The Ramifications of the COVID-19 Pandemic for Future Public Health Capabilities

Brownson et al. (p. 1605), in their article published in this issue of AJPH, focus on the dangers of misleading public health information, challenges posed by the COVID-19 pandemic, and public health officials’ responsibility to respond effectively to meet the needs of those affected by the pandemic. However, they fail to address several vital points.

First, the authors reiterate the roles and responsibilities of the public health field in preparing and responding to a pandemic and the insufficient surveillance measures that have been discussed in past Centers for Disease Control and Prevention reports regarding H1N1 flu in 2009.¹ However, the authors make the excellent point that visibility of public health has increased during the pandemic. Media coverage of public health and epidemiology increased by 1000% from June 2019 to June 2020. The authors ask how to use this attention on public health to improve health equity, but they fail to pursue this excellent line of inquiry.

Furthermore, the authors neglect to explain the path to increased use of public health science, particularly during an international public health crisis. Rather, they shift from a solution-focused approach to criticism of current public health shortcomings during the COVID-19 pandemic without providing actionable suggestions to public health scholars and officials regarding how to address the pandemic. Although their criticisms are correct, exhaustive media discussion exists of the reactive rather than proactive approach of the current US administration and its failure to successfully manage public health.²

Moreover, it is clear to most scholars and health policymakers that the US administration sought to abuse the system’s weaknesses via misinformation fed by lack of accountability, rather than failures being attributed to the administration’s ignorance. Nevertheless, in their reactive approach, the authors fail in that they direct attention away from using media outlets to promote public health and toward government failures. They could have used this opportunity to discuss specific evidence-based policy by which to use public health and epidemiology during the current pandemic.

Second, I agree that long-term public health planning and policies must use evidence to establish effective countermeasures by population and circumstances before their implementation and dissemination. However, this cannot be achieved if all efforts are devoted to national services while in survival mode. The appropriate time to engage in long-term public health planning, let alone reinvent an entire public health system, is not now, for three reasons: (1) there is insufficient evidence for public health scientists, scholars, and health policymakers to develop policy from; (2) we do not know what we do not know about the mutating COVID-19 virus, as new unexplained symptoms appear, and its long-term effects worldwide remain unknown; and we cannot yet fully explain some COVID-19 symptoms or whether the virus may affect the human genome³; and (3) we are still observing the severe consequences of the pandemic on public well-being.⁴ Among those affected are first responders and health care workers, to whom the media appears to pay insufficient attention, even with recent increases in suicide among these persons.^4,5

The pandemic’s timeline and its impact on the United States and the rest of the world are uncertain. We cannot conduct “express science” because that is not how science works. Nevertheless, the current public health crisis is providing a unique firsthand experience and evidence of the pandemic’s impact on humans with disparities in underlying health determinants. This valuable public health information will help scientists and health policymakers build a global well-connected public health information network that is independent of politics. This will enable an improved response to future pandemics, which would represent a genuinely reinvented world-class public health system.