Learn From International Peers to Prevent Future Outbreaks

The United States was not prepared for COVID-19, nor were many countries around the world. Making appropriate and timely use of public health measures, a struggle to provide real-time data to inform decision-making and understaffed hospitals with insufficient supplies were just some of the early challenges that allowed the initial surge of cases to overwhelm health systems across the country.

At least initially, however, the pandemic was not entirely a story of failure in every country. In fact, many low- and middle-income countries mounted strong initial responses to COVID. In Africa, the Africa Centres for Disease Control and Prevention galvanized a continent-wide response, dramatically expanding public health capacity and saving countless lives. In Vietnam, a “whole of government” response saw hospitals properly isolate, treat and manage patients while strong public guidance helped keep cases from spiraling out of control.

So why did the U.S. and other seemingly well-prepared countries fail the pandemic test? And what can we learn from countries that performed better in limiting the health and societal harms of COVID-19?

Although the context in terms of access and cost of care is different, the challenges that the U.S. and other wealthy countries face in detecting, responding to and preventing infectious disease outbreaks are similar to those faced in low- and middle-income countries across the world.

For example, a common problem around the world is insufficient resources for public health. High-income countries don’t necessarily have highly resourced public health departments – in fact, the U.S. spends significantly less on its health defense than its military defense. An immediate consequence is inadequate funding for training and supporting staff in public health systems: Simply put, there are not enough public health workers globally, and many of those that are employed by health systems are poorly paid and under-protected. During the COVID-19 pandemic, public health and health care workers shouldered the strain of ill-prepared and underfunded public health systems; by one estimate, up to 180,000 health care workers worldwide have lost their lives from COVID. Many of these deaths could have been prevented with adequate training, enough personal protective equipment and well-resourced health departments.

Vietnam’s initial COVID-19 response shows what is possible with decisive action and a strong, well-coordinated public health system. Cases of viral pneumonia in December 2019 triggered the government to institute a response plan and screening for the disease at hospitals the following month. By April 2020, Vietnam had a fleet of 12,000 contact tracers who helped stop COVID spread among its population of about 98 million people; the U.S., in contrast, initially had only 2,200 despite having more than three times the population.

In both the U.S. and Vietnam, the signs of a new and emerging disease threat were there. Only one mounted an effective nationwide response utilizing coordinated clinical and public health resources.

The U.S. led the way in rapid development and production of vaccines using new mRNA technology, making two effective vaccines available in under one year. Despite the head start the U.S. had on access and quantity, its overall vaccination effort lags behind much of the world. Increasing vaccine hesitancy and mistrust of public health messaging demonstrate that we cannot fight our way out of a pandemic with science alone. Without fundamental support for – and trust in – public health, the entire response will suffer.

To do better, U.S. public health institutions and leaders at all levels must rebuild trust with the public, including through clear and consistent communication and community outreach. One study found that in many countries, public trust in government was critical to a successful pandemic response.

The U.S. can again find great examples in the strong risk communication efforts of low- and middle-income countries. During the early days of the pandemic, for example, Senegal’s public health authorities worked with anthropologists and communication experts to create and disseminate campaigns about public health measures and share information about COVID-19 as it became known in real time, and in clear, understandable terms.

During 2021 Ebola outbreaks in Guinea and the Democratic Republic of the Congo, response teams included risk communication specialists who worked with communities on safe burial practices and to dispel misinformation about the disease and vaccines. When there was an anthrax outbreak in a rural village in Kenya, the government and the Red Cross held community dialogue sessions to foster a shared understanding of the threat of the disease as well as mitigation efforts to contain it.

Public health needs to step away from the keyboard and step into communities. Building trust starts with community engagement, which takes staff, time, money and consistency. But this work is crucial – communities are where outbreaks are often first detected, and every community has strengths that can be enlisted to stop spread. Increasing funding for public health programs to get trusted local public health workers out into the populations they serve and build community-level trust will ensure a strong front line in stopping the spread of any outbreak.

The United States has lost more than a million lives from COVID. When it comes to pandemic preparedness, low- and-middle-income countries have demonstrated that effective public health responses are worth more than wealth, scientific strength or past success. It’s public health grounded in communities and built on trust. The United States can learn from the rest of the world so that when the next pandemic strikes, our communities and public health systems are ready.