America’s Coming Public Health Crisis
There are other glaring weaknesses of a vibes-based public health strategy. Take the endless debate over medical masks. Many people still don’t understand when and why they should mask, but they did come away with the overwhelming message that public health officials aren’t telling the whole truth, a suspicion that further inflames tensions about Covid and other outbreaks. Ironically, by striving to keep trust by reassuring the public, officials lose it. That has enormous and often unpredictable ripple effects beyond a given crisis. The pandemic-era questioning of public health authority has supercharged vaccine skepticism and undermined long-established practices, with more parents forgoing vaccines for common yet alarming illnesses like measles and chickenpox—often because they falsely believe that the vaccines are worse than the illnesses or that the effects of vaccines aren’t well understood or discussed.
The Covid pandemic has been a humbling experience for Rivers, as it has been for many of us. She’d believed, without examining the belief too closely, that epidemiology had the power to address or even control a pandemic, a feeling that she soon recognized as hubris. Controlling outbreaks relies on more than the technical science of tracing contacts, understanding how the pathogen spreads, or developing and deploying vaccines. Instead, the most important tool is clear communication about the risks a community faces and what they might do to protect themselves, she writes—and that’s an ongoing challenge for the field. It’s a challenge that will likely only grow as the second Trump administration assumes office, with a proposed Cabinet of anti-science activists and, of course, an anti-science president. Existing challenges will be compounded by potential disruptions to our current vaccine program, even less funding for public health, and burnout and brain drain among researchers and health workers in an increasingly stressful and thankless job—all of which would create immense long-term setbacks for public health.
The book closes with a warning: not that another outbreak is imminent—you can’t have read this far without realizing there will always be another outbreak—but that the next crisis will require humility above all else. That’s not a quality many politicians embody, and the new slate of proposed health agency leaders has a long history of denying science and overlooking evidence of best public health practices. History shows again and again the importance of investing—money, time, talent—in public health. We have learned, and must continue learning, that giving out timely and accurate information is paramount for preparation, whether for a tornado or a pathogen.
