New threats of infection are coming and it is very likely that the United States will not be able to contain them

Specifically for the New York Times Infobae.

(New Analysis)

If it wasn’t clear enough during the COVID-19 pandemic, it’s been made clear during the monkeypox outbreak: The United States, one of the world’s wealthiest and most advanced nations, remains unprepared to combat emerging pathogens.

The coronavirus has been a cunning and unexpected adversary. Monkeypox was a known enemy, and tests, vaccines, and treatments were already available. But the response to both threats was shaky and flawed at every turn.

“It’s like watching the movie again, except some of the excuses we rely on to rationalize what happened in 2020 don’t apply here,” said Sam Scarpino, who oversees the department of pathogens Rockefeller Foundation heads Institute for Pandemic Prevention.

No single agency or management is to blame, more than a dozen experts said in interviews, although the Centers for Disease Control and Prevention (CDC) has acknowledged they have not responded to the coronavirus.

The price of failure is high. COVID-19 has so far claimed the lives of more than 1 million Americans and caused untold misery. Cases, hospitalizations, and deaths are all declining, but COVID-19 was the third leading cause of death in the United States in 2021, and every indication is that it will continue to blind Americans’ lives for years to come.

Monkeypox is currently spreading more slowly and has never posed a challenge on the scale of COVID-19. Still, the United States has reported more cases of monkeypox than any other country — 25,000, about 40 percent of all cases worldwide — and there’s a good chance it will that the virus remains as a persistent low-level threat.

Both outbreaks have revealed deep fissures in the nation’s framework for epidemic containment. Added to this is the loss of public trust, rampant misinformation and deep divisions between health authorities and patient practitioners as well as between the federal and state governments. It seems almost inevitable that the response to future outbreaks will be unstable.

“We’re really, really unprepared,” said Larry O. Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.

There is no doubt that new infection threats are on the way, largely due to the concomitant increase in global hesitancy to travel and vaccinate, and the increasing proximity between humans and animals. For example, Africa saw a 63 percent increase in animal-to-human outbreaks of pathogens from 2012 to 2022 compared to the period from 2001 to 2011.

“There might be an idea in people’s minds that this whole COVID-19 thing was a natural phenomenon, a one-time crisis, and after that we’re going to be safe for the next 99 years,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

“It’s the new normal,” he added. “It’s like we built levees for this crisis that happens every 100 years, but then there’s still flooding every three years.”

A chronic underfunding

Ideally, the national response to an outbreak might be like this: Reports from a clinic somewhere in the country would indicate the arrival of a new pathogen. In parallel, continued wastewater monitoring could ring alarm bells about known threats, as happened recently with polio in upstate New York.

Information would flow from local health departments to state and federal agencies. On an accelerated basis, federal officials would approve and provide guidance for the development of tests, vaccines and treatments, and then make them fairly available to all residents.

Neither of these moves went smoothly in the two recent breakouts.

“I’m very familiar with outbreak response and pandemic preparedness, and nothing we do is like that,” said Kristian Andersen, a virologist at Scripps Research Institute in San Diego who has spent years studying epidemics.

Andersen said he assumed the shortcomings exposed by the coronavirus would be ironed out as soon as they became apparent. Instead, he assures “that we are less prepared today than when the pandemic began”.

Public health in the United States has always operated on a tight budget. The data systems used by the CDC and other federal agencies are ridiculously outdated. Many public health workers have been abused and assaulted during the pandemic and have left or are planning to leave their jobs.

Several experts say that not all problems can be solved with more money. But the additional funding could help health departments hire and train staff, upgrade aging data systems and invest in robust surveillance networks.

But in Congress, preparing for a pandemic remains a tough sell.

President Joe Biden’s fiscal 2023 budget proposal is $88 billion over five years, but Congress has shown no interest in passing it.

The United States spends 300 to 500 times more on its military defenses than on its healthcare systems, and yet “no war has killed a million Americans,” said Thomas R. Frieden, who headed the CDC during the tenure of former President Barack Obama.

A renewed urgency

The United States should be the best country when it comes to fighting epidemics. A global health security assessment conducted in 2019, a year before the coronavirus hit, ranked the nation first: best in outbreak prevention and detection, most adept at risk communication and second only to the UK in terms of reaction speed.

However, all of this assumed that leaders would act quickly and decisively when confronted with a new pathogen, and that the populace would obey orders. The analyzes did not consider the possibility of a government minimizing and politicizing every aspect of the COVID-19 response, from diagnostic tests to the use of face masks to vaccine administration.

Too often in a crisis, government officials look for simple solutions with dramatic and immediate repercussions. But there are no such solutions to deal with pandemics.

“A pandemic is by definition one hell of a problem. It’s very unlikely that you can eliminate all of the negative consequences,” said Bill Hanage, an epidemiologist at Harvard TH Chan School of Public Health.

Instead, Hanage added, officials should rely on imperfect combinations of strategies, with an emphasis on speed rather than precision.

shared responsibilities

The biggest obstacle to a coordinated national response comes from the division of responsibilities and resources between federal, state, and local governments, as well as communication gaps between the public health officials who are coordinating the response and the doctors and nurses who are actually responding to patients take care of.

The complex laws that govern healthcare in the United States are designed to protect patient confidentiality and rights. “But they’re not optimized to work with the public health system or to give the public health system the data it needs,” said Jay Varma, director of the Cornell Center for Pandemic Prevention and Response.

In principle, federal states are not obliged to pass on health data such as the number of cases of infection or demographic data of the vaccinated to federal authorities.

Some state laws actually prohibit officials from sharing information. Smaller states like Alaska may not want to provide patient identifiable information. Hospitals in small jurisdictions are reluctant to release patient data for similar reasons.

Healthcare systems in countries like the United Kingdom and Israel rely on nationalized systems that make it much easier to collect and analyze information about cases, said Anthony Fauci, the Biden administration’s top medical adviser.

“Our system isn’t connected in that way,” Fauci said. “It’s not uniform, it’s a mosaic.”

Epidemics are managed by public health agencies, but it is the workers – doctors, nurses and others – who diagnose and care for patients. An efficient response to the epidemic is based on mutual understanding and information sharing between both groups.

The parties have not communicated effectively during either the COVID-19 pandemic or the monkeypox outbreak. This separation has led to absurdly complicated procedures.

For example, the CDC has not yet included monkeypox in its computerized disease reporting system. That means state officials have to manually enter data from case reports, rather than simply uploading files. Often a request for a diagnostic test must be faxed to the government laboratory; Results are typically relayed through a state epidemiologist, then to the provider, and then to the patient.

According to some experts, few public health officials understand how health care is delivered in each location. “Most people at CDC don’t know what the inside of a hospital looks like,” said James Lawler, co-director of the Global Center for Health Security at the University of Nebraska.

Frieden, who once ran the New York City Department of Health, suggested that integrating CDC employees with local health departments could help officials understand the obstacles involved in responding to an epidemic.

Frieden has also proposed what he calls a “7-1-7” accountability metric loosely modeled on a strategy used to combat the HIV epidemic. Any new disease must be identified within seven days of outbreak, reported to health authorities within one day, and treated within seven days.

The strategy could give the government a clearer picture of the issues hampering the response, he said.

In the United States, “we have repeated cycles of panic and abandonment,” Frieden said. “The most important thing we have to do is to break this cycle.”

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