Five years after the World Health Organization declared COVID-19 a pandemic, public health experts say that, despite some gains, the United States is not fully prepared for another public health disaster. At least two people have died in a measles outbreak that has infected at least 222 people in 12 states. Avian influenza has evolved to move from mammal to mammal. And President Donald Trump’s key health advisers, who were nearly uniformly critical of the Biden administration’s response to the pandemic, are, in some cases, vaccine skeptics. In the first weeks of the Trump administration, Robert F. Kennedy Jr.’s Health and Human Services Department has made sweeping changes to the health agencies, including firing swaths of employees or offering buyouts to leave their posts. Two key vaccine panels at the Centers for Disease Control and Prevention and the Food and Drug Administration had meetings abruptly canceled. The National Institutes of Health has reportedly cut grants related to mRNA vaccines and vaccine hesitancy. In response to the ongoing measles outbreak, Kennedy has said the decision to get vaccinated is a “personal one.” In an interview with Fox News on Monday, Kennedy claimed that if people are healthy it’s “almost impossible” to die from an infectious disease. He also appeared to link measles to nutrition and touted unproven treatments for the illness, such as cod liver oil. “What we need is good science on all of these things so people can make rational choices,” Kennedy said. Future of pandemic legislation Congress also hasn’t done all it can to prepare for another pandemic. Many provisions in a key piece of pandemic preparedness legislation known as the Pandemic and All-Hazards Preparedness Act expired in September 2023. Lawmakers tucked a reauthorization into an early draft of the most recent year-end stopgap spending law but that draft was pulled at the 11th hour. The 2006 pandemic preparedness law was in part a response to the 9/11 attacks in 2001 and Hurricane Katrina in 2005. It was reauthorized in 2013 and then again in 2019, each time with changes. Some of the provisions typically included in the pandemic law were attached to a fiscal 2023 appropriations law, which established the White House Office of Pandemic Preparedness and Response Policy. A fiscal 2024 spending law also extended some measures through the end of last year. But authorities included in the pandemic preparedness law had certain sunset dates that have since expired. Among them include the authority to temporarily reassign certain state and local personnel during public health emergencies and national advisory committees for at-risk populations. Senate Democrats last week circulated last year’s broad health care package — which included a reauthorization of the pandemic law — in an effort to fast-track the bill’s passage. The pandemic legislation was not included in a potential legislative vehicle — the continuing resolution to keep the government running that Congress is voting on this week. View from experts Public health experts said that since the pandemic, the United States has improved its data-sharing abilities. There’s also a greater public awareness of infectious diseases than there was before COVID-19. But in other ways, the country has yet to learn some key lessons from the pandemic, they say. “Unfortunately when we look at the responses to our current bird flu and measles outbreaks (not to mention our historically bad flu season), we seem to be making the same mistakes over and over again,” Jerome Adams, the former surgeon general under the first Trump administration, said. Adams criticized the decision to cancel the FDA’s vaccine advisory panel meeting to select the flu strain to target in the fall and winter vaccine rollout. “By sidelining these processes, we risk creating gaps in our readiness, which can have dire consequences when a public health emergency arises,” he said. He also said that the growing threat of antimicrobial resistance is one of the most pressing and underappreciated threats facing the country. He said as people use more antibiotics, the risk of creating superbugs that are resistant to treatment grows, which could lead to the next pandemic. Jeffrey Kerby, the chair of the Committee on Trauma at the American College of Surgeons, said that the country learned from the COVID-19 pandemic how to design systems that best help public health institutions work across jurisdictions. He said in addition to a pandemic, the country also should prepare for other mass population events, like natural disasters or military combat. He said that he’d like Congress to focus on maintaining resources for medical operations coordinating centers, entities developed during the COVID-19 pandemic to help coordinate responses across jurisdictions. “We need that resilience to be able to handle that with the limited bed capacity we have in the U.S. health care system,” he said. He said he’d like the centers to be kept up and running even when there’s not an existing emergency so the system is prepared in the event that a disaster occurs. “The daily coordination of time-sensitive care keeps the engine of disaster response warm and running,” he said. Chrissie Juliano, the executive director of Big Cities Health Coalition, a nonprofit that focuses on public health policy in urban areas, said the country’s data infrastructure is more prepared to handle another health threat now compared with five years ago. She pointed to the CDC's Public Health Infrastructure grant, which provided flexible funding for state and local health departments to invest in public health programs. But she said that public health institutions face the growing issue of misinformation and disinformation, particularly when it comes to vaccines. She said the nation is seeing that play out on a smaller scale with the ongoing measles outbreak. “On the one hand, we've made real investments and real change, and we're in a place where the system as a whole can respond better,” Juliano said. “Now, on the other hand, the field, governmental public health, et cetera, has lost the public's trust.” Juliano said that the recent clawbacks of federal funds and pandemic-era policies also worry her. She said that as lawmakers consider whether to reauthorize the legislation this time around, she'd like to see funding for the Public Health Emergency Preparedness Program prioritized. "Not reauthorizing legislation whose primary purpose is to protect the public health and emergency is exceedingly shortsighted,” she said.
