Public health analysts are recommending real-time data on emerging diseases and robust systems for sharing that information to allow the U.S. to respond more quickly in the event of another disease outbreak.
The U.S. health system was ill-prepared when Covid-19 landed. Federal responsibility was spread out across agencies such that accountability for responding to catastrophic events was unclear, industry participants said.
“If we had much more real-time information about who was infected in the country back in February and March, we could have avoided not only a lot of illnesses and deaths, but a lot of unnecessary economic consequences resulting from closing the country down,” said Eric Toner, senior scientist at the Johns Hopkins Bloomberg School of Public Health.
Health professionals are grappling with what exactly went wrong, and how to prepare the next time a public health threat emerges.
“We need to think about how public health in the United States is managed, through a federal, state, and local partnership that has shown to be very porous with lots of gaps in communication and a lot of challenges about who’s responsible,” Georges Benjamin, executive director of the American Public Health Association, said in an interview.
Ideally, the U.S. public health system should be able to track emerging disease data county by county and monitor hot spots of previous outbreaks, Rick Bright, senior vice president of pandemic prevention and response at the Rockefeller Foundation, said on a webinar hosted by the Milken Institute. Bright led the Department of Health and Human Services’ unit that coordinates the development of vaccines and treatment for public health medical emergencies in the previous administration.
“Closely monitoring data across the U.S., and across the world, can help health officials spot signals or irregularities that suggest something abnormal is happening,” Bright said. Health professionals can then form a hypothesis on how the emerging threat could harm the population and devise ways to reduce the spread.
A year ago, public health analysts floated the idea of creating a National Weather Service-like system to predict disease outbreaks the same way the NWS forecasts weather. That project is yet to be funded, Toner said.
The NWS collects information that goes out to every local meteorologist. In contrast, public health data is now gathered at the local level and reported up the chain to federal agencies like the Centers for Disease Control and Prevention.
The bottom-up reporting system works as long as local communities are consistent about reporting cases to the federal government. Even with the most well-connected surveillance system, efforts to thwart the next pandemic will fail if there isn’t enough data collected, Phil Febbo, chief medical officer and senior vice president of Illumina, said at the event.
Currently reporting is spotty. “We do not have enough data to really leverage the power of the technologies we have today,” said Dennis Carroll, senior advisor for Global Health Security. “If we build a layered strategy that looks from clinical to community to high-risk settings where we’re not [now] seeing this collection, we may be able to use that information to begin building models for forecasting elevations of risk over time.”
The federal government is already experimenting with reporting mandates, recognizing that voluntary systems aren’t working. A recent HHS rule requires nursing homes and other congregate care facilities to report data on Covid-19 vaccination and therapeutic treatments. Less than 20% of nursing homes sent data to the CDC under voluntary conditions, the HHS said.
If a disease forecasting system is going to work, more mandates could be on the horizon.
Attention to a public health crisis tends to fade once the threat dies down.
“What often happens in our country is that we throw a lot of short term money into something because things are going so poorly and once the emergency is over, we kind of walk away and say we’ll get to it later,” Benjamin said. “We never build anything in a holistic, organized manner. We need to make sure that doesn’t happen this time.”
A system to monitor outbreaks isn’t complete unless the U.S. is sharing and receiving data from other countries, said Christine Parthemore, CEO of Council on Strategic Risks.
“The [World Health Organization] needs to tightly coordinate with other organizations next time on early warning to make sure what happened with this pandemic doesn’t happen again,” she said. “Let’s just go ahead and start setting up the infrastructure now and not spend years thinking about how we’ll do it in the future.”