranked the most prepared among 195 countries to handle a pandemic on the Global Health Security Index in 2019, when Covid-19 arrived, the United States fared terribly by most measures.2
During the pandemic, well-described weaknesses in the U.S. public health response were often masked by overconfidence, as some elected officials and political appointees continually reassured Americans that the country had “the tools” to respond adequately to this new threat. The types of testing and surveillance problems that marred the response to Covid-19 are now being repeated with H5N1, with recent genetic analyses suggesting that the virus circulated undetected in cattle for months.3 Because of inadequate testing, the actual number of cases among dairy and other agricultural workers is also unknown. As with meatpacking facilities in the early months of the Covid-19 pandemic, the reluctance of dairy-farm employers to cooperate with health officials has hampered widespread testing and surveillance.
The initial response to H5N1 has also suffered from fractured lines of jurisdiction among government entities. Early in the Covid-19 pandemic, the U.S. response was weakened by uncertain divisions of authority and lack of coordination and cooperation among the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Department of Homeland Security, the Administration for Strategic Preparedness and Response, the White House, and states and localities. To address this problem, numerous experts called for granting the CDC greater authority to lead the federal response to a pandemic, but no such measures were enacted. Despite efforts supporting enhanced interagency coordination and the establishment of the Office of Pandemic Preparedness and Response Policy in 2023, there continue to be ambiguities regarding jurisdictional boundaries and authorities, and turf battles between the federal government and states have reappeared.
The H5N1 threat is also emerging in a social, political, and fiscal environment that is less conducive to public health efforts than the environment in early 2020. For example, capacity to rapidly scale up pharmaceutical countermeasures, including vaccines, in the United States may be impaired because of the rise of antivaccine sentiment and litigation, which makes it riskier for manufacturers to invest in research and production. The fact that some Covid-19 vaccine manufacturers, such as Johnson & Johnson, AstraZeneca, and Novavax, struggled to gain market share in the United States underscores the economic risks associated with developing pandemic vaccines on an emergency basis.
Furthermore, in the current political climate, Congress may be unwilling to invest billions of dollars in research and development, as it did for Operation Warp Speed. Indeed, given increasing political polarization, congressional appropriations cannot be counted on to support widespread access to testing or treatments, which could leave patients dependent on a deeply fragmented insurance system and disadvantage people who are uninsured or underinsured. Congress may also be less willing to provide the types of social supports, such as expanded unemployment- and eviction-related protections, that helped buffer Covid-19’s blow. Moreover, in the case of H5N1, congressional interests may be fragmented, since different committees have authority over agricultural and health policy. The congressional decision to mandate the return of unspent CDC funds in the fiscal year 2024 appropriations agreement and the expiration of Covid-19 emergency programs have also raised concerns among public health officials about whether they will have the necessary resources to respond to new threats.
A future pandemic — one caused by H5N1 or a different pathogen — could also arise in a far different legal environment than Covid-19 did. Over the past few years, many states have rushed to restrain health officials’ authority, thereby limiting their ability to respond to public health emergencies.4 Reflecting the widespread backlash against masking, for example, states such as Iowa and Tennessee have enacted laws prohibiting schools from requiring masking in most circumstances; other states have limited state or local health officials’ capacity to restrict religious gatherings or impose other types of public health orders. In some states, judicial decisions have also constricted the ability of state or local officials to respond to a pandemic.5 For example, in James v. Heinrich, the Supreme Court of Wisconsin held that local health officials lack the authority to close schools.
Over the course of the Covid-19 pandemic, federal courts also altered their approach to reviewing public health orders, substituting skepticism for deference to health officials.5 In 2021, the U.S. Supreme Court in Tandon v. Newsom held that a California order limiting the number of people who could meet in a private home violated the religious liberty of people who wanted to gather for Bible study. In addition, relying on the newly minted “major questions doctrine” — which holds that federal agencies, including health agencies, cannot issue regulations or orders on issues of major economic or political importance without explicit congressional authorization — the Court blocked the CDC’s eviction moratorium and the Occupational Safety and Health Administration’s rule requiring large employers to mandate Covid-19 vaccination or testing and masking for their employees. Lower courts enjoined vaccine mandates that applied to federal contractors and the CDC’s mask mandate for public transportation.5 Such rulings mean that federal health agencies would most likely need explicit authorization from Congress before they could take critical measures to slow the spread of a new pandemic in the United States. The Supreme Court’s decision in June to overturn the Chevron doctrine, which granted deference to administrative agencies’ interpretation of their statutory powers, is likely to further impair health agencies’ capacity to respond to new health threats.
