Pandemic Center analyzes the lessons of COVID-19
Brown University
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In
2022, the Brown University School of Public Health launched its Pandemic Center
with the goal of reducing the chance for repeat mistakes. There’s no doubt that
future public health emergencies will arise, said founding director Jennifer
Nuzzo, and the country urgently needs to be better prepared.
“The reality is that we have seen over time an increasing number of new infectious disease threats,” said Nuzzo, an epidemiologist who focuses on global health security, public health preparedness and response, and health systems resilience.
“That has to do with several factors, including how we've changed
our relationship with the environment and how we, as humans, have changed
behaviorally. In the future, we could see events that have an even greater
potential to negatively impact society than COVID-19.”
At
the outset of the pandemic, she said, the nation launched into crisis mode, and
leaders made decisions quickly with the best information they had at the time.
But the next emergency should come as less of a surprise: “Three years later,
we should absolutely be asking what worked and what didn’t, so that next time
we can do better.”
Scholars at the Pandemic Center are working not only to ensure the world more fully understands catastrophic threats like viral pandemics, but also to develop tools, policies and practices to mitigate and prevent their harmful impacts. Brown’s commitment to collaboration across disparate fields of study makes it an ideal place to carry out that work, Nuzzo said.
Working
with partners toward the center’s mission extends well beyond campus. too. As
just one example, the Pandemic Center is collaborating with the COVID
Collaborative and the Center for Strategic and International Studies Global
Health Policy Center to convene a bipartisan effort focused on unearthing state
and community lessons from the pandemic. Beth Cameron, senior advisor to the
Pandemic Center and a Brown professor of the practice, is leading that effort
for the School of Public Health.
Most
recently, that team organized a roundtable of nearly 40 leaders: governors and
mayors; officials from red, blue and purple states and from the Biden, Trump,
Obama and Bush administrations; and experts in incident management and pandemic
inequity. The group produced a report that discusses failures,
highlights community successes and, Nuzzo said, points to a path forward.
With
the three-year anniversary of COVID’s major impact in the U.S. having arrived
this month, Nuzzo and Cameron shared three key takeaways from pandemic, and
described how the Pandemic Center will use them to inform realistic strategies
for future response.
Lesson 1: A successful public health response does far more than
limit the number of disease cases
The
impacts of the pandemic have been profoundly far-reaching: it cost the world
millions of lives and trillions of dollars, and caused major societal deficits
in learning, health and well-being.
“Case
numbers didn't represent the totality of how the virus was affecting us,” Nuzzo
said.
She
pointed out that beyond the individuals directly infected by the virus, the
COVID-19 pandemic harmed health and society in multiple ways — for example, by
setting back a generation in terms of learning, worsening a national mental
health crisis, causing people to forgo necessary medical treatment, and
damaging the well-being of workers unable to make a living.
Unintended
harmful effects of laser-focused COVID mitigation strategies can erode public
support for public health, Nuzzo said, citing stories from people who were
prevented by lockdowns from getting medical care or tending to a dying loved
one.
“Emergencies
touch all aspects of not just public health, but of society,” Nuzzo said. “So
we need plans that have a broad scope.”
Nuzzo
said that expanding the definition of a public health response means
integrating the effects of pandemics on education, the economy and society
overall; broadening and updating the concept of how public health operates to
protect Americans; and creating stable, consistent mechanisms that are capable
of bridging sectors and parties during biomedical crises.
Data
is essential to creating those kinds of complex, multi-layered approaches, she
added: “We need better, faster data to inform better, faster decision-making.”
In a
pandemic, useful data goes beyond case counts, Nuzzo explained — it identifies
gradations of risk. She cited masks as an example: Part of the reason there is
such an intense and heated debate over mask mandates, she said, is that there
aren’t enough good studies that help communities understand how to use masks
and masking policies to reduce infections.
“My
husband works for NASA, so I've gotten to see what it means when a government
agency has well-exercised playbooks and implementation plans,” Nuzzo said. “We
don't send a rocket to space without having data to understand if that rocket
is on course. Unfortunately, in the case of the pandemic, the country didn’t
collect the data that was needed in order to understand if our response was
having the right impact, or if there were ways the response could be improved.”
That’s where places like the Pandemic Center can play a role, Nuzzo said. A major goal of the center is for its scholars to generate, synthesize and translate evidence.
