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    Lessons from COVID-19 for the next pandemic: Invest in public health, earn public trust

    NIH Director Francis Collins, MD, PhD, and CDC Deputy Director Anne Schuchat, MD, say the United States must strengthen its public health systems, rethink its clinical trial process, and get more public buy-in on safe behaviors.

    Dr. David Skorton, Dr. Anne Schuchat, and Dr. Francis Collins speak during Learn Serve Lead 2020.
    David Skorton, MD, president and CEO of the AAMC; Anne Schuchat, MD, principal deputy director of the Centers for Disease Control and Prevention; and Francis Collins, MD, PhD, director of the National Institutes of Health, speak at Learn Serve Lead 2020.
    Photo by Laura Zelaya

    COVID-19 has demonstrated that the United States must prepare for future pandemics by increasing investments in public health, shifting more resources to clinical trials, and getting more people to change behaviors, top federal health officials said Nov. 16 at the opening plenary session of Learn Serve Lead 2020: The Virtual Experience, the annual meeting of the AAMC.

    Francis Collins, MD, PhD, director of the National Institutes of Health (NIH), and Anne Schuchat, MD, principal deputy director of the Centers for Disease Control and Prevention (CDC), said the medical and scientific fields responded to COVID-19 with remarkable speed and innovation, but the nation must apply lessons from that response in order to combat the next fast-sweeping disease. 

    “The mathematical probability of another pandemic is essentially the same every single day,” Schuchat told moderator David Skorton, MD, AAMC president and CEO. “The chances that we're going to have something else horrible, imminently, are very real.”

    Responding effectively will require investing more money and manpower in public health systems at the federal, state, and local levels, they said.

    “We’ve neglected public health. That has not served us well,” Schuchat said. “We can’t take public health capacity for granted.”

    Collins lamented that although the nation turns its attention to public health systems during a health crisis, “we tend to shift … to complacency” after the crisis — a pattern that should not repeat after the COVID-19 pandemic subsides.

    “We need to revitalize the public health system to be prepared to deal with whatever that next pandemic is,” he said. “That system needs resources, it needs people.”

    Speaking just hours after announcing one of the most uplifting scientific developments in the fight against COVID-19 — preliminary data showing that a vaccine developed by Moderna was 94.5% effective in protecting clinical trial participants from the disease — Collins shared observations about the nation’s ability to conduct such trials in an emergency.

    “It has been astounding to see the way the entire scientific community has pulled together” to produce treatment and vaccine candidates in a fraction of the usual time, Collins said.

    Yet clinical trials of therapies and vaccines for COVID-19 have sometimes been slowed by insufficient capacity, he noted. That’s because some laboratory resources and personnel were already dedicated to ongoing trials that could not be stopped — and also because some staff were needed to care for COVID-19 patients.

    “We had some difficulties, and still are, trying to rapidly activate clinical trials for the most pressing issues,” he said. “Some of our system is still clogged up a bit by trials” for other diseases that, while important, are not as critical as a highly deadly pandemic.

    While research must continue into chronic diseases, Collins explained, the NIH will “take a hard look at whether our clinical trial system in the United States is really optimized to handle what might be coming next” — that is, a disease that requires the fast mobilization of massive scientific resources.

    Because laboratory and clinical research takes a long time even under the best circumstances, Schuchat turned to the science of human behavior as another vital factor in defeating a pandemic. She said health and government leaders need to guide the public to adopt behaviors that prevent the spread of a disease while scientists research and implement medical interventions. 

    “We can't put all of our eggs in the countermeasure basket,” Schuchat said. “As great as technology is … we’re not going to have vaccines on day one. So we have to get better at the human-to-human, social behavioral kinds of changes” that can slow infections.

    That, she explained, requires clear and consistent communication — starting at the community level and including public health leaders, and moving up through various levels of government.

    “When we have inconsistent messages from different jurisdictions or different voices, it's really confusing for the public,” Schuchat said. “The value of coordinated messaging that acknowledges uncertainty, that acknowledges transparency, is just vital.”

    Communicating with specific populations is also important — such as marginalized communities that feel they have been poorly served and even abused by medical institutions. Companies have found it challenging to establish trust in vaccine development among Black Americans, and the challenge will continue when it comes time to administer COVID-19 vaccines, Collins said.

    He recalled that early in several of the current vaccine trials, the companies “were having a very difficult time recruiting African Americans.”  A history of mistreatment in research and medicine — including the infamous Tuskegee syphilis study — has left many Black Americans distrustful. Collins said that when companies tried to enroll Black people in their COVID-19 trials, two words that they commonly heard in response were “Tuskegee and no.”

    “You can understand the dark history here of how medical research has not treated certain populations with justice,” Collins said. “We have a lot of work to do.”

    He said the NIH worked with Moderna to increase Black participation in its vaccine trial and is working now on ways to ensure that treatments and vaccines reach populations — including Black and Latino — that have been disproportionately harmed by COVID-19 and other diseases. To achieve that, the NIH will broaden its outreach among experts, Collins explained.

    “We’re tapping into not just the most senior members of the research community, but we also want creative ideas from people who are earlier in their careers and are able to see bolder ways we can address health disparities,” Collins said. “So watch us.”