By Kristen Rogers, CNN
More than two years into the Covid-19 pandemic, we have reached a crossroads.
On one hand, “this is the most teachable moment the world has had about the importance of public health in 100 years,” said Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention. “On the other hand, we’re really at risk of heading full steam ahead into the neglect phase of the ‘panic-neglect cycle.’ “
The panic-neglect cycle is the habit of underinvesting or paying inadequate attention to the public health infrastructure and functions needed to prevent, identify, contain and respond to infectious disease outbreaks.
Another pandemic seems inevitable. We “live in an age of pandemics,” said Dr. Larry Brilliant, an epidemiologist and CEO of Pandefense Advisory, an interdisciplinary network of experts engaged in pandemic response.
More than six out of every 10 infectious diseases originated in animals and jumped to humans. This risk has “been increasing for the last 20 years,” Brilliant said. “Every year, the risk increases more.”
Public health “certainly had a number of missteps” during the Covid-19 pandemic, but the experience has offered lessons, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at the Life Itself conference, a health and wellness event presented in partnership with CNN.
“The investment in basic and clinical biomedical research allowed us to, with unprecedented speed, develop highly effective vaccines that essentially, (we never would) have imagined you could have done it that quickly,” he added. “We need to keep making those investments, not only in science … but in the public health infrastructure.” We must also remember “what it means to have a public health system that was not able to respond in a manner that was matching to the challenge that we’re facing,” he said.
“What we don’t want is to have our children, and perhaps our grandchildren, forget what we’ve been through.”
Whether we’re going to apply lessons from the current pandemic remains to be seen, Frieden said, but doing so is key to ending that cycle, so that outbreaks don’t become pandemics with countless consequences — including millions of lives lost and drastic effects on health care, mental health, the economy, education, relationships and careers.
Much of the preparedness burden lies in the hands of public health institutions, but the public can play a vital role. Here’s what some of the top infectious disease experts think both can do to help:
1. Increase public health funding
The US spends at least “about 300 and 500 times more on our military defense than we do on our health defense,” Frieden said. “And yet, no war in American history has killed a million Americans.”
As of June 1, nearly 6.3 million people have died from Covid-19 worldwide, including more than 1,007,000 Americans.
“So we really do need to up our game in terms of protecting people in this country and around the world,” said Frieden, who is also CEO of Resolve to Save Lives, an independent organization focused on preventing epidemics and cardiovascular disease. “You can’t make a safer US without making a safer world.”
“It’s hard, especially from a funding perspective, to convince people with big pocketbooks … to say, ‘Maybe it might happen, maybe it won’t, but we do need to put billions of dollars in that arena,’” said Kizzmekia Corbett, an assistant professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, said at Life Itself. Corbett’s team developed mRNA-1273, a leading vaccine against coronavirus manufactured and developed by ModernaTX, Inc. and NIAID.
“Because of that, oftentimes a lot of the research dollars and a lot of the research mental capacity goes to the side of treatments,” Corbett added. “We want to be able to really shift that way of thinking.”
More funding is also needed for staples such as having enough testing when the time comes, Brilliant said, “so that we won’t get behind the eight ball like we were” with Covid-19.
More investment in global health is needed, too. The World Health Organization’s budget is lower than those of some large US cities, Brilliant said, “and they’ve got to take care of pandemic risk for 200 countries and all the other things WHO does.”
“We have to think about pandemic preparedness as really strengthening the public health system worldwide,” he added. “Right now, it’s not clear that Congress is going to appropriate the amount of money that makes sense. Because for 80% of the country, they feel like — and legitimately feel — that their (Covid-19) risk has passed.”
2. Protect nature
Pandemic prevention also means “we need better systems to protect nature so that nature doesn’t come back to bite us,” Frieden said.
In studies of drivers of zoonotic diseases, the risk has been highest when human exploitation and habitat destruction threatened wild animals. When we hunt and occupy wild animals’ natural homes or sell wild animals in markets, they experience great stress — which makes them more likely to get infected and produce higher numbers of viruses. This leads to greater viral shedding, which is the expulsion and release of virus-carrying excretions.
Being around stressed, sick animals or eating them exposes humans to a greater chance of catching a virus, Dr. Christine Kreuder Johnson, a professor of medicine and epidemiology at the University California, Davis, told CNN in 2020. The possibility of virus spillover is also higher between humans and animal species that have similar DNA or have lived together over time, such as pigs or livestock.
Thinking about environmental health as part of our health is critical for reducing virus spillover, Johnson said.
Everyone doing their part to slow climate change is essential, Brilliant said. “Because of increasing temperatures, animals are migrating from the south to the north,” he said. “When animals migrate and they change their territory, they come in contact with other animals that they’ve never been in contact with before. And they exchange viruses, just as they exchange viruses with us.”
3. Act early and quickly
Infectious disease experts detecting outbreaks of a new disease early and addressing them quickly while they’re small is key to preventing a larger emergency.
“My group, Resolve to Save Lives, has suggested a global galvanizing goal we call 7-1-7: that every single outbreak anywhere in the world is detected within seven days of emergence, reported within one day and control measures implemented within seven days,” Frieden said. This approach “allows us to quickly identify things that need to be fixed.”
4. Improve public health communication
We have better tools to address infectious diseases than we’ve ever had, but we’re also more vulnerable than we’ve ever been, partly because of a widespread lack of trust between communities, governments and health care systems, Frieden said.
“The CDC literally wrote the book on public health communication in an emergency: Be first, be right, be credible, be empathetic, give people practical, proven things to do to protect themselves, their families (and) their communities,” Frieden said. “Unfortunately, that hasn’t been implemented (in the US), either by the prior administration or by this one. And we have suffered for that.”
“You cannot surge trust in an emergency,” Frieden added. “You have to have it there as baseline.”
Communication about the pandemic has “been challenging,” said Dr. Rochelle Walensky, director of the CDC, at Life Itself. “We’ve been divided against a common foe, which has been this pandemic virus.”
“We have had to make decisions with imperfect data and imperfect times, but if we didn’t make a decision at that time, that would have been a decision itself,” she added. “We need to follow and understand the best science that we have at the time the decision is being made.”
Walensky plans to spend much of her time working on ways to make public awareness part of pandemic surveillance, she said.
“You have to be consistent, always stick with the facts and the evidence and the data. That was one of the issues that obviously arose when I was part of the Coronavirus taskforce in the prior administration,” Fauci said.
5. Fight misinformation
There’s a saying that a lie can travel halfway around the world before the truth has even put on its boots. “It’s been very challenging for health, for doctors and others to deal with viral misinformation, which spreads even faster than Omicron,” Frieden said.
Pandemic misinformation can influence people’s motivations, beliefs and decision-making concerning their health, politics, the environment and more.
Some social media apps, such as Instagram and TikTok, have launched features that lead people to accurate information from credible health organizations when viewing content concerning the coronavirus or vaccines.
Confronting loved ones about their misleading or false social media posts isn’t easy, but there are ways to do it skillfully with empathy.
6. Support your own health
Individual resilience is another key factor in preventing serious illness and deaths during pandemics, Frieden said.
“One of the reasons Covid has killed so many people is there were so many people who were vulnerable to health problems,” Frieden said.
Healthy lifestyle habits that support immunity can “make a really big difference,” he said. Take any medications you have been prescribed, find healthy food you love and don’t smoke or be exposed to others’ smoke, Frieden recommended.
“Getting healthy doesn’t mean denying ourselves things we want to do,” Frieden said, “but rather figuring out what are healthy things we love to do and doing more of them.”
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Correction: This story previously misstated the current structure of the organization Resolve to Save Lives.
