Ahead of the 2024 US presidential election, leading clinicians and researchers are advocating for urgent reforms to prevent mass casualties in future pandemics. The BMJ has launched a forward-looking series that examines the lessons learned from the US’s COVID-19 experience and proposes actions to protect population health and improve response capabilities.
Written by experts from across the United States, the articles in the series explore various topics such as the role of systemic racism and economic inequality in contributing to disparities during the pandemic, the impact of mass incarceration and poor prison health, labor market inequalities, and the diminished role of the public sector.
The authors emphasize that these systemic reforms should be a central focus in the manifestos of the 2024 US presidential candidates. The goal is to transform public health and preparedness, preventing the loss of another million citizens while also improving overall population health.
In an editorial introducing the series, guest editors Gavin Yamey from Duke Global Health Institute and Ana V. Diez Roux from Drexel University Urban Health Collaborative highlight the devastating impact of COVID-19 on the United States. They point out that the country experienced eye-wateringly high death rates compared to other nations, with 1.16 million Americans losing their lives to the virus, representing 16% of global deaths despite having only 4% of the world’s population.
The series delves into the complex causes of the poor US pandemic response, with two key contexts underpinning the outcomes. Firstly, pre-existing structural and systemic features in the nation, including gaps in healthcare and public health systems, the absence of social safety nets and workplace protections, social inequality, and systemic racism, contributed to the devastating impact of the pandemic. These factors help explain why COVID-19 mortality rates were higher in the US compared to more equal countries, and why death rates were closely linked to social class and race.
Secondly, although the US possessed significant scientific resources, the government struggled to generate reliable information, effectively communicate it, and translate it into sound policy. The editorial criticizes former President Trump for frequently spreading disinformation during the pandemic, which undermined public trust. The confusion caused by poor communication further led to delayed actions and inappropriate measures. For instance, some states kept parks, playgrounds, and beaches closed despite evidence showing minimal transmission in those settings, and too many jurisdictions kept schools online even though research indicated they could be safely reopened.
The authors highlight the importance of addressing these failures and learning from the experience of the pandemic. They note that while the US faced significant challenges, it also demonstrated how a different role of government and society can protect public health. Strategies such as rapid vaccine development, publicly funded interventions including expanded unemployment benefits and food assistance programs, and federal funding for public schools showcased the potential for broader government actions to safeguard health during future crises.
The first article in the series, authored by David Michaels from George Washington University and colleagues, focuses on the impact of COVID-19 on frontline workers in the US. It highlights the disproportionate effects on low-wage workers who had to continue working outside their homes to maintain essential services. The authors argue that occupational and public health agencies failed to provide adequate workplace protections during the pandemic. They stress the need for immediate action to ensure worker safety in future pandemics, including paid family and medical leave, better social supports, and improved workplace protection policies.
Overall, the series aims to shed light on the systemic issues within the US that contributed to the devastating impact of COVID-19 and proposes crucial reforms to prevent such casualties in future pandemics. By addressing issues such as systemic racism, economic inequality, and the role of the public sector, the authors hope to improve population health and enhance the country’s preparedness and response capabilities. As the 2024 US presidential election approaches, these topics will likely take center stage in the national discourse, emphasizing the importance of implementing meaningful reforms to avert future public health crises.
