Inside America’s Covid-reporting breakdown
For decades, scientists warned that a pandemic would one day wreak havoc on global populations, potentially killing hundreds of thousands of people. The global health community needed to prepare, these scientists said.
In a medical journal published in 1988, Joshua Lederberg, the Nobel prize winner in physiology and medicine in 1958 and president of The Rockefeller University, wrote that after the emergence of AIDS, the world “will face similar catastrophes again.”
“We have too many illusions that we can, by writ, govern the remaining vital kingdoms, the microbes, that remain our competitors of last resort for dominion of the planet,” Lederberg wrote. “The bacteria and viruses know nothing of national sovereignties.”
Since then, outbreaks have come at almost regular intervals: Severe Acute Respiratory Syndrome (SARS) in 2003; the swine flu, also known as H1N1, in 2009; the Middle East Respiratory Syndrome (MERS) in 2012; and Ebola in 2014. With each came renewed demands from public-health leaders to implement surveillance systems that could help contain disease and save more lives.
Despite those pleas, the United States did not commit the funding or organizational resources necessary to fight a pandemic like Covid-19.
In interviews, current and former health officials in dozens of states attributed their struggles to decades of underfunding on both the federal and state level. And, they said, despite repeatedly asking the federal government for additional resources to improve their data systems to prepare for an infectious disease epidemic, public health departments were largely left to fend for themselves.
Tom Frieden, the director of the CDC under President Barack Obama, acknowledged the failings at a hearing before the House Energy and Commerce Committee in March: “Our nation had a patchwork of underfunded, understaffed, poorly coordinated health departments and decades out-of-date data systems — none of which were equipped to handle a modern-day public health crisis.”
Since the 2008 recession, more than 35,000 state and local public healthcare jobs have vanished, according to data from the National Association of County and City Health Officials. In 2009 alone, 45 percent of local health departments reported having cut their budgets, according to the same data. In Oklahoma, where Taylor and his team scrambled to fix Covid-19 data errors, the state legislature cut its health budget by 27 percent between 2009 and 2018.
Health budgets in some places recovered slightly after the recession, during which states were forced to balance their budgets despite massive shortfalls in tax revenues. And over the last two decades, Congress has allocated billions of dollars to help states prepare for major public health threats. But local and state officials said not enough of the federal funding went specifically to the improvement of the country’s surveillance systems and the data programs that run them. As a result, public health departments have fallen further and further behind.
Still, it was more than a lack of funding that hampered data collection, many officials acknowledged. Over the years, some health departments struggled with the need for transformation. Local offices pushed back against moving away from systems and processes they relied upon. Some bucked the idea of digitizing records.
In 2013, top CDC officials concluded the agency needed a better strategy for strengthening the country’s surveillance systems. One of the main components was to modernize the National Notifiable Diseases Surveillance System (NEDSS) — the agency’s national surveillance system that states use to report disease data to the federal government.
The agency began working on finding ways to create new IT infrastructure and standards. In the summer of 2013, only 62 percent of 20 million laboratory reports were being received electronically. The new five-year strategy called for increasing that number to 90 percent.
The CDC used tens of millions of dollars allocated through the Affordable Care Act and congressional funding to help states across the country improve their electronic reporting and data systems over the next several years, and by 2019, about 85 percent of the nation’s labs were reporting electronically.
Frieden created an entire epidemiology and surveillance unit to strengthen surveillance at the agency and around the country. The CDC also created a program called DCIPHER during the Ebola outbreak that allowed the agency, states and other federal partners to share vital epidemiological data more easily.
But local officials said federal interest in continuing to rebuild the nation’s capacity to surveil and report diseases eventually waned. Federal officials were increasingly of the belief that pandemics were not a top national security threat.
