Almost four decades ago, when I was deputy director of the first major global health communications program supported by the US Agency for International Development (USAID), my work involved child survival and family planning. But our project, and its lessons learned about health promotion, went further than that, modeling a proven methodology related to behavior change for better health outcomes.
It was during those years that the HIV/AIDS crisis erupted, which I learned about before most people took it seriously, through a journalist I knew who had written about what was coming at us around the world and here at home. When I alerted my boss to what would become a deadly epidemic, advising him that as a health communication organization we needed to be paying attention to the problem and thinking of ways to mount a strategic health communication response, was typical. “If you’re not gay it’s not going to amount to much,” he said, which in itself was shocking in its prejudice. It was also irresponsible coming from someone working in public health. When HIV hit hard and several gay men in our organization began to die, the head of the organization publicly apologized to me in a staff meeting for not taking the crisis seriously.
Later, when I worked in public health advocacy, promotion, and communication internationally, I followed news, challenges, and concerns shared with the public health community from the World Health Organization (WHO) and the Centers for Disease Prevention and Control (CDC). That’s how I knew that they were worried because, they said, we were long overdue for another huge epidemic, bigger than the early 20th century “Spanish flu,” and we weren’t prepared for it.
So when Covid-19 showed up, I wasn’t surprised that we still weren’t prepared, nor was I particularly shocked when the Trump administration was totally unprepared for an event that would take millions of lives here and globally. What was shocking was the disinformation, misinformation, and dangerous false information Republicans glibly spread in soundbites and press briefings as more and more people succumbed to the virus.
Those memories come back to me now because history seems to be repeating itself when it comes to public health preparedness related to epidemics and pandemics in light of myriad lessons learned by now.
It’s not for lack of scholarship on this issue. In researching this topic, I found no shortage of analysis about a rising concern about what’s going on as we recognize that we’re going to have to struggle all over again when another health crisis occurs.
The pressing issues include the need for more research as new and mutant viruses rise, scaling up production of newly developed and FDA approved vaccines, planning for broad and rapid vaccine distribution, cost containment, and equal access to vaccines from various health facilities. It’s no longer only about Covid. Other infectious diseases are on the rise. According to WHO, “zoonosis”, infectious diseases that jump from animals to humans, now number over 200 identified bacterial, viral or parasitic agents. “They can be transmitted through direct contact, food, water, or the environment, constituting a major public health problem,” WHO says. “Many of these emerging infections have the potential to cause global pandemics.”
The Covid pandemic revealed the challenges related to supply chains and their disruptions when it comes to vaccine distribution, in addition to vaccine shortages, which can occur when companies no long choose to make vaccines, often because of manufacturing and production problems. That leads to insufficient stock piles, and reduced competition so that prices for vaccines rise.
Another major failure in pandemic preparedness revealed itself during the Covid crisis. As health communication specialists like Kizzmekia Corbett, a researcher at the National Institutes of Health (NIH) point out, “Public health practitioners need to recognize that our research is only as strong as our communication. Even our strongest peer reviewed, evidence-driven findings won’t have full impact if we cannot clearly and effectively communicate them to the public.”
Practitioners also need to understand and respect the field of health communications as a multidisciplinary methodology aimed at behavior change for health promotion and disease prevention. Vicki Freimuth, former director of communications at the CDC, says that “the agency struggles to assure that experienced communication professionals are included in decision-making and developing scientifically sound public messages free of political influence.” (personal communication). The exclusion of experts whose work has proven that behaviors can be changed (e.g., mask wearing) with research-based messaging is a troubling omission.
According to a poll taken in March and reported by Politico, two-thirds of respondents believed the threat of future deadly pandemics is growing, while almost 90 percent wanted the federal government to be more prepared for another pandemic in its budget and planning. Still, the focus in Washington, DC seems to be on assessing what went wrong during Covd-19.
Mauricio Santillana, a professor at Northeastern University paints a daunting picture regarding future efforts. He says the influence of politics on government funding causes a “collective amnesia,” that leads to reactive responses to crises vs. proactive prevention.
If the government prioritizes the prevention of deadly viruses, perhaps they will remember to include health communication strategies along with financing and other challenges that accompany pandemics that need to be stopped quickly. I’m not holding my breath.
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Elayne Clift has a master’s degree in health communications and has worked internationally with a focus on maternal and child health.