Vaccines’ historic success undermined by public health failures

The COVID-19 pandemic is revealing a basic truth: You get what you pay for. 

Decades of investment in basic science research, specifically mRNA technology, allowed for the rapid development of two of the safest, most effective vaccines in history.

On the other hand, paltry levels of investment in public health over decades left the global community with a patchwork system woefully ill-prepared to engage citizens, counteract misinformation and, in the end, deploy the scale of testing, contact tracing and vaccinations necessary to tamp down the current surge of COVID-19 fueled by the delta variant.

Those are two takeaways identified by leaders and experts from government, academia, health care and business during discussions on the first day of “The Pandemic Puzzle: Lessons from COVID-19,” a symposium series hosted by the Stanford School of Medicine and Stanford Graduate School of Business.

The fallout — compounded by inequities and inadequate political leadership in the U.S. and globally — is forcing a recalculation of what our post-pandemic world might look like.

“We don’t see this virus disappearing,” said Soumya Swaminathan, MD, chief scientist at the World Health Organization. “It’s really spread across the world. We know it affects other species as well, so I don’t think we’re realistically thinking about elimination, let alone eradication. What we’re thinking is how do we get this under control?”

The first installment of the free, virtual symposium focused on the U.S. and global response to the pandemic and the pandemic’s effect on the economy. 

Numerous factors contributed to an individual country’s ability to respond, but three elements generally led to success: political leadership adopting evidence-based policies, clear communication from the outset and a robust public health system.

While the symposium was planned as a retrospective of the greatest public health crisis in generations, the pandemic’s persistence forced an evolution of the discussion. “We hope that we’ll be able to have a more complete picture of the challenges surrounding COVID-19 and the path forward,” said Lloyd Minor, MD, dean of the School of Medicine. “Every single one of us has a role to play in ending this pandemic.”

Jonathan Levin, dean of the Graduate School of Business, spoke to the massive societal, economic and health ramifications of the pandemic. 

“We put together this series with the idea that we’ll be studying and learning from this episode of history for years, for decades,” he said. “It’s not too early to start.”   

Public health investment critical

The weaknesses of the United States’ neglected public health infrastructure have exacerbated health disparities and hindered COVID-19 mitigation efforts since the start of the pandemic. How did public health infrastructure get this way? In part, it was a victim of its own success. 

Yvonne “Bonnie” Maldonado, MD, the Taube Professor in Global Health and Infectious Diseases at Stanford Medicine, credited the incredible gains in life expectancy in the past century to public health advances.

“It’s just gumshoe epidemiology,” she said. “It’s hard work that nobody sees. It’s not just infectious diseases. It’s other things like occupational health and environmental health. All of those people who work behind the scenes. It’s multifaceted, and it doesn’t happen overnight.” 

The problem is that when public health officials do their work well, nobody sees it because a bad event is prevented, said Joanne Kenen, editor-at-large for health care at Politico. And in the absence of crises, investment in public health dwindles, she said. 

Compounding the problem, as the science about the virus and disease evolved, so did the guidance, which often left the public confused. In the divisive political environment of the past few years, the distrust and confusion snowballed.

They want to hear from their neighbor, their friend, their nurse or their trusted physician.

Rochelle Walensky, MD, director of the Centers for Disease Control and Prevention, said that persuading more people to get vaccinated remains the top priority — and that is complicated.

“We are working every day to meet people where they are to address concerns,” she said, calling on everyone to be a vaccine ambassador. “Not everyone wants to hear from us. They want to hear from their neighbor, their friend, their nurse or their trusted physician.” 

The WHO’s Swaminathan noted that one of the many surprises of the pandemic was that some countries in Africa were fighting the virus more effectively than expected.

“This is because they did not depend on technology,” Swaminathan said, adding that key relationships had been established over the years in these communities as health workers went from house to house treating people for tuberculosis or distributing bed nets to fend off mosquitoes. “These relationships were extremely critical because people believe messages when they come from people they know and trust.”

Economic recovery hinges on pandemic

The disparity of pandemic responses from countries, regions and U.S. states provides a wealth of data. Analyzing those efforts shows that future intervention efforts need to be tailored. Also, when public health measures are matched with societal and economic support programs, the negative impacts are reduced.

The pandemic only exacerbated inequalities within and between nations.. And mitigation efforts affected communities differently. In the U.S., millions of people lost their jobs and with them, their health care insurance. Lockdowns for people living in dense urban areas or in multi-generational homes were markedly different than they were for people with backyards or access plenty of green space.

“People who work for a salary and the people who work by the hour experienced the pandemic very differently, as did people in communities of color,” said Andy Slavitt, a former senior adviser on President Joe Biden’s COVID-19 response team. “But the fact that kids had no school lunches and didn’t have internet at home — that predated COVID-19.”

The pandemic is hammering home the close link between economic prosperity and health outcomes, but the U.S. government responded with $5 trillion in new spending — so far — and that had a significant impact, according to Chad Jones, PhD, professor of economics at Stanford. He cited reports that the number of Americans living in poverty actually declined during the pandemic.

Diedra Henry-Spires, senior adviser for COVID-19 programs at the U.S. Small Business Administration, said that while a wealth of programs injected a much-needed lifeline to businesses across numerous sectors, it was more difficult to get money where it might be needed most, such as small neighborhood businesses like barbershops and hair salons.

As goes the pandemic, so goes the economy.

“It’s no surprise that as we go through a major health event, we also go through a major economic event,” she said. “Even with the intention to be equitable, you must bake it into everything you do.”

Still, despite the added government spending, the economy’s recovery is not assured.

Amit Seru, PhD, professor of finance at Stanford, warned that while debt forbearance programs, which allow consumers to defer payments on home mortgages or auto loans, are particularly effective at providing help where it’s needed, pulling that support will be much more difficult than offering it was.

“You’re talking about places and households that are facing a lot of stress,” Seru said. Calling the deferred debt “a ticking time bomb,” Seru said the recovery hinges on how the situation is handled.

Jones agreed that the economy is not out of the woods yet.

“I think the big picture point I would take away from all of this is that as goes the pandemic, so goes the economy,” Jones said. “The most important macroeconomic policies now are to solve the pandemic.”

Day Two of the four-day symposium, scheduled for Oct. 13, will focus on building health equity and ensuring an inclusive recovery. Register here.