With fewer tools at the public health community’s disposal, a new pandemic could potentially spread even faster than Covid-19 did, overwhelming hospitals and morgues more quickly, putting more stress on health care workers, and causing more deaths — even if the causative virus isn’t more lethal than SARS-CoV-2. Most troubling, we believe, is the apparent inability of politicians and pundits to understand that a new pandemic may look different from the previous one, threatening different populations and presenting different trade-offs. Certain key community-level mitigation measures, such as school closures — which might be far more important, should a new pathogen be associated with higher mortality among young people than SARS-CoV-2, as has been seen in multiple avian influenza outbreaks — are now likely to face political, legal, and popular resistance. The blanket nature of new restrictions on public health authority and certain mitigation measures, especially in an environment rife with misinformation and attacks on public health workers, may deter officials from making evidence-based decisions that could help protect vulnerable populations.
The United States must be ready for the challenges ahead, even as government agencies and political leaders seem unprepared for the emergence of a new infectious disease or the reemergence of an old foe, such as influenza. In the face of multiple constraints on public health, health care professionals can speak out about the importance of remedying the problems that Covid-19 exposed, advocate for new investments in public health preparedness, and advise local health departments, elected officials, and their patients on evidence-based approaches to protecting against the spread of disease. In troubling times, scientific expertise must remain a guiding light; health care professionals can help ensure that it does.
Audio interview available through the link!
The spread of H5N1 avian influenza among cattle and other farm animals as well as to agricultural workers in the United States has raised concerns about the potential for an influenza pandemic. Although the threat of pandemic H5N1 doesn’t appear to be imminent — this variant has yet to show the potential to be transmitted from human to human — the federal government’s initial response suggests that, rather than heeding the lessons from Covid-19, elected officials and other key decision makers may be relying on a dangerous type of revisionism that could lead to more deaths, should H5N1 cause a pandemic.
The prospect of an H5N1 pandemic has been a source of concern ever since the virus was isolated from humans in Hong Kong in 1997. In response, the U.S. government began developing pandemic-preparedness plans. A series of reports from the Institute of Medicine (now the National Academy of Medicine) and the National Academies of Sciences, Engineering, and Medicine has emphasized the need for the stockpiling of personal protective equipment, resilient supply chains, and greater coordination between agencies and various levels of government.1 Yet despite these plans and warnings, and despite being ranked the most prepared among 195 countries to handle a pandemic on the Global Health Security Index in 2019, when Covid-19 arrived, the United States fared terribly by most measures.2
During the pandemic, well-described weaknesses in the U.S. public health response were often masked by overconfidence, as some elected officials and political appointees continually reassured Americans that the country had “the tools” to respond adequately to this new threat. The types of testing and surveillance problems that marred the response to Covid-19 are now being repeated with H5N1, with recent genetic analyses suggesting that the virus circulated undetected in cattle for months.3 Because of inadequate testing, the actual number of cases among dairy and other agricultural workers is also unknown. As with meatpacking facilities in the early months of the Covid-19 pandemic, the reluctance of dairy-farm employers to cooperate with health officials has hampered widespread testing and surveillance.
The initial response to H5N1 has also suffered from fractured lines of jurisdiction among government entities. Early in the Covid-19 pandemic, the U.S. response was weakened by uncertain divisions of authority and lack of coordination and cooperation among the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Department of Homeland Security, the Administration for Strategic Preparedness and Response, the White House, and states and localities. To address this problem, numerous experts called for granting the CDC greater authority to lead the federal response to a pandemic, but no such measures were enacted. Despite efforts supporting enhanced interagency coordination and the establishment of the Office of Pandemic Preparedness and Response Policy in 2023, there continue to be ambiguities regarding jurisdictional boundaries and authorities, and turf battles between the federal government and states have reappeared.
