Epidemiologist stresses need for investment in public health ahead of next pandemic | SteamboatToday.com

Epidemiologist stresses need for investment in public health ahead of next pandemic

Jennifer Nuzzo, a doctor of public health at Johns Hopkins University, said it won’t be 100 years until there is another COVID-19-like crisis

In the aftermath of the Sept. 11 terrorist attacks, Jennifer Nuzzo was monitoring the sale of regular over-the-counter medications with the hope that public health officials could get ahead of any potential mass illness in New York City.

That crisis sparked increased investment in public health, but it tapered off in later years.

At Monday’s third Seminars at Steamboat talk, Nuzzo, a doctor of public health at the Johns Hopkins Center for Health Security, said while COVID-19 has been called a once-in-a-century event, it likely won’t be 100 years before something like it happens again, and there needs to be sustained investment in public health to prevent that.

“Unfortunately, that is very much not the case,” said Nuzzo, who is trained in epidemiology and focuses on pandemic preparedness. “All the data that we have suggests the likelihood of these events is increasing.”

Global conditions are favorable for more infectious diseases, in part because people are more frequently living among wild animals that can harbor disease. That disease can spread faster because of global travel, and outbreaks can grow in cities with high population densities.

The core goal of public health is to keep that from happening, Nuzzo said. Even if it isn’t possible to stop a virus jumping from an animal to a human, they can work to prevent it from spreading between humans.

“I believe that epidemics and pandemics are optional,” Nuzzo said. “I think that increased surveillance and better public health capacities in all parts of the world is key to doing that.”

Born out of a mid-19th century effort to increase sanitation throughout society, public health departments have grown to deal with a broad variety of issues.

“Really, (it’s) an extraordinary list of things that public health does, day in and day out, that you probably don’t even see,” Nuzzo said. “Really, when public health is working, you don’t see it.”

The U.S. has a federalist design to public health, with the primary governmental responsibility for public health resting with state and local departments. After World War II, public health acted in targeted ways to reduce the spread of infectious diseases and was very successful, Nuzzo said.

The anthrax attacks in 2001 further grew budgets of national health institutions and the portfolio of public health officials to include national security. While there were limited cases and five deaths, the attacks exposed how unprepared health departments were, Nuzzo said.

“Following 2001, we went from bare bones funding for state and local health departments to a real noticeable increase,” Nuzzo said.

Now, there is a myriad of infectious diseases across the world that are being tracked, including some coronaviruses: SARS, MERS and, most recently, COVID-19. But public health is also focused on noncommunicable diseases like cancer, diabetes and heart disease, among others.

“We are also battling another war, and I can’t emphasize enough how deeply concerning this one is,” Nuzzo said. “I have never before in my career seen the level of disinformation that I have been seeing in this past year and a half around COVID.

“This is an extraordinary problem that, in my view, goes beyond anything that we have experienced before,” she continued. “In my view, this is informational warfare that just can’t be left in the hands of clinicians and public health professionals to try to communicate their way out of.”

Nuzzo cited a recent analysis that found roughly two-thirds of all the anti-vaccine information online is spread by 12 people who have huge businesses, sometimes across multiple countries, with staff propagating the same lies over and over again. This misinformation will likely continue into the future.

There is also the possibility that health could be used as a weapon, and Nuzzo said public health experts need to be prepared for that possibility.

“One of them is the possibility that a state, government or fringe actor could misuse biology to cause harm,” Nuzzo said, referencing the anthrax attacks.

But unlike other areas of national security, biological weapons, Nuzzo said, are one of the most challenging. Unlike with nuclear weapons, biological agents are harder to counter, as they can grow on their own and can spread through people.

The total cost of the COVID-19 pandemic has been estimated at more than $16 trillion, but in the preceding nine years, there had been at most $89 billion spent in preparedness for a pandemic. Nuzzo said this was an under-investment, and like after 2001, there needs to be more investment made in public health.

She said she hopes society can properly invest in preventing these crises consistently, rather than seeing a flurry of initial spending and action that eventually tapers off. Nuzzo likened investment in public health to building a firehouse after a large fire but tearing it down after several years without a fire.

“We don’t often do that, and we shouldn’t do that,” Nuzzo said. “We shouldn’t do that for fires, and we shouldn’t do that for public health.”

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