Pandemic response and the impacts of racism: "Our leadership and systems have failed us."

As the U.S. COVID-19 death toll nears 125,000 lives, it’s clear that the nation’s leadership has failed in its duty to protect us, said a panel of public health leaders earlier this week.

“COVID-19 has been the big pandemic we’ve been talking about and planning for our entire professional lives, and our leadership and systems have failed us,” said Georges Benjamin, MD, APHA’s executive director, during a U.S. News & World Report webinar on “Public Health Leadership and Policy: Lessons from Crisis.” 

Benjamin joined fellow public health leaders earlier this week for the webinar, which focused on COVID-19, lessons learned in the response and the health impacts of racism. Panelists took on a range of issues, from police violence and health inequities to the failure of U.S. leadership to contain COVID-19.

“In 2005, H1N1 caused alarm bells to go off,” said panelist Anand Parekh, MD, chief medical advisor at the Bipartisan Policy Center and former deputy assistant secretary for health at the U.S. Department of Health and Human Services. “So did COVID-19, but this time the White House didn’t respond, didn’t take it seriously and sent mixed messages to the public.” 

APHA member Leana Wen, MD, emergency physician and visiting professor of health policy and management at George Washington University’s Milken Institute School of Public Health, cited a number of factors contributing to the nation’s ineffective pandemic response, including a lack of a national strategy, the inability of the Centers for Disease Control and Prevention to lead and years of underfunding the public health system. 

“COVID-19 has unmasked disparities in the social determinants of health that public health works to address,” she said during the webinar. “But we’re having to pull resources from existing health challenges to address COVID-19.”  

From 2015 to 2018, Wen served as health commissioner at the Baltimore City Health Department, where she said the budget was less than the amount of overtime paid to local police officers. 

“There is a role for law enforcement,” she said, sharing her thoughts on police violence and calls to defund police. “It’s not either/or, but we need to rethink our budgets and really look at police brutality, racism, the broken criminal justice system. Health is more than just the health care system.” 

With people of color being hit hardest by COVID-19 and a renewed urgency to hold police violence to account, panelists said we must focus on the root problem: systemic racism.

“People of color are more exposed to this virus as essential workers unable to stay at home,” Benjamin said. “Historical injustice means these populations have more heart, kidney and lung disease that worsen the outcomes of infection; and the social determinants of health are policy decisions that disadvantage communities.”

Asked how officials can balance health priorities with policy and economic concerns as the country reopens, Benjamin said: “Health is first right now. It’s a tragedy today as we see COVID-19 numbers go up in places. Some governors are pulling back, saying they’re reopening too fast, and I’m glad to see it. Until we fix the health problem, we can’t fix the economic problem. If we don’t have political will now, we never will.”

Anand agreed that the “economy will come back, but a public health response has to come first. Physical distancing, smart, data-driven reopening…all these take time and need support through effective bipartisan policies.”

But public health has been underfunded for so long that, over the past decade, its workforce has shrunk by approximately 56,000 positions. And the problem is only growing as public health workers try to perform their jobs in a highly politicized environment, Benjamin said. 

“Twenty-seven public health officials during the pandemic have left their positions, many under threat from members of the public, who don’t want to follow public health guidelines,” he said during the Wednesday webinar. “As an ER physician, I’ve never had a patient threaten me when I was trying to save their life. It’s the most bizarre thing I’ve ever seen.”

All the panelists agreed that progress begins with responsible leadership that respects the role of public health and effectively communicates and builds trust with the public. The main takeaway: Public health leadership starts at the top. 

To listen to the webinar or download a transcript, visit U.S. News & World Report.