The H5N1 threat is also emerging in a social, political, and fiscal environment that is less conducive to public health efforts than the environment in early 2020. For example, capacity to rapidly scale up pharmaceutical countermeasures, including vaccines, in the United States may be impaired because of the rise of antivaccine sentiment and litigation, which makes it riskier for manufacturers to invest in research and production. The fact that some Covid-19 vaccine manufacturers, such as Johnson & Johnson, AstraZeneca, and Novavax, struggled to gain market share in the United States underscores the economic risks associated with developing pandemic vaccines on an emergency basis.
Furthermore, in the current political climate, Congress may be unwilling to invest billions of dollars in research and development, as it did for Operation Warp Speed. Indeed, given increasing political polarization, congressional appropriations cannot be counted on to support widespread access to testing or treatments, which could leave patients dependent on a deeply fragmented insurance system and disadvantage people who are uninsured or underinsured. Congress may also be less willing to provide the types of social supports, such as expanded unemployment- and eviction-related protections, that helped buffer Covid-19’s blow. Moreover, in the case of H5N1, congressional interests may be fragmented, since different committees have authority over agricultural and health policy. The congressional decision to mandate the return of unspent CDC funds in the fiscal year 2024 appropriations agreement and the expiration of Covid-19 emergency programs have also raised concerns among public health officials about whether they will have the necessary resources to respond to new threats.
A future pandemic — one caused by H5N1 or a different pathogen — could also arise in a far different legal environment than Covid-19 did. Over the past few years, many states have rushed to restrain health officials’ authority, thereby limiting their ability to respond to public health emergencies.4 Reflecting the widespread backlash against masking, for example, states such as Iowa and Tennessee have enacted laws prohibiting schools from requiring masking in most circumstances; other states have limited state or local health officials’ capacity to restrict religious gatherings or impose other types of public health orders. In some states, judicial decisions have also constricted the ability of state or local officials to respond to a pandemic.5 For example, in James v. Heinrich, the Supreme Court of Wisconsin held that local health officials lack the authority to close schools.
Over the course of the Covid-19 pandemic, federal courts also altered their approach to reviewing public health orders, substituting skepticism for deference to health officials.5 In 2021, the U.S. Supreme Court in Tandon v. Newsom held that a California order limiting the number of people who could meet in a private home violated the religious liberty of people who wanted to gather for Bible study. In addition, relying on the newly minted “major questions doctrine” — which holds that federal agencies, including health agencies, cannot issue regulations or orders on issues of major economic or political importance without explicit congressional authorization — the Court blocked the CDC’s eviction moratorium and the Occupational Safety and Health Administration’s rule requiring large employers to mandate Covid-19 vaccination or testing and masking for their employees. Lower courts enjoined vaccine mandates that applied to federal contractors and the CDC’s mask mandate for public transportation.5 Such rulings mean that federal health agencies would most likely need explicit authorization from Congress before they could take critical measures to slow the spread of a new pandemic in the United States. The Supreme Court’s decision in June to overturn the Chevron doctrine, which granted deference to administrative agencies’ interpretation of their statutory powers, is likely to further impair health agencies’ capacity to respond to new health threats.
With fewer tools at the public health community’s disposal, a new pandemic could potentially spread even faster than Covid-19 did, overwhelming hospitals and morgues more quickly, putting more stress on health care workers, and causing more deaths — even if the causative virus isn’t more lethal than SARS-CoV-2. Most troubling, we believe, is the apparent inability of politicians and pundits to understand that a new pandemic may look different from the previous one, threatening different populations and presenting different trade-offs. Certain key community-level mitigation measures, such as school closures — which might be far more important, should a new pathogen be associated with higher mortality among young people than SARS-CoV-2, as has been seen in multiple avian influenza outbreaks — are now likely to face political, legal, and popular resistance. The blanket nature of new restrictions on public health authority and certain mitigation measures, especially in an environment rife with misinformation and attacks on public health workers, may deter officials from making evidence-based decisions that could help protect vulnerable populations.
The United States must be ready for the challenges ahead, even as government agencies and political leaders seem unprepared for the emergence of a new infectious disease or the reemergence of an old foe, such as influenza. In the face of multiple constraints on public health, health care professionals can speak out about the importance of remedying the problems that Covid-19 exposed, advocate for new investments in public health preparedness, and advise local health departments, elected officials, and their patients on evidence-based approaches to protecting against the spread of disease. In troubling times, scientific expertise must remain a guiding light; health care professionals can help ensure that it does.