A Pandemic Tested the Limits of Our Public Health System. There’s Work to Be Done.

May 20, 2021 Kristen Ballantine

Women with masks bumping elbows

When the World Health Organization declared COVID-19 a global pandemic in March 2020, things changed — and changed quickly. Workplaces, classrooms and doctors’ offices went virtual. Barriers between industries and sectors were broken. Vaccines — as in several — were brought to market in record time.

This was possible in part because many of the forces that underlie our public health system were optimized in response to the pandemic. Relaxing cumbersome regulations related to telehealth, for example, enabled doctors to treat patients safely from their homes. Public-private partnerships, combined with an accelerated regulatory pathway, led to the rapid development and emergency use authorization of multiple COVID-19 vaccines. In the face of urgency and adversity, stakeholders from all areas of industry and government rallied to respond to the crisis.

Alongside these gains, COVID-19 has revealed — and, in some cases, exacerbated — deep disparities in our nation’s healthcare system, evidenced by the pandemic’s disproportionate effect on certain communities. As we begin to emerge from the crisis and deal with the health and economic fallout, we have a unique and pivotal opportunity to address some of these shortcomings and bring our public health system into the future.

Upgrading Infrastructure & Technology

As millions of Americans leveraged technology to connect with one another from afar during the COVID-19 lockdown period, millions of others lacked — and continue to lack — the broadband capacity to do so. Pew Research Center data reveals just 63% of rural residents report having a home broadband internet connection, while 44% of low-income adults do not have home broadband services.

The implications of these disparities go far beyond the ability to FaceTime with friends and family. In the age of telehealth, which can serve as a vital lifeline for rural and home-bound Americans, accessing healthcare typically requires a broadband connection that supports audio-visual communication. Although the Centers for Medicare and Medicaid Services waived the audio-visual requirement for telehealth visits during the COVID-19 emergency period, that waiver is set to expire at the end of it.

President Biden’s $100 billion plan to expand broadband access in the U.S. is a promising step toward achieving healthcare equity for rural and otherwise underserved populations. Concurrently, investments are needed in the technology that federal and state governments rely on to monitor and manage public health. Antiquated systems that weren't easily adaptable during the pandemic should be overhauled in favor of technology that is agile, interoperable and secure.

Setting Certification Standards, Interoperability Mechanisms for Immunization Records

The COVID-19 pandemic has brought unprecedented focus on immunization records and the registries that house them. Currently, there are no national certification standards governing how these records are handled, resulting in a patchwork of regulations across states and jurisdictions. Additionally, because it is optional in many states for pharmacies, providers and other entities administering vaccines to report immunization information to their respective registries, there is no single source of truth on this critical aspect of public health.  

Just as HL7 standards offer a framework for exchanging electronic health information, there needs to be a similar structure in place for immunization registries, and reporting this information should be mandatory regardless of the payer or place of administration. As we work to vaccinate the population against COVID-19, we have an opportunity to modernize our immunization registries in preparation for future pandemics, while better monitoring routine immunizations against vaccine-preventable illnesses.

Implementing Sustainable Mechanisms for Cross-Sector Partnerships

During the COVID-19 pandemic, we saw the benefits of coordinated responses and decision-making across different regions and jurisdictions. In the D.C. metro region, for example, residents living in one state could get vaccinated in another, permitting they were eligible to receive a vaccine. In the New York tri-state area, travel advisories and other restrictions were issued in unison in order to limit the spread of COVID-19 throughout the commuting area.  

This spirit of federal, state and private sector cooperation is one that should be carried through in the aftermath of the pandemic. Breaking down silos between agencies, regions and jurisdictions can help to ensure preparedness in the event of future national crises as well as the mobilization of resources in the event of more localized emergencies. Beyond acute disasters, having efficient and secure mechanisms in place for government and healthcare entities to exchange information is vital to disease prevention and population health.

Reforming Cumbersome Regulations

When COVID-19 hit, one of the first actions the federal government took was to lift or relax certain regulations that could potentially hinder the nation’s pandemic response or serve as a barrier to care. One such modification was to the Federal Communication Commission’s Telephone Consumer Protection Act (TCPA). Enacted in 1991, the TCPA restricts telemarketing calls and solicitations, along with the use of automatic dialing systems and prerecorded voice messages, in order to protect consumers from unsolicited and harmful robocalls. However, the TCPA has had the residual effect of blocking valuable and wanted healthcare communications from physicians and health plans to patients.

During the COVID-19 emergency period, calls and text messages from healthcare providers and government officials were exempt from TCPA rules. With the exemption, these entities and their business associates were able to provide critical information and resources to patients without fear of litigious consequences. The pandemic was a lesson in the importance of communication and engagement to public health preparedness and response, underscoring the need to modernize the TCPA — if not holistically, then, at a minimum, by creating vehicles for disaster response communications in the event of a national, regional or local emergency.

Investing in the Long Term

With previous pandemic threats, such as the H1N1 virus, the U.S. was fortunate to avoid a full-blown health crisis. Back in 2009, the Centers for Disease Control and Prevention administered a $1.4 billion grant to support state and local governments in responding to a potential influenza pandemic.

Fast-forward to 2020, when we weren’t nearly as lucky, and prior pandemic funding had dried up. While there are many lessons to be learned from the COVID-19 pandemic, the biggest perhaps is the need for proactive, long-term and sustained investments in our public health system — both in mitigating future large-scale crises as well as the many issues that threaten public health and safety on a regular basis.

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