As it worsens, the COVID-19 pandemic is both revealing and creating extraordinary challenges to our nation’s health care system and public health infrastructure.
Since the beginning of the pandemic a year ago, there have been more than 24 million confirmed cases, and more than 400,000 deaths across the country, accounting for 25% of the confirmed cases and 20% of deaths worldwide. After heart disease and cancer, COVID-19 was the nation’s third leading cause of death in 2020. Communities of color are being disproportionately impacted, accounting for 40% of deaths. While on average 3,000 people a day are losing their lives to COVID-19 and hospitalizations are high, the pandemic is also creating a substantial economic loss, with millions of Americans experiencing unemployment and food and housing insecurity.
Given this backdrop, the Bipartisan Policy Center’s Future of Health Care initiative reconvened in August 2020 and expanded its group of key health care leaders. Their mission: Develop recommendations that not only improve the resilience of America’s health care and public health systems, but more urgently, address the threat of the coronavirus and the nation’s response to it.
BPC’s Future of Health Care initiative, launched in 2017, is co-chaired by former Senate Majority Leaders Tom Daschle and Bill Frist, M.D.; Andy Slavitt*, former acting administrator, Centers for Medicare and Medicaid Services, and Gail Wilensky, Ph.D., former administrator of the Health Care Financing Administration (now CMS). Members include: Sheila Burke, fellow, BPC and strategic advisor, Baker Donelson; James Capretta, resident fellow, Milton Friedman, chair, American Enterprise Institute; Dan Crippen, former director, Congressional Budget Office; Peggy Hamburg, M.D., former commissioner, Food and Drug Administration; Chris Jennings, fellow, BPC and former Clinton and Obama White House Senior Health Care Policy Advisor; Risa Lavizzo-Mourey, M.D., former president and CEO, Robert Wood Johnson Foundation; William Roper, M.D., former director, Centers for Disease Control and Prevention; Avik Roy, senior advisor, BPC and president, The Foundation for Research on Equal Opportunity; Mark Smith, M.D., former founding president and CEO, California Health Care Foundation; and Leana Wen, M.D., former Baltimore health commissioner. *Mr. Slavitt has recently been appointed to serve as Senior Advisor to the COVID Response Coordinator for the Biden administration, and therefore is no longer affiliated with the Bipartisan Policy Center.
As a first step, in October 2020, the Future of Health Care leaders urged Congress to pass a short-term relief package that would allocate additional funding and resources for COVID-19 testing and contact tracing, vaccine distribution and monitoring, school COVID-19 safety, housing and nutrition assistance, health care providers serving disproportionately vulnerable populations, and states burdened by the health and economic disruption caused by the pandemic.
In late December 2020, Congress passed and President Trump signed into law a $900 billion bipartisan relief package that addressed many of these issues. The bill included significant federal funding for vaccine distribution; COVID-19 testing, contact tracing, and mitigation efforts; nutrition and rental assistance; and health care providers, as well as needed financial resources for small businesses, unemployed workers, and American families.
In January 2021, President-elect Biden unveiled a $1.9 trillion American Rescue Plan to further accelerate the nation’s COVID-19 response and jumpstart the American economy. The plan includes $400 billion to launch a vaccination program, expand testing and contact tracing, create a public health jobs program to assist with the response, eliminate supply shortages, and assist schools with implementing COVID-19 safety protocols. One day after taking office, President Biden released the National Strategy for the COVID-19 Response and Pandemic Preparedness, a comprehensive national plan to fight the current pandemic, and issued a series of executive actions to implement the response.
These are important steps to help struggling Americans and gain control of coronavirus. BPC looks forward to working with the 117th Congress and the new administration to effectively implement the new law, achieve consensus on additional legislative action, and institute further actions necessary to save lives and reduce the transmission of the virus.In this report, BPC’s health care leaders outline short-term recommendations for immediate execution to address the challenges of the current pandemic.
The recommendations focus on six key issues:
- Testing and contact tracing
- Vaccine transparency, equitable distribution, and uptake
- Surge capacity
- Supply chain management
- Racial disparities
- State, local, and provider funding
There are six key recommendations in this report with additional supporting recommendations for each.
Expanding COVID-19 Testing and Contact Tracing
Release a national testing strategy that outlines a path forward to reduce positivity rates in each state to under 5%. The strategy should detail how positivity rates should be defined, standardized, and reported by states; the amount and type of tests (e.g., diagnostic, screening) needed over the course of the pandemic; innovations in testing; use cases for existing tests; a user-friendly schematic for the public to understand which tests to obtain under what circumstances; guidance on payment for tests; a transparent analysis of the supply chain necessary for test production; and a timeframe to achieve the stated goals. The strategy should also detail the role of testing, particularly antibody testing, as vaccine administration progresses.
Ensuring Vaccine Transparency, Equitable Distribution, and Uptake
Launch a national COVID-19 vaccination campaign that ensures efficient vaccine distribution, so doses can be promptly administered, and educates Americans on the importance of obtaining a vaccine. The current lag between vaccine allocation and administration must be reduced through coordination at all levels—federal, state, and local—to ensure ample, publicly accessible and appropriately staffed sites for vaccine administration. A science-based communications strategy and education campaign should be tailored to subpopulations in order to maximize impact. It is also critical that health care professionals be a focus of the campaign, as their acceptance of the vaccine will instill confidence in their patients. States should also develop a specific strategy to vaccinate vulnerable populations and track vaccination rates, with a specific focus on communities of color, Tribal nations, older adults, low-income Americans, and those living in disparate geographic areas (rural and urban) to ensure gaps do not develop over time.
