Systemic reforms in the United States are needed to avoid mass deaths in the next pandemic

On the eve of the 2024 US presidential election, The BMJ launched a forward-looking series that highlights lessons that can be learned from America’s COVID-19 experience and actions needed to prevent the loss of an additional million citizens in the next pandemic and improve and protect health Population.

The articles, authored by leading clinicians and researchers across the United States, explore topics such as how systemic racism and economic inequality have contributed to COVID-19 disparities; mass incarceration and poor prison health as drivers of the pandemic; inequalities in the labor market; and the impact of “state weakening” (the diminished role of the public sector).

The authors call for a set of crucial systemic reforms, which they say should be at the heart of the platforms of the 2024 US presidential candidates.

It’s important to note that the aim of the series is not to place blame – there is much to be done – but to look forward and define the critical steps that need to be taken to transform public health and preparedness in the United States and improve population health more broadly.

In an editorial to kick off the series, guest editors Gavin Yamey of the Duke Global Health Institute, Duke University and Ana V. Diez Roux of the Drexel University Urban Health Collaborative explain how, during the devastating global COVID-19 pandemic, the United States suffered “from the eyes”. “Incredibly high” mortality rates compared to peer countries.

The 1.16 million Americans killed by COVID-19 represent 16% of global deaths in a country that represents 4% of the world’s population, they write. Around 300,000 children are estimated to have lost one or both parents, and the burden of long COVID remains considerable.

The series documents the many complex and interrelated causes of America’s poor response to the pandemic, underpinned by two key contexts.

The first concerns the country’s pre-existing structural and systemic characteristics, which contributed to the devastating consequences of the pandemic. These include gaps in healthcare and public health systems, lack of social safety nets and workplace protections, entrenched social inequalities and systemic racism.

“These are the main reasons why the country experienced higher COVID-19 death rates than its more equal counterparts, and why pandemic deaths in the United States were so closely modeled on social class and race” , write the authors.

The second is that although the United States had many scientific resources, the government demonstrated a worrying inability to generate reliable information, communicate it in a timely and consistent manner, and translate it into policy. judicious.

These failures started at the top, say Yamey and Diez Roux. President Trump has frequently lied about the pandemic, and his suggestion of using bleach to combat COVID-19 “came to symbolize chaotic presidential communications during the pandemic’s first year “.

Poor communication of existing evidence has also contributed to confusion and delays in action. Such communications missteps partly explain the partisan difference in how quickly states have moved to put in place public health protections and the excess death rates during the pandemic, particularly since vaccines became available.

Poor communication of evidence has also led to inappropriate actions, they add.

For example, even after studies showed that transmission through fomites (objects and surfaces) was rare and transmission outdoors was much less common than indoors, some municipalities or states continued to restrict closure of parks, playgrounds and beaches.

And after research showed schools could be reopened safely with basic public health measures, too many jurisdictions kept schools online-only.

Additionally, communication failures were compounded by federalism – the division of power between the national government and the 50 US states – which ensured that the response to COVID-19 depended on zip code, showing the limits of federalism in the face of a deadly pandemic. .

Yet despite these failures, they note that the pandemic has also shown the United States how a different role for government and society in protecting health is possible.

For example, in addition to the rapid, publicly funded development of a vaccine, strategies such as expanded unemployment benefits, food assistance programs, expanded children’s health insurance coverage, and enrollment in Medicaid, along with federal funding for public school upgrades, was put in place to help curb suffering and death.

“Particularly relevant to the 2024 U.S. presidential election, they illustrate how a range of government actions, beyond health insurance, can be critical to protecting health during the next pandemic and beyond” , they conclude.

In the first article in the series, George Washington University’s David Michaels and colleagues examine how COVID-19 has affected frontline workers in the United States and what needs to be done to ensure they are better protected in the future.

They argue that COVID-19 has disproportionately affected low-wage workers who have had to leave home and go to work to keep society functioning, and say measures taken by U.S. occupational health and safety agencies public health have fallen well short of what was needed to make workplaces safe during the pandemic.

They acknowledge that temporary social and economic interventions during the pandemic have brought some relief to these workers, but say that protecting workers’ health in the next pandemic will require action now on paid family and medical leave, better social supports and better workplace protection policies.