OPINION: More Will Die From Covid Without Meaningful Change to Health Care

by Asqual Getaneh, MD

In February 2020, International Community Health Services (ICHS) was the first of the nation's nearly 1,400 federally qualified health centers — serving 30 million people, most of them low-income immigrants and refugees — with a positive COVID-19 diagnosis.

Our staff have seen the tragic costs of a pandemic that has infected more than 100 million people worldwide and claimed more than 2 million deaths. So, when the first doses of the Moderna vaccine rolled through our doors on Dec. 23, we felt ready.

On Jan. 14, the Biden administration unveiled the details of a $1.9 trillion rescue package that includes funding for expanded testing; a national vaccination program in partnership with states, localities, tribes, and territories; and 100,000 public health workers to carry out vaccine outreach and contact tracing.

This boost from the federal government and commitment to community partnerships is a step in the right direction to beat this current pandemic, but it's still just a band aid.

If we are to ensure that our children and grandchildren are prepared to withstand the pandemics of the future, we need public health funding to be the norm, not just in the middle of a global crisis. There are glaring, long-standing problems that were highlighted with the COVID-19 pandemic that we can finally learn from and address.

Three major national vulnerabilities in particular aided and abetted the spread of SARS-CoV-2 in the U.S. in 2020. Unless addressed, these vulnerabilities will obstruct our ability to effectively deliver the vaccine, as well as our response to future pandemics.

1. Limited authority of public health policymakers

Trust in public health experts is critical to controlling pandemics because human behavior either helps spread or stop them. Public health policies tell the people in our communities what they need to know and what they need to do. People need to trust these policies are guided solely by the available knowledge and evidence, not politics. The politicization of the pandemic response in the U.S. eroded effective preventive messaging and stoked public skepticism of public health guidance. In New Zealand and Iceland, where public health officials were empowered to direct the pandemic response, cases and deaths were virtually nil.

2. Underfunded and uncoordinated public health infrastructure

Effective public health measures lead to healthy people who are less susceptible to severe cases of infection during a pandemic. And yet, we've seen funding cuts to public health at all levels. The Affordable Care Act's Prevention and Public Health Fund was whittled from $15 billion to less than $3 billion over 10 years. Here in Washington State, our public health budget declined from $65 to $53 per capita between 1998 and 2014. The proposed Washington State budget for 2021 reduces public health spending by $4.6 million. The COVID-19-related economic downturn has created additional public health budgetary constraints. When the next pandemic hits, a lack of public health funding leaves us all at risk and positioned to fall short of the staff and tools needed for the mass deployment of the vaccine.

3. Inadequate and maldistributed primary health care networks

In addition to a well-funded and empowered public health infrastructure, strengthening primary care is key to responding early and effectively to a pandemic. Less than 8% of U.S. health care spending goes toward primary care services. Only 75% of the U.S. population has a primary care provider. Community health centers alone provide care to 29 million people in both rural and urban centers across the United States. Primary care centers are key partners in identifying outbreaks, screening and testing, and vaccinating the population, in addition to managing chronic illnesses that could mitigate risk of severe infection. Yet, primary care remains underfunded. Reimbursement for primary care services lags behind hospital and procedure-based services.

When a pandemic occurs, our greatest asset is a rapidly deployable public health and primary care workforce. We have the means to quickly develop diagnostic tests, treatments, and vaccines. But they are as helpful as an unarmed weapons system without a functional network of primary care infrastructure to collaborate with public health to screen, quarantine, and vaccinate those most at risk.

It's time for a meaningful shift to investments in universal health care and for our lawmakers to fully fund and strengthen our public health infrastructure. Without it, we are left with the continued threat of losing a million or more lives from an entirely preventable infection.

International Community Health Services (ICHS) is a nonprofit community health center providing culturally and linguistically appropriate health services to improve the wellness of King County's diverse people and communities. Since its founding in 1973, ICHS has grown from a single storefront clinic in Seattle's Chinatown-International District with deep roots in the Asian Pacific Islander community, to a regional health care provider employing more than 600 people and serving over 32,000 patients at 11 clinic locations. For more information, please visit their website at www.ichs.com.

Featured image courtesy of ICHS