The U.S. has made great strides in controlling the Covid-19 pandemic. However, we can destroy it all, both in the short and long term, if the Biden administration does not move quickly to fill this key position at the FDA and prioritize stable leadership in the NIH to create a unified national approach capable of responding in this way. to the crisis as well as routine public health preparedness.
Z national decline in new daily cases
and a relative stabilization in hospitals
, the immediate fall crisis is under control. It is also a moment of danger. In response to different regional conditions, when we move indoors and the pandemic intersects with seasonal flu, Covid-19 control and mitigation strategies are likely to differ for both reasonable scientific reasons and deeply problematic political interference
with public health safeguards that sow confusion and outrage. And there is a threat that we will not tackle this basic structural conditions
creating major health disparities nationally and globally. Here, it is crucial to have a reliable leader who makes decisions, implements the action plan, informs it publicly, and sees the plan.
The FDA has been in the past criticized for moving too slowly in approving new therapies
, which not only costs lives, but also raises prices. In fact, the FDA approved vaccinations against Covid-19 because it allowed emergency use. an unprecedented pace
– an average of 21 days for the three main vaccines currently approved, compared to 12 months for the 21 vaccines approved between 2010 and 2020. However, there are still problems in getting people to take vaccines that are safe and effective.
The FDA could benefit from a trusted individual – much like Dr. Anthony Fauci, chief medical adviser to President Biden, or Rochelle P. Walensky, director of the U.S. Centers for Disease Control and Prevention – who provided clear and reassuring messages about FDA approval was based on substantial and thorough verification of evidence of safety and effectiveness. After the FDA issue emergency use permit for Pfizer Covid-19 for children 5-11 years
on Friday, a permanent leader who knows how to instill confidence in parents is urgently needed.
Even with established leadership, cohesive federal communications are needed to build and maintain public confidence. When he originally approved reconstitution injections for Pfizer, he did The FDA recommends
that they are available to individuals aged 65 and over, those with a basic health condition, or those working in a highly exposed environment, such as health professionals or teachers. However, when the CDC Advisory Committee on Vaccination Practices recommended vaccination for only the first two categories, CDC Director Rochelle Walensky outvoted its own commission
ensure compliance with the FDA on an important fundamental ethical issue: given the risk disagreement, how widely should the state expand the facilitation access network?
There have been differences in the assessment of such trade-offs for a decade point of tension between the two agencies
on major public health issues, including the place of e-cigarettes in the control of combustible tobacco. Scientific disagreements cannot and should not be covered up, but public confidence erodes when we get mixed guidelines.
As a result, filling leadership gaps to help create a clear vision and ensure institutional stability will only go so far. Protecting public health requires a multi-agency, multi-sectoral response. Federal government coordination is crucial, but best practices, policies, and resources to support them need to be extended to state and local governments, the private sector, and NGOs.
The nation has a pattern in National Incident Management System (NIMS)
, which coordinates emergency responses requiring access to resources such as food, energy, housing, or health care managed by different agencies. Although we at CDC have a leading public health agency and a center for disease reporting and policy guidance, it is only one of the agencies contributing to public health goals.
We do not have a comprehensive national public health management system that can address both the acute crises and the chronic structural deficits that have put us at the beginning of what we could, without daring action
, be the fifth consecutive decade in which the U.S. is losing its position in life expectancy
with regard to equivalent countries. And it’s not just that life expectancy in other industrialized democracies has outpaced achievements in the US. Life expectancy in this country is since 2014 it has been slowly eroding
Successful management of Covid-19 and other public health threats requires constant effort. It requires not only investment in emergency preparedness and response systems, but also in destruction of systems that create racial, ethnic, gender and social class differences
. This will require cooperation and coordination between agencies that are not accustomed to the level of interconnectedness needed to better prevent and mitigate death and disease. And this requires leadership with the ability to go beyond stewardship to the exercise of assigned authority.
Noisy disagreement will always exist on the edge. The great middle of this country will listen and do what is needed when it is called to action and when it is provided with clear, trustworthy instructions. Most of us can save all of us.
But only if this nation can unite, fill key leadership positions and create a structure in which these leaders will call public health in a coordinated way. Anything less risks not meeting the challenge of responding to acute crises and addressing the historically ingrained structural, social and economic conditions that hold us back so much.