- As COVID’s Delta wave begins to subside, we can see glaring holes in our nation’s resilience.
- Whether the pandemic leads us back to the status quo or triggers reform depends on the story the nation tells itself about what happened.
- The pandemic was a catastrophe. It doesn’t have to be a lost opportunity as well.
- Dr. Joshua M. Sharfstein is Professor of the Practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health
- This is an opinion column. The thoughts expressed are those of the author.
As the COVID pandemic’s Delta wave begins to subside, people across the US are itching for life to return to normal.
But still unclear is how different the new normal will be from our world prior to the pandemic. We now know there are better ways to do things – from flexible work to telemedicine. We can also see glaring holes in our country’s preparedness and resilience, including profound underfunding of public health agencies, enormous racial and ethnic disparities in housing, education, and employment, and poor access to healthcare in many rural communities. Now is a unique opportunity to tackle these problems.
At least, that’s one lesson of history, which is full of examples of reforms that were previously unthinkable actually happening in the wake of a crisis. But change is not automatic. For every example of a national event that cast a long shadow on policy, there is a counterexample of an event that barely budged the national agenda.
Whether the pandemic leads us back to the status quo or triggers fundamental reform may depend most of all on the story the nation comes to tell itself about what happened.
Who is trusted to tell the story?
The story told depends first on who has the credibility to be the storyteller.
In 1937, a deadly batch of a medication called the Elixir Sulfanilamide killed more than 100 people. A small federal agency named the Food and Drug Administration (FDA) jumped into action, earning public acclaim by sending inspectors across the country to track down remaining doses. The agency then wrote a comprehensive report explaining why the public was so vulnerable to dangerous medications. Congress responded by passing the landmark Food, Drug, and Cosmetic Act, which for the first time in history required medications to be reviewed and approved before marketing.
A very different scenario unfolded in 1976, however. The Centers for Disease Control and Prevention (CDC) launched a campaign to immunize every “man, woman, and child” in the nation against a new strain of influenza. But the feared “swine flu” pandemic never came; even worse, the vaccine was linked to some rare but severe neurological side effects. Its reputation damaged by tough news coverage, CDC could do little to stop a slide in vaccine confidence.
What story is told?
A good story compels attention, recounting not just the tragedies that transpired but the heroes who prevented further harm.
In 1961, a new sedative called thalidomide caused thousands of severe birth defects in Europe — but very few in the United States, because the FDA had refused to approve the medication. Sensing an opportunity, Tennessee Sen. Estes Kefauver encouraged journalists to tell the story of how a single heroic drug reviewer, Dr. Frances Kelsey, had protected thousands of American babies from tragedy. Kelsey subsequently appeared in every major national magazine and newspaper and on every major television news program.Kefauver and his colleagues used this hero’s tale to make a larger change by passing historic legislation to transform the regulation of medical products.
By contrast, the more than 12,000 US deaths from the H1N1 pandemic in 2009 drew no serious national review of what had gone right and wrong with the response. The desire to return to normal and move on undermined serious consideration of urgently needed investments in preparedness for infectious threats.
What energy does the story generate?
Stories that inform are important; stories that inspire people to action are the ones that lead to the most significant reforms.
The 2017 shooting rampage from a hotel room in Las Vegas killed 60 people and wounded 411. This terrible tragedy, however, led to few reforms. Media attention and policy discussions centered on the narrow question of bumper stocks, which were banned by the Justice Department in 2018 and then reinstated by an appeals court in 2021.
Less than six months later, a shooting at the Stoneman Douglas High School in Parkland, Florida killed 17 people and wounded 17 others. Defying local elected officials who predicted that yet again, “nothing” would happen because “we’ve seen this show before,” survivors of the shooting attacked the gun lobby as blocking even the most common sense reforms. Young people across the state and the nation mobilized. Despite blocking similar provisions for years, Florida legislators quickly passed major legislation establishing background checks, a waiting period, and a new program to remove guns from those considered to be at extreme risk for using them. These laws have now passed in 19 states and the District of Columbia.
So what changes after COVID-19?
It is easy to imagine this scenario: The nation’s profound polarization leaves little room for story-telling or lesson-learning. Harassed and demoralized, public health leaders and agencies are unable to command enough trust or respect to play a major role outlining a path forward. As cases decline, policymakers fall back into their regular routines, and the public embraces a return to normalcy.
And yet. It is also possible to think of an alternative scenario. First, a source of authority emerges, such as a bipartisan national commission or panel. Its investigation covers not only why the US fell short of the best COVID responses in the world, but also why the US had one of the most inequitable and divisive pandemic experiences anywhere.
Second, a compelling story of what happened captures the nation’s attention. Millions of Americans come to understand what might have been done differently, and what could yet be done differently, to avoid the needless loss of life.
Third, and finally, the story gets people moving. The time window for reform may be short, and obstacles of all kinds are likely to block the path to reform. Nonetheless, advocates will have a chance to make their case: The pandemic was a catastrophe. It doesn’t have to be a lost opportunity as well.