COVID's legacy: Public health's diminished power

• Republicans in Congress have also called for funding cuts to the Centers for Disease Control and Prevention, and the Trump administration and Health and Human Services Secretary Robert F. Kennedy are pivoting to chronic diseases, nutrition and nontraditional cures.

What they're saying: Public health experts say it's all left the system weaker and less prepared for everyday threats — let alone the next big crisis.

• "Imagine if we just had a major fire ripping through our city, and our first instinct once we finally put the flames out is to basically get rid of all of our fire departments," said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.
• "That is essentially what we're seeing happen here."

The big picture: The weakening of public health is evident at every level, from small rural counties up to the highest ranks of the federal government, experts say.

• The postponement of a key CDC vaccine advisory meeting, as well as the cancellation of a Food and Drug Administration advisory meeting to select the next strain of flu vaccine have only heightened anxiety.
• "We are seeing a systematic erosion of even those capacities that existed at the start of the COVID-19 pandemic," Nuzzo said.

Zoom in: A federal pullback in preparedness leaves states even more on the hook to respond to crises, according to an analysis published last week in JAMA Health Forum. But legislatures in mostly conservative states have been taking aim at public health powers for the past few years.

• State lawmakers introduced 1,500 bills between 2021 and 2022 targeting public health authority, with nearly 200 becoming law, most of them curbing officials' power.
• Dozens of states restricted vaccine mandates, the ability to order business closures and masking rules. Others went further, banning stay-at-home orders, limiting emergency declarations, and blocking local governments from enacting stricter health measures than their state.
• More than 60 of these laws stretch beyond the pandemic period, taking powers off the table for future crises, an analysis in the BMJ found.

Picture this: In February, Louisiana's surgeon general canceled the promotion of all mass vaccination campaigns in the state.

• Montana barred employers from requiring vaccinations while Ohio law bans the state health department from issuing quarantines unless a person has been diagnosed with a disease.
• Such controls could hamper the response if a pathogen like H5N1 bird flu becomes transmissible among humans.
• "The idea that you that you would completely eliminate flexibility to use tools like that without knowing what you're up against is bananas," said author and Stanford Law School professor Michelle Mello.

Between the lines: Public health officials say some of the more recent DOGE-directed cuts to federal health agencies feel retaliatory for what critics see as a heavy-handed pandemic response.

• The intense criticism of the COVID response has left a lingering public distrust in health and diminished their influence.
• "I think people got really angry at the federal government for what they felt was an invasion of their rights, and thus was born an even greater sort of medical freedom movement," said Paul Offit, a member of the FDA's vaccine advisory committee since 2018.

The effect of cuts isn't just less preparedness for emergencies, but the ability to provide services for infectious and communicable diseases, and air and water quality.

• Public health departments around the U.S. largely rely on federal funds for their budgets, and many are alarmed at the cuts that have already occurred or been threatened.
• Some are trying to prepay bills because they aren't sure they'll be able to cut checks in a month, Nuzzo said.
• "I'm hearing about health departments wondering if even some of our bread and butter public health programs like studying the high burden diseases in our communities ... if those systems are going to be able to function," Nuzzo said.

The bottom line: COVID demonstrated in many ways what can go right when there's a strong public health infrastructure backed by government.

• The prime example is the development, testing, evaluation and distribution of a vaccine in record time, said Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC.
• "It was done without cutting any corners on safety, and resulted in saving millions of lives," Besser said. "The chances of us doing that again are zero."