Improved future pandemic responses hinge on more government involvement, experts say

Subway train passengers with protective masks crowding to get on and off subway station platform on Serdika Metro station, Sophia, Bulgaria.

February 14, 2024—Increased government oversight of public health research, disease surveillance, and policy is critical to saving lives and promoting equity during future pandemics, according to Harvard T.H. Chan School of Public Health’s Mary Bassett, Justin Feldman, and Gregory Wagner.

Wagner, adjunct professor of environmental health; Bassett, director of the FXB Center for Health and Human Rights; and Feldman, visiting scientist at the FXB Center, were among the experts who contributed to The BMJ’s series on lessons from the U.S. response to the COVID-19 pandemic. Wagner and his co-authors wrote about a lack of adequate protections for frontline workers, arguing that Americans employed in industries such as health care, manufacturing, and transportation “were rarely seen as a population that needed special attention.” Bassett and Feldman wrote about the impacts of privatization and limited government involvement in pandemic response, arguing that “unprecedented spending was not accompanied by parallel efforts to address fundamental deficiencies in government capacity—staff, skills, experience, and facilities.”

Huge loss of life—particularly among racial minorities—unnecessarily resulted from these deficiencies, according to both papers. Wagner and his co-authors pointed out that Black and Hispanic workers are disproportionately represented among frontline workers and were therefore exposed to COVID-19 at disproportionate rates. Bassett and Feldman wrote that anti-Black racism underpins Americans’ prevailing belief in limited government control over public health efforts, and explains why management consultants, rather than federal and state officials, led much of the pandemic response.

The way forward, both papers say, is greater investment in government-led public health efforts. Wagner argues for paid family and medical leave and for more resources for the Occupational Safety and Health Administration so it can better enforce workplace protection policies. Bassett and Feldman argue for limiting the role of management consultants and expanding the role of health and government leaders in responding to future pandemics.

“COVID-19 will be followed by other pandemics, and the growing impact of climate change is likely to make crises more frequent,” Bassett and Feldman wrote. “Health workers have important roles in setting policy and educating the public about the causes of the seemingly intractable problems of governance that undermine the people’s health.”

Read Wagner’s paper: US workers during the covid-19 pandemic: uneven risks, inadequate protections, and predictable consequences

Read Bassett and Feldman’s paper: US public health after covid-19: learning from the failures of the hollow state and racial capitalism

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