As COVID-19 emergency ends, Johns Hopkins experts wary about next time

Several emergency declarations have ended, but panelists at Wednesday's virtual briefing agree that the pandemic isn't over, even as its severity has waned

As the U.S. government ends its COVID-19 public health emergency declaration this week, Johns Hopkins experts continue to worry that three years of pandemic response has not adequately prepared the nation to better manage the next global infectious disease outbreak.

The rapid creation of vaccines and medical treatments after SARS-CoV-2 emerged as a worldwide threat in early 2020 has clearly demonstrated the nation's scientific, medical, and clinical prowess, the experts said. But various missteps related to tracking outbreak and testing data, communicating mitigation strategies such as masking, and supporting frontline health care workers hobbled the national response while diminishing trust in public health institutions.

"I'm not sure if we are better prepared for the next pandemic," said Crystal Watson, a senior scholar at the Bloomberg School of Public Health's Center for Health Security, during an hour-long Johns Hopkins Briefing on Wednesday. "But we've seen a real degradation in the public health workforce, trust in government, and trust in public health. These are things that we need to build back up before we can be prepared for the next event. There is a lot of investment and rebuilding we need to do."

Watson was joined by Lainie Rutkow, vice provost for the Office of Interdisciplinary Initiatives and project lead for the Johns Hopkins Coronavirus Resource Center; Brian Garibaldi, director of the Johns Hopkins Biocontainment Center and CRC clinical lead; William Moss, executive director of the International Vaccine Access Center and CRC vaccinology lead; and Beth Blauer, associate vice provost of Public Sector Innovation and CRC data lead.

"I think we were caught flat footed in this pandemic, particularly with the data infrastructure" needed to track infections, deaths, and other measures, Blauer said. "We rapidly were able to scale up at the state, local, and federal levels, but all signals are pointing to the fact that those were not sustained training, that they were temporary measures, that there aren't a lot of resources or efforts going into a national [public health] data infrastructure."

She said county, state, and national public health agencies learned many lessons about the importance of requiring uniform reporting to more effectively track trends, detect hotspots, and deploy adequate resources where best needed.

"Some of the anti-vaccine, anti-science sentiment has become more deeply entrenched in many communities. That is not going to position us well for the next pandemic."
William Moss
Executive director, International Vaccine Access

"I think that we learned a lot around data flows and ways to improve data collection," said Blauer, who addressed many of the same concerns on the Pandemic Data Initiative. "But I think the jury is still out whether those lessons will be heeded."

Moss hailed the "remarkable progress" that the scientific community displayed by rapidly developing effective vaccines against COVID-19 and the world's ability to conduct what he called "the largest global mass vaccination campaign ever."

But government agencies and the health care sector must relentlessly work to combat the rise of anti-vaccine sentiment fueled by the social-media-powered onslaught of misinformation.

"Some of the anti-vaccine, anti-science sentiment has become more deeply entrenched in many communities," Moss said. "That is not going to position us well for the next pandemic."

Garibaldi said the federal government needs to recommit to the federal funding it committed after the 2014 Ebola outbreak to establish 13 regional treatment centers—including the Johns Hopkins Biocontainment Center—capable of managing special pathogens.

"As that funding cycle is there going to be attention in Congress to fund national preparedness, to fund national special pathogen assistance, to fund the ability to develop new vaccines, to fund counter measures in anticipation of what may be the next pandemic," Garibaldi said.

He added that the depletion of the healthcare workforce that has experience dealing with a pandemic jeopardizes the nation's ability to respond to a new disease.

"We are at risk right now because of how depleted the healthcare workforce is," Garibaldi said.

"We're still in a pandemic. Although the severity has gone down considerably, I don't think we can say it's endemic yet."
Crystal Watson
Senior scholar, Center for Health Security

The experts agreed that the end of the U.S. federal emergency declaration—as well as the World Health Organization's decision to lift the Public Health Emergency of International Concern for COVID-19—indicates a new, less deadly phase of the pandemic. But, they agreed, the two decisions do not mean the pandemic is over.

With about 1,000 reported COVID-19 deaths each week in the United States, the disease could end 2023 as one of the nation's top 10 leading causes of death, Watson said.

"We're still in a pandemic," she said. "Although the severity has gone down considerably, I don't think we can say it's endemic yet."