Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation in Princeton, N.J.
In spring 2009, the H1N1 influenza virus surfaced in Mexico, swiftly evolving from “outbreak” to “pandemic” in just two months. As acting director of the Centers for Disease Control and Prevention at the time, I led our work to issue preliminary warnings and evidence-based recommendations to help Americans reduce their risk of infection — very similar to what we’re hearing about covid-19 today.
Crises such as H1N1 and covid-19 provide a mirror for our society and the actions we take — or fail to take. Today, the United States in that mirror is one in which the risk of exposure and the ability to protect oneself and one’s family depends on income, access to health care, and immigration status, among other factors.
The failures of public policy and imagination have been stalking us for years, creating haves and have-nots: parents who don’t have paid sick leave from work (only 10 states and the District of Columbia mandate it); a lack of affordable childcare or sick child care; at least 28 million Americans living without insurance and nearly one-third of the population still underinsured; health protections that are not distributed evenly from region to region; and fear among undocumented immigrants regarding access to care.
The CDC is an evidence-based public health agency, but if the evidence used to make recommendations does not incorporate these health equity issues, we will fall short. The nation will not be prepared to weather what is becoming a pandemic. If systems and tactics that can help to control the spread of covid-19 — such as paid sick days, shown to reduce the spread of flu in jurisdictions where they are mandated — are not available to every American, CDC recommendations are, effectively, words that cannot be implemented.
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