As an epidemiologist on the front lines of the COVID catastrophe from the start, I’ve witnessed the public health system buckling and failing in multiple ways. In order to mount a data-driven national recovery from COVID-19, far-reaching change is still urgently needed to sustainably address the systemic public health needs now exposed. While I welcome the Biden-Harris approach as a centralized national strategy—rather than countless competing responses from states, counties and territories—let’s make the most of this opportunity to identify and rise to its unprecedented challenges of (1) data collection and (2) human capital.
Fancy graphics, online dashboards and even the new projections cited at the first COVID briefing from the new administration give the impression that data systems have been doing a fine job of tracking the pandemic. But slick tools implying precise data updated in real time mask a more complex underlying reality—one that is now finally starting to be acknowledged by the president’s strategy. There is no standardized secure system to communicate test results.
Worse, the monitoring system is trapped in a tech era a quarter century old. Due to privacy regulations, health care providers can transmit lab reports electronically only if they have purchased rights to an electronic lab report system or encryption software. As a result, health department staff are literally standing by fax machines, waiting for test results that must be painstakingly deciphered and manually reentered into the health department’s database through a haphazard and resource-intensive data entry process before they can be added to a dashboard or reported publicly.
The localized nature of record-keeping systems tracking infections and exposures further hinders the response. If a New York resident is tested for COVID-19 while in Chicago, results are transferred from the Chicago health care provider to the Illinois health department to the New York health department for data collection and outreach. However, reporting follows wildly different formats. I’ve encountered countless lab reports and interstate transfer forms completed in illegible handwriting and others for which a local health department developed its own numeric code but didn’t provide a key. Early in the pandemic response, a local health department asked me to develop a database to assess risk factors for people who tested positive, a task that would have been unnecessary had the CDC been funded to update its national electronic disease surveillance system.
It’s encouraging to see the new strategy finally starting to grapple with these challenges for collecting the data that will inform the path forward. It’s impossible for me to overstate the challenge that this represents: a truly data-driven response will require a complete overhaul, modernizing to electronic data transfer throughout every stage of the public health system, from individual patient care to national metrics. I’d like to see the president’s team make an even bolder push, not just for collecting sorely needed data on race and ethnicity, but also towards developing a nationally standardized public health information platform that would connect health departments with individuals seeking local resources and also provide regions with comparable data to direct resources toward communities most in need. Health departments, for so long starved of funding and lingering in the backwaters of outdated technologies, must now be on the cutting edge of innovative technologies for tracking health metrics—not just for the current crisis and even the next one, but also to run ongoing health promotion activities such as childhood vaccinations.
The long-term underinvestment in state and local health departments has also led to an erosion of investment in human capital and technical resources. The emergence of the new virus variants has exposed limited capacities for genomic sequencing, real-time surveillance and other resources. President Biden has proposed that 100,000 new recruits of the proposed Public Health Corps will be responsible for contact tracing and community mobilization; while this is a worthy step, it is insufficiently ambitious. The Biden-Harris team now has the opportunity to build a public health jobs program where a skilled and well-equipped workforce is rewarded for exploring difficult questions, leading to opportunities for transparency and creative thinking.
The U.S.-based NGO Partners in Health proposes that at least 1.6 million permanent jobs are needed to address health disparities and rebuild national capacity to address current and future crises. We need to create and support a cadre of skilled professionals trained to implement and manage all aspects of public health throughout state, health and territorial health departments nationally—including boosting those already working there to bring their skills and morale up to date, and recruiting those lost through brain drain to the private sector, where their talents and innovations have been recognized and rewarded.
As in other government agencies, many employees who have thrived in health departments are those who have learned to navigate the systems despite their inefficiencies and a work culture that cannot afford to encourage innovation. Let’s create new jobs and career paths at health departments and end their current culture of relying on temporary contractors and deployments. Furthermore, those of us working on the public health front line still seek opportunities for leadership and partnership with the CDC at all levels and locations. I look towards the CDC for a trusted, reliable voice issuing evidence-based guidance, tools, training, data sharing and a platform for collaboration.
One of the primary purposes of the public health system is to proactively prevent illness among communities, rather than treating it as it arises among individuals. In the United States, where health has become regarded as a commodity to be purchased individually, rather than a collective social responsibility and public good, the role of the public health system has been chronically neglected. The Biden-Harris administration has an opportunity to reassert the importance of public health by encouraging a firm data-driven foundation and by supporting the use of innovative technologies.
I welcome the Biden-Harris team’s new strategy, prioritizing science, data and public health at last. I call upon the Biden-Harris administration to be even more explicitly ambitious in its plans to invest in an innovative public health infrastructure and equip it for service that brings it up to date—not just for the needs of a population currently in extreme need but also for future needs of community health care access and equity exposed by the current crisis.
This is an opinion and analysis article.