To that end, its leaders are currently building and integrating better global, national and local data systems for detecting and responding to pandemic threats and mitigating their impacts.
A new satellite office in
Washington, D.C., will soon open, enabling close partnership with the Brown in Washington program, where students
will have opportunities to complete internships, and where Brown researchers
will have more direct access to policymakers.
“Our
goal is to do actionable research at the Pandemic Center and then ensure it
gets translated to policymakers and quickly and efficiently implemented in
communities,” Nuzzo said.
Lesson 2: Pandemic planning needs to reflect the political and
social realities of the country as it is
Not
long into the pandemic, it became clear that the zero-COVID approach adopted by
China’s government would not work in the U.S. Instead of expecting the country
to change so drastically, Nuzzo said, an effective response needs to engage
people in defining the response strategy, to ensure that approaches work for
communities and align with their values. Crucially, she added, it’s important
that future pandemic response efforts are equitable and don’t leave behind the
most vulnerable.
Organizing the conversation and report — titled “American Democracy and Pandemic Security” — with the COVID Collaborative and the Global Health Policy Center is one way the Pandemic Center is trying to understand what that means and engage a diverse group of leaders in identifying new solutions.
The conveners of the
roundtable discussion said they were struck by how much agreement there was
around the fact that the country doesn’t have enough tools for communities to
be able to function even somewhat normally in a pandemic.
According to the report, many leaders felt that pandemic responses put Americans in a position of choosing between health or the economy, online or in-person education, locking down or lifting restrictions, and individual freedom or collective responsibility.
These blunt, binary options created divisions within
and among political parties and forced some Americans to take sides, Cameron
said. The choices also weren’t adaptable for the wide range of communities in
the country, from rural to urban to tribal.
“What
we need are tools that allow communities to stay as safe as possible while
preventing spread, so that they don’t always have to make impossible choices
and can more easily open schools and businesses, scale community testing, and
improve equitable access to vaccines and treatments,” Cameron said.
To that end, and to engage people in solution-planning, Pandemic Center leaders plan to work with partner organizations to host a series of discussions in communities with a wide variety of political demographics to capture experiences and local successes, and to understand when communities had to make do and what worked for them.
The plan is to combine the feedback from those
discussions with additional research to create playbooks that give communities
what Nuzzo has referred to as “a menu of options” to prepare for and respond to
future pandemics.
"We plan to define different measures and when they can or should be used,” Nuzzo said.
She
added that lockdowns and shutdowns made many Americans equate public health
with restrictions and mandates. “It’s time to get back to that point where the
public is engaged in public health, and sees it as helping them do the things
they care about in a safer and healthier way.”
Lesson 3: Social vulnerabilities are pandemic vulnerabilities
Early
on, many experts believed that simply sharing science with the public would be
enough to change human behavior. The problem, Nuzzo said, is that even when
people understood the science, they weren’t always able to act upon it.
For example, while many Americans were able to avoid large groups by working remotely, others had jobs that required them to report to work in-person; they couldn’t “Zoom in” to the nursing home, the warehouse or to a restaurant shift.
Then there were those who worked in-person and didn’t have paid sick leave, which meant that following public health recommendations and staying home after testing positive would mean forfeiting compensation.
Nuzzo also cited the high
cost of high-quality N95 and KN95 respirator masks, which meant that many
people weren’t able to wear them as health experts advised.
She
stressed that social vulnerabilities exacerbated the pandemic’s effects.
“We saw that social vulnerabilities like having a low income, being uninsured, and lacking a safe place to isolate were associated with a higher risk of getting sick,” Nuzzo said.
“Vulnerable populations can’t be considered a special case;
we need to recognize that these individuals should be the highest priority to
attend to. Protecting our vulnerable populations is central to the goal of
protecting society and keeping the public safe.”
Moving
forward, Nuzzo said, equity needs to be a focus of pandemic preparedness plans,
not an addendum. Future interventions need to recognize where society falls
short; and sick leave policies, housing policies, childcare availability and
transportation options all need to be factored into a pandemic response
strategy.
Nuzzo
pointed toward the Biden administration’s equity-focused COVID-19 vaccination program as a public
health success story. When the administration made efforts to engage
underrepresented communities in planning and organizing, vaccination rates among Black and
Hispanic populations increased significantly, and as a result, the racial gap
in death rates disappeared.
“That’s
the kind of lesson we can learn from,” Nuzzo said.