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Where public health stands 4 years after the COVID-19 pandemic began

(SOUNDBITE OF STATE OF THE UNION ADDRESS)

PRESIDENT JOE BIDEN: Four years ago....

AYESHA RASCOE, HOST:

President Biden reflected on COVID during his State of the Union.

(SOUNDBITE OF STATE OF THE UNION ADDRESS)

BIDEN: ...The country was hit by the worst pandemic and the worst economic crisis in a century.

RASCOE: All this past week, we've been reflecting on it, as well.

(SOUNDBITE OF ARCHIVED RECORDING)

BIDEN: Remember the spikes in crime and the murder rate, raging virus that took more than 1 million American lives of loved ones, millions left behind, a mental health crisis of isolation and loneliness.

RASCOE: President Trump declared COVID a national emergency on March 13, 2020. That anniversary has come and gone, but COVID continues to affect us as we live alongside the disease. Today on the program, we look ahead at the future of the public health system that COVID pushed to the brink four years ago. We're joined now by Dr. Nancy Messonnier, formerly of the Centers for Disease Control and Prevention. Now she is the dean at the University of North Carolina Gillings School for Global Public Health. Thank you for being with us.

NANCY MESSONNIER: Thank you.

RASCOE: So Dr. Messonnier, you were one of the voices inside the CDC as COVID-19 began to spread that called attention to how disruptive the coronavirus could be. We want to play a clip of an interaction you had during your time in the CDC under the Trump administration.

(SOUNDBITE OF ARCHIVED RECORDING)

MESSONIER: I had a conversation with my family over breakfast this morning, and I told my children that while I didn't think that they were at risk right now, we, as a family, need to be preparing for a significant disruption of our lives.

RASCOE: You know, following this comment, the stock market crashed, and then President Trump was reportedly furious about your comments. What comes to mind when you think back on that moment?

MESSONIER: Yeah. I, at this time of year, for the past several years, have reflected back on that moment and the data that I and my colleagues at CDC were looking at that drove us to really want to warn the country. But now that I look back, I realize it's hard for any of us to remember the fear and uncertainty and, frankly, chaos that was part of our lives at that time.

RASCOE: It was extremely chaotic. Do you think that was a product of the political system, the administration at the time, which was the Trump administration? Or do you think it was reflective of a greater problem with the public health system in the U.S.?

MESSONIER: I actually don't think any of us would have expected disruption of this scale and scope. While I do think that a stronger public health system would be helpful, frankly, the chaos was really a product of COVID-19.

RASCOE: In your view, though, what do you think could have been done better in those early days, especially from the public health perspective? So I guess maybe starting with, like, maybe communication, what do you think could have been done better?

MESSONIER: Yeah, it's really easy to sit here four years later and say, all of that could have been better 'cause the truth is, all of that certainly could have been better. But frankly, I also think that we should be proud about how many parts of our country stepped up. I mean, hospitals and doctors and nurses, the public health professionals that work at local and state governments - they were working full-tilt every day, 24/7, to really respond to the pandemic. And I admire their resilience and their willingness to throw themselves at those kind of emergencies.

RASCOE: Will the next once-in-a-century event - will it look like COVID-19?

MESSONIER: We are not great at making these predictions. And that's why when public health officials think about preparedness for the next emergency, we think about what we call all-hazards preparedness because if you too narrowly prepare around a specific scenario, you're not ready for something outside that. And that's why when you hear us talk about data systems or community-level activities or even racism, we're talking about things that have broad application not just for that next once-in-a-century pandemic but for the everyday emergencies that we're still dealing with.

RASCOE: All right. Now we also have two students on the line from UNC's Gillings School of Global Public Health, Jennifer Greene and Raven Walters. Welcome, and thank you for being here.

RAVEN WALTERS: Thank you.

JENNIFER GREENE: Thanks for having us.

RASCOE: So, Jennifer, I'll start with you. You lead the Appalachian District Health Department, which is a part of a big health system in the more rural parts of North Carolina. You're now pursuing a graduate degree in public health. Did the pandemic play a role in that decision?

