Trust in our public health systems can help guide COVID-19 recovery
By Kevin Sia
In the short and painful history of the COVID-19 pandemic, one pattern that remains unchanged is that racial minorities are disproportionately bearing the brunt of this disease. Glaring underinvestment in public health compounded the effects of structural racism during the COVID-19 pandemic to devastating results.
A study in the New England Journal of Medicine found, in a one month span, that 7 out of 10 people in a hospital system in Louisiana diagnosed with COVID-19 were Black. Among people hospitalized for COVID-19, almost 78% of the people who died were Black. An age-stratified study on COVID-19 deaths found that Black and Latinx individuals between the ages of 35–44 perished at 7–9 times the rate of their white counterparts. These statistics are staggering facts on the toll that COVID-19 has taken on minority communities.
There are many possible reasons for this tragedy. For one, racial and ethnic minorities make up a significant fraction of primarily minimum wage, yet essential, occupations with a high potential for exposure. They also frequently live in multi-generational households. Racial and ethnic minorities with underlying conditions, such as diabetes or cardiovascular conditions, are at higher risk of severe COVID-19 disease relative to white counterparts.
Occupations, housing, and underlying health conditions of minorities are tied to structural racism in ways that have crippled those communities’ ability to keep COVID-19 at bay. The negative effects of structural racism, though, have been compounded by the tendency for government to underinvest in public health.
At the outset of the Trump administration, federal agencies across the board were instructed to institute a rigid hiring freezes that left significant numbers of vacancies, many at national scientific institutions such as the CDC, NIH, FDA, and EPA. This reduction of the federal workforce by attrition was compounded by a record number of scientists leaving federal posts in the first two years of the Trump administration. Vacancies and resignations leave holes that make research and operational continuity very difficult.
It will be impossible to determine if the butterfly effect of such disruptions affected the early responses to the COVID-19 pandemic. But the United States, long a global leader in public health responses, uncharacteristically stumbled at the first hurdle of developing and distributing an accurate diagnostic test that could have been critical in uncovering the extent of the virus’ penetration. These missteps cost thousands of lives.
Investments in local public health departments have been similarly dire. According to an analysis by the National Association of County and City Health Officials, the number of full-time employees at local health departments has fallen an estimated 16% since 2008. At the same time, budgetary reductions for local health departments impaired their capability to prepare for and respond to emergencies. We are now seeing first-hand the effects of those handicaps on our public health institutions.
The kind of bare minimum financial investments in public health by government is suggestive of a broader trend of distrust of the scientific enterprise by the public.
With the pandemic far from over, commentary on the CDC’s early missteps in its COVID-19 response hides the years of national underinvestment in priority areas such as chronic diseases and public health preparedness. A recent poll highlights the tenuous nature of the public’s trust in agencies meant to safeguard the public’s health. Now, conversations about potential vaccines for COVID-19 center on political theater rather than more pressing concerns, such as ensuring the enrollment of adequate numbers of racial minorities in efficacy trials or navigating vaccine hesitancy for preventable diseases like measles in the age of COVID-19.
Distrusting scientific guidance has hurt every citizen of the United States in this pandemic, but it has hurt racial and ethnic minorities the most. Confusing, often politicized, messaging on viral transmission and deadliness of the novel coronavirus left local leaders paralyzed and delayed implementation of strategies that could have saved lives. Different experts and non-experts competed for attention and resulted in a race to the bottom when it came to which advice to take.
To better serve everyone going forward, we need to include scientists in policy conversations to aid in developing better evidence-based policies. In turn, scientists must become better communicators to engage with the public without appeals to authority. This type of training should ideally be mandatory and in the Toastmasters vein. Including communications training for scientists at all levels in public service or in academia is a relatively easy investment to make that could have cascading positive effects.
The United States stands at a crossroads in many ways as 2020 finally comes to an end. Re-investing in our public health and scientific institutions, in dollars and in the currency of trust, will be repaid in healthier communities for all.
Kevin Sia, PhD is a postdoctoral fellow at Memorial Sloan-Kettering Cancer Center.