Supporting Health Systems’ Surge Capacity
Direct HHS to engage in continuous quality improvement of its COVID-19 Hospitalization Dashboard and publicly disclose real-time health care system capacity data (e.g., ICU beds, staffing, PPE). An accessible and accurate dashboard will enable leaders at all levels of government to have better situational awareness and appropriately adjust community mitigation measures. This data will also help identify settings with adequate capacity for designation as relief health care facilities. While more granular facility-level data on bed capacity, hospital admissions, and emergency department visits is now available from HHS Protect, similar data on critical medical material (e.g., ventilators, medicines) and PPE would also be helpful.
Enhancing Supply Chain Management
Define and publicly communicate the roles, responsibilities, and authorities of agencies at the federal level to ensure that PPE and other critical medical materials are adequate. Clarifying functional roles will help federal agencies coordinate efforts to stabilize the supply chain, address supply issues rapidly, and ensure sufficient resources. A gap analysis of the PPE and critical medical materials required for the duration of the pandemic must be conducted to inform federal agencies as to when the Defense Production Act should be utilized to increase domestic manufacturing capacity.
Evaluating and Addressing Racial Disparities
Provide the CDC with the authority to require states and localities—working with health care providers—to submit race and ethnicity data on COVID-19 testing, cases, hospitalizations, and deaths on a regular basis. Currently, states report disaggregated data by race and ethnicity to the federal government on a voluntary basis. This policy change, coupled with new resources to enhance the nation’s public health data infrastructure, would allow policymakers to have access to consistent and comprehensive data to inform policy decisions that address the unique needs of communities of color.
Increasing State, Local, and Provider Funding
Provide an additional, one-time emergency appropriation for state and local public health departments with maximum flexibility to allow local officials to best meet the needs of their communities. While Congress recently passed a significant relief package with additional resources for COVID-19 testing, contact tracing, and vaccine distribution, it will be critical to monitor if states and localities have the resources that they need to address COVID-19, as well as other pre-existing public health challenges.
Read more on the recommendations
Political and public health leadership are central to successfully coordinating and managing a pandemic crisis.
Looking back to the 1918 influenza pandemic, we learned lessons that could have translated across a century to today’s public health emergency. The 1918 pandemic and the COVID-19 pandemic were and are highly political events. Leaders selectively chose what scientific results to recognize and, in some cases, ignored science and downplayed the seriousness of the illness; crowds continued to gather; cities shut down but reopened too soon; and people refused to wear masks. Successfully tackling a public health emergency of this magnitude requires federal leadership establishing a national plan paired with unified coordination and communications efforts across the country.
Trust in science and a commitment to public health are paramount to making progress in fighting a pandemic.
At the federal level, bipartisan leadership must support and elevate our nation’s federal scientific agencies, allowing science to guide critical decisions in response to COVID-19. Leaders must emphasize the importance of science and effectively communicate the scientific basis of public health guidelines, particularly those that require economic or personal sacrifice of the American people. Restoring trust in our nation’s health institutions and leading health experts will demand transparency at all levels with a focus on the safety, efficacy, and equitable distribution of treatments and vaccines. National and state leaders should lead by example and adhere to the scientific guidelines by wearing masks, physically distancing, and obtaining the vaccine. Trust in science, our health agencies, and scientists is imperative for reducing transmission, ensuring vaccine uptake, and successfully defeating the coronavirus.
National leaders must communicate and adhere to clear, consistent, and customized public health and safety messages and serve as role models.
Transparent communication with the American people will ensure people understand and trust the scientific process and the tools and actions needed to end this pandemic. When new evidence emerges prompting public health leaders to update their scientific advice, it is imperative to communicate with humility and transparency. Sharing and repeating clear, consistent, and customized public health messages by trusted leaders at the national and local level will help change the conversations between people and on social media where many people keep informed. Tailoring messages and public education campaigns to focus more on empathy than authority or politics and target specific communities will go a long way toward changing behavior and moving public opinion.
Federal, state, and local leaders—Democrats and Republicans—must take action to debunk conspiracy theories.
Conspiracy theories that have evolved around COVID-19 treatments and vaccines, even the existence of the virus itself, have been dangerous and put communities and individuals at greater risk of illness and death. Our political leaders need to speak out against these conspiracy theories and theorists and speak about what is actually known and true.
Federal efforts must recognize and address vulnerable communities.
Public officials must consider the unique experience of communities of color and other vulnerable populations, including seniors living in nursing homes and Native and rural Americans. There must be recognition of the need for political leaders to engage with the American public in a culturally competent manner. For example: They must understand and address deep-seated mistrust that many communities of color feel toward the medical establishment because of discrimination around access to care and medical research like the Tuskegee project. This pandemic exposed the need to focus attention on our nation’s nursing homes where chronic conditions, understaffing, lack of accountability, and isolation have been hallmarks of COVID-19. An effective pandemic response must include a dedicated effort to address and mitigate the health disparities and unique challenges facing these vulnerable populations who are shouldering the burden of COVID-19 cases, deaths, and hospitalizations.
Over the next few months, BPC’s Future of Health Care leaders will make additional recommendations on longer-term issues addressing future pandemics, including augmenting the public health infrastructure, bolstering health care capacity, improving federal interagency coordination during public health emergencies, reviewing federal health care coverage policies during a pandemic, and enhancing safety in congregate living facilities and transitions to home and community-based services.
So the final lesson of 1918, a simple one yet one most difficult to execute, is that…those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to to manipulate no one. – John M. Barry, The Great Influenza