New surveillance and reporting methods implemented during the COVID-19 pandemic need to be funded and enhanced.
Prior to the COVID-19 pandemic, public health data infrastructure was lacking at best. Per capita funding for public health emergency preparedness has been decreasing steadily since the early 2000s. Historically, public health programs only receive reactionary funding when crises occur, and funds are often insufficient to maintain the same level of activity moving forward 1. Similarly, in response to COVID-19, the United States invested in the wide-scale development of public health data systems, and funding remains available to maintain them 2. As COVID-19 cases dip to record lows following a devastating winter surge, many states have dialed back their case reporting. But this is not the time to slow data collection and reporting; instead we must solidify and unify data systems to prepare for the next public health crisis.
Thus far the United States has invested over $75 billion of additional funding in the Centers for Disease Control and Prevention to strengthen nationwide public health data infrastructure, something that should have been in place long before 2020 3. The Biden Administration is looking to invest another $3 billion in public health to prepare for the next pandemic 4. This money will primarily be allocated in the form of grants to keep the public health workforce, expanded by the pandemic, employed in the coming years. Congress should expand this funding mechanism to include updating, maintaining, and transforming state COVID-19 dashboards into versatile public health surveillance tools.
The public health community has already emphasized the necessity of data infrastructure maintenance once the pandemic resolves 5, 6. This has become even more critical given the recent announcement that American life expectancy has decreased by more than one full year over the course of the pandemic 7. This indicates that after the pandemic there will still be substantial work needed to improve all American lives. Such an effort could be led by the CDC; however, there remains an urgent need for states to continue reporting their own data to the public. The most successful path forward is going to be the maintenance of rigorous data systems at the local, state, and federal levels.
The state and national COVID-19 dashboards we have today are a great start and a novel concept in the United States. The average American can access data on a particular disease, investigate hotspots and infection rates, and browse pertinent articles directed at the lay public. The only major source of publicly available health data prior to this pandemic has been the Global Health Observatory, established by the World Health Organization to monitor global disease eradication 8. The U.S. databases created to monitor COVID-19 could similarly be leveraged for other disease surveillance systems to improve America’s health in the future.
As the pandemic experiences a resurgence in certain countries, the United States can play a major role with regards to public health data infrastructure. We must help to build public health surveillance data systems in these countries and invest in public health data management systems that are supported long-term, not just temporarily for this pandemic. The health of the United States is deeply tied to that of the rest of the world. We need robust international public health data reporting systems to monitor genetic variants and disease outbreaks. That work starts at home by solidifying our own public health data infrastructure and serving as a role model for the global community.
The Pandemic Data Initiative aims to formulate a framework for public health infrastructure development. This is not something the world can postpone until the next critical health emergency. There must be an intact, sustainable system of data collection so we are ready when the next public health crisis inevitably occurs.
Later this week we will be speaking with Dr. Lauren Gardner about the difficulties aggregating and analyzing public health data during this pandemic, and what the world should be learning from these efforts to better prepare for the next outbreak.
1. B.P. Murthy, N.-A.M. Molinari, T.T. Leblanc, S.J. Vagi, R.N. Avchen, Progress in Public Health Emergency Preparedness—United States, 2001–2016, American Journal of Public Health 107(S2) (2017) S180-S185.
2. R. Cohrs, Biden pushes Congress to boost public health, pandemic preparedness funding, Stat, 2021.
3. CDC-OFR, Novel Coronavirus (COVID-19), 2021. (Accessed 24 May 2021).
4. FACT SHEET: Biden-Harris Administration to Invest $7 Billion from American Rescue Plan to Hire and Train Public Health Workers in Response to COVID-19, The White House, 2021.
5. S.R. Bailey, Pandemic exposes dire need to rebuild public health infrastructure, American Medical Association, 2021.
6. N. MAANI, S. GALEA, COVID-19 and Underinvestment in the Public Health Infrastructure of the United States, The Milbank Quarterly 98(2) (2020) 250-259.
7. R. Sohn, U.S. life expectancy fell by a year in the first half of 2020, CDC report finds, Stat, Boston Globe Media, 2021.
8. The Global Health Observatory. https://www.who.int/data/gho. (Accessed 21 May 2021).