Be Prepared

I was in fact a Boy Scout, and that was our motto. We had a creed and an oath as well, which were more controversial, but the motto carries over into the realm of public health very well. Preparedness is a major obsession of public health planners and advocates, but it's hard to maintain because people get complacent and politicians don't want to raise the taxes and spend the money for preparedness in between crises.

Covid-19 has demonstrated what fools we are in that regard. Now JAMA has a theme issue on pandemic preparedness and response, including some prognostications about how we can live with this going forward, and they've taken down the paywall for the articles. (The link is only good for  a week -- I'll see if it can be updated when the time comes.)

I can't comment on all of it in a blog post, but you might want to look specifically at Nuzzo and Gostin specifically on preparedness. They discuss inequity, lack of infrastructure, and other issues, but I'll quote this:

Public distrust of health agencies and lack of population-level adherence to risk-mitigation measures proved major impediments in the COVID-19 response. A US survey of 1305 people in early 2021 found high levels of distrust: only 52% expressed high trust in CDC, 37% in the Food and Drug Administration, and 41% in state health departments.⁴ This distrust has led to social and political division over the utility of masks and vaccinations. Nonpharmaceutical interventions require high levels of population-level adherence. Even highly effective medical countermeasures such as vaccines require population-wide uptake to reduce disease transmission and progression to serious disease. Building public trust in scientific recommendations, especially through community leaders and social and religious institutions, is vital to future preparedness.

 

Obviously the government response in 2020 was abysmal, and distrust in scientific authorities and public health leadership was fostered directly by the person occupying the office of president. However, we have an underlying socio-cultural problem with two major dimensions: rejection of expertise, and rejection of collective action on behalf of the public good. People used the former to rationalize the latter, in many cases. As a society we are in serious trouble if we cannot mobilize the population on behalf of real dangers, but that's what it has come to. It is a badge of pride for many people to deny both the reality of threats to the public good, and the responsibility we each have to it. This must end.