GREENE: Yes, in some ways, it did. I - well, once I decided that I was going to stick it out. I had a few doubts there in the middle of COVID, but...

RASCOE: Well, can I ask you why you had doubts?

GREENE: Yeah, I had doubts because it just felt like this insurmountable mountain to climb. You know, we were working so hard. Think about testing access. Think about vaccines when they became available, all of the contact tracing - it was a heavy lift.

RASCOE: Raven, I want to turn to you now. You're wrapping up a master's in public health this spring. What drew you to this work?

WALTERS: Well, I started off a pre-med in undergrad, and I just wanted to keep conversations about preventative care, about maternal health. But then I got into the health equity concentration, and it opened an array of ideas and concepts for me that felt more broad but felt that I could also place it in any aspect of public health that I wanted to go in.

RASCOE: Since the pandemic, you know, people are really unhappy with the public health response during and after the pandemic, and that's from the perspective of people who felt like too much was done and from the people who feel like there was too little done. How do you communicate with a public that is increasingly skeptical of public health messaging?

MESSONIER: I think that we need to help the public understand more about what public health means. You know, there was a pandemic, but in fact, today, there are a variety of emergencies and urgencies that local health departments are working on and that schools of public health are studying. So I'm talking about opioids and the mental health emergency and climate change and the PFASes in our environment. Those are the kind of challenges that we are working on still every day.

RASCOE: We often hear a common criticism that public health does not have enough funding. In your view, what types of research or programs need more funding?

GREENE: Well, at the heart of it, we've got to invest in public health infrastructure. And what I mean by that is not buildings but people, staff development, data systems to help us modernize our antiquated and often very disjointed or siloed data systems. We saw CDC put out a public health infrastructure grant, and North Carolina has been using that at the state level and the local level, which is fantastic, and it's not enough. We need to do more.

WALTERS: But also, I'm working adolescent health right now, and my job is in mass incarceration and adolescent health. And we - there needs to be more conversations happening around mass incarceration as a public health topic.

RASCOE: Well, I wonder if you all are concerned about whether there is enough public trust to get people to buy in to prevention and containment efforts?

WALTERS: I think it's not necessarily a concern. I think the pandemic has taught us so much about public health and what can happen. Working to establish more trust, but also just making sure that language is there - that this is what public health is, and it's what it does.

MESSONIER: Maybe I'll add two more things that I don't think we've directly spoken about yet. One is that clearly, the pandemic made very apparent the inequities that exist in our health care systems and the impact of racism on outcomes. And I think that we have to be forthright at calling that out and addressing it.

The second issue that I would raise that we haven't spoken about is that this pandemic also really made clear how global the work of public health is. Countries are connected in a way that they haven't been before, and that is both for transmission of a virus through travel - but even the epidemic of misinformation can really cross country lines, and we really do need to think more about the global aspect of public health, including, for example, on data systems and surveillance.

RASCOE: So I have one extra thing I want to ask. It's this idea of an acceptable level of risk because it seems like there is a lot of concern from some people that public health officials have undersold the risk of COVID-19.

GREENE: We're in a different place than we were, which is great. We have a safe and effective vaccine, we have treatments available, and we aren't seeing the same volume of people who have severe illness, hospitalization and death. And that's a real accomplishment. And what I've noticed is people who are choosing on their own to make decisions about what events they visit or if they're going to wear a mask or how frequent they're going to wash their hands, and that's their choice. I've also heard people with more questions, and so that's why that communication and that relationship is important.

RASCOE: Raven, does hearing all of this - you know, the polarization, the lack of funding - does it give you any pause about the future of this sector?

WALTERS: No, it lights a fire, actually. I'm excited to do the work. I'm excited to fight for my communities. I'm excited to work with people to get what needs to be done, done.

RASCOE: Thank you so much for joining us. I really appreciate it.

WALTERS: Thank you.

GREENE: Thank you.

MESSONIER: Thank you.

RASCOE: That's Dr. Nancy Messonnier, dean of UMC Gillings School of Global Public Health, and students Jennifer Greene and Raven Walters.

(SOUNDBITE OF JOAN SHELLEY SONG, "OVER AND EVEN") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.
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