America Is Not Ready for the Next Pandemic — and a Leading Public Health Expert Explains Why
America Is Not Ready for the Next Pandemic — and a Leading Public Health Expert Explains WhyIn a wide-ranging conversation on Meidas Health, Dr. Vin Gupta and Rutgers School of Public Health Dean Perry Halkitis examine the crumbling state of America’s health security infrastructure
The recent hantavirus scare may not represent a pandemic-level threat, but to Dr. Perry Halkitis, Dean of the Rutgers School of Public Health and author of Humanizing Public Health, it represents something more troubling: a window into just how vulnerable the United States has become to biological threats of any kind. In the latest episode of Meidas Health, host Dr. Vin Gupta sat down with Halkitis for a frank assessment of where America’s public health infrastructure stands and how far it has to go. A Weakened FoundationHalkitis identified two interlocking crises at the heart of America’s diminished pandemic preparedness. The first is structural: a public health infrastructure that has been systematically defunded and hollowed out. The second is relational: a field that has, in his assessment, sometimes forgotten how human beings actually work. “We have a public health infrastructure that is extremely weak, that has been torn apart,” Halkitis said, adding that responsibility doesn’t rest entirely with budget cuts. “I’m going to also point fingers at ourselves and say in part because maybe we have not done the best job we could have possibly done during COVID and in other pandemics.” That self-criticism is central to his broader argument. During COVID-19, the public encountered a wave of experts telling them what to do; people they had never seen before and had no particular reason to trust. When institutions failed to admit mistakes, or were slow to communicate, the damage to credibility was compounded. Halkitis described a conversation with a fellow dean who argued that while the public health community made errors during the pandemic, it should not say so publicly. Halkitis disagreed sharply. “Human beings want to hear us say we did something wrong,” he said, “and own that, because the more we own that, the more we become human again.” Two Kinds of MistrustThe trust deficit in American public health is not simple, Halkitis argued. It runs in two opposing directions simultaneously. On one side are people who feel that institutions have failed to respond adequately to disease threats, a concern made more acute by the U.S. withdrawal from the World Health Organization. On the other side are those who believe that government overreached into their lives. Navigating both simultaneously requires understanding the emotional and psychological underpinnings of health decision-making, not just the epidemiological data. “People don’t operate rationally,” Halkitis said. “They don’t operate always with what’s best on their mind.” That insight forms the thesis of his book: that public health has historically relied on disease-centered, data-driven approaches that fail to account for how human beings actually process fear, uncertainty, and information. A person in a neighborhood where a neighbor’s child has measles is not weighing odds ratios. They are afraid. And fear, not data, drives behavior. The Institutional VoidGupta raised the structural leadership gaps that have emerged in recent months: the United States currently lacks a confirmed CDC director, a confirmed Surgeon General, and recently lost its FDA commissioner. He asked Halkitis directly whether those vacancies are costing the country in a moment when credible, evidence-based voices are most needed. Halkitis was measured but clear. The country does not simply need warm bodies in those roles. It needs people with genuine connections to the communities they serve. He recalled his longtime colleague Dr. Demetre Daskalakis conducting HIV and STI testing in New York City bathhouses early in his career, not because it was conventional, but because that was where people were. “We need people like him in those roles who understand human beings,” Halkitis said. In the absence of that federal leadership, he argued, communities themselves are filling the gap. Local health departments, community-based organizations, trusted medical providers, and grassroots networks are doing work that Washington is not. “Right now at the local level is where I would be getting my information,” he said, “because certainly at the federal level, there’s not the leadership there.” The Policy PrescriptionsAsked what the country most needs to be doing, and is not, Halkitis offered two clear priorities. The first is treating economic policy as health policy. Health outcomes, he argued, are inseparable from zip codes, income, and access to resources. He pointed to the HIV epidemic in New York City as a stark illustration. People living with HIV in certain Manhattan neighborhoods are living full lives, while people in parts of Brooklyn and the Bronx are dying from the same disease, just a few miles away. “That tells you something,” he said. “These are a few miles apart.” The second is what he called public health psychology: taking seriously the psychological and emotional drivers of health behavior rather than assuming that accurate information alone changes minds. “We need to be focusing on what drives humans to act the way that they do,” he said. “We haven’t asked those hard questions because we just assume that people use their cognitive, their left hemisphere.” He also pointed to the need for a restructured communication model, one in which federal agencies equip local authorities, who in turn deploy trusted community messengers to deliver health information where people actually live and gather. That model, he noted, is central to how Rutgers is reimagining its own public health training program. A Generation of Reason for HopeBoth Gupta and Halkitis acknowledged the weight of the current moment — budget cuts across HHS, the dismantling of USAID programs like PEPFAR that had served as global disease surveillance nodes, and a broader erosion of the institutions that undergird public health. But Halkitis resisted pessimism. He pointed to the generation of students now entering the field as a source of genuine optimism. Enrollment in public health programs may be declining in absolute numbers, but the students who are showing up, he argued, are doing so with unusual conviction and activist energy, often against significant financial headwinds from the same administration cutting their loan access. “Maybe I don’t need five hundred students,” he said. “Maybe I just need three hundred really, really dedicated ones.” The conversation closed with a quiet but pointed observation. Polls consistently show that Americans, regardless of political affiliation, trust their own medical providers above all other sources of health information, far above federal agencies. The infrastructure to meet people where they are, with voices they trust, already exists in communities across the country. The challenge is building the systems and training the people to activate it — before the next outbreak makes the question more than academic. Humanizing Public Health: How Disease-Centered Approaches Have Failed Us by Perry Halkitis is available through Johns Hopkins University Press. Use code HTWN for 30 percent off. Thanks for your support of Meidas Health and all of our initiatives here at MeidasTouch as we work to counter health disinformation. Please feel free to let us know your thoughts in the comments below — and support initiatives like this by becoming a subscriber today.
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