(Brett Jordan / Unsplash)
We are about to reach a sobering threshold in the Covid debacle: a half-million of us dead. And yet, there is much to be hopeful about, as case rates plummet and vaccines are reaching millions of people. I was nonetheless shocked to learn recently that two elderly women in my neighborhood had no idea when or where they would get the Covid vaccine. One is 88 years old and the other 95. They have the same health insurer, a large, well-respected provider. And yet…they weren’t contacted to get the vaccine. My 86-year-old mother had a similar problem in North Carolina. Her vaccine priority group actually closed because the vaccinators were moving to younger people – and she had no idea it even existed. When I called the Covid information line in my mom’s county, the kind, patient woman explained that the information had been available on the local TV news. But if you don’t watch local TV news? If you don’t use a computer or smart phone?
We’ve heard plenty of stories about chaos and inequity. Elderly people using walkers waited outdoors in the predawn in the hope of getting a vaccine. People spend hours and days calling hotlines and refreshing their browsers minute after minute in the hope of getting lucky. Officials in New York City recently released information about how the percentage of fully vaccinated people in the wealthier Upper West and East Side zip codes is as much as eight times that of predominantly Black sections.
The vaccines are a miracle, created so quickly and so well. What boggles my mind is how disorganized we are with aspects of the rollout. We knew this moment would come. And yet, we have a shockingly decentralized system. The states get their allotment of vaccine and each decides how to parcel it out. We have primary care physicians telling the news media they have been overlooked. Our cadre of first responders who know the most about all of us – because they are our doctors – haven’t been able to get the vaccine for themselves, never mind for us.
We also lack a reliable national system for collecting vaccine side effect data. If we don’t have that, millions of people waiting for information so they can decide whether to be vaccinated may be stuck in limbo. This includes health care workers and people who have historical reasons to be skeptical about safety and equity issues. We also lack a good early warning system, such as a Global Immunological Observatory, to give early warning when the next rogue pathogen starts spreading. Wouldn’t we all come out ahead if we invested in systems now – with so many lessons freshly learned – that will serve us in the future?
Currently, we spend over $11,000 per person on health care in the U.S. (Most other wealthy countries spend a little over half that and get better results.) In recent years, we’ve been spending under 3% of our health care dollars on public health, which is different from health care. Public health is the science of prevention of illness and protection from health risk. When surveyed, the vast majority of us say we believe in the need for public health. More than half of us are willing to pay higher taxes to have it.
Our lawmakers are paying attention to our struggles, and they will vote to fund public health in the future if we demand it. If we don’t, I predict we will lapse back into the lack of preparedness we have found so shocking. Change needs to happen at the federal and state levels; coordination between them needs to be planned before crisis strikes. Effective public health also protects our economy. If we don’t do anything, scientists are clear that we’ll get to live new versions of disaster in the future. I feel a terrible sadness about what happened to us and our families and our country this past year. I don’t want it to ever happen again.