Navigating public health through the noise

Georges Benjamin, executive director of the American Public Health Association (APHA), thinks the COVID-19 pandemic has led to people becoming much more health literate.

The results have been a mixed blessing, he said.

Prior to March 2020, public health officials were not household names and their actions were not making national news daily. But now they and front-line workers are facing threats and harassment.

“In the old days, and that wasn’t that long ago, we would have a public discussion around — well, we wouldn’t have a public discussion. There would be a foodborne outbreak somewhere in the community, or a hepatitis A outbreak in a restaurant or from a wedding, and it might be on page 10, depending on who the wedding couple was or whether or not an elected official was at the event,” Benjamin said in a recent interview with The Hill.

Benjamin has spent decades in the sector, beginning in 1990 when he served as acting commissioner of the District of Columbia Department of Health. He became Maryland’s health secretary in 1999 and stepped down to lead the APHA in 2002.

Benjamin said he’s seen his fair share of policy arguments, but most of them have been substantial, fact-based disagreements, rather than the extreme anger and hatred that’s been directed at health officials this year and last.

“I think it’s in line with a lot of the disorder that we’re seeing in our nation, so I guess in many ways I’m not surprised that we have been brought into this but obviously dismayed that we have,” Benjamin said.

“I’m obviously a strong believer in the First Amendment and people’s right to protest. But … showing up in front of somebody’s house and threatening their kids … that’s unacceptable,” he said.

While much of the U.S. pandemic response has become politicized, Benjamin said, “it’s a mistake to think that public health is not going to be brought into politics.”

“Public health has always been about politics; we kind of pretend like it isn’t.”

“Public health does its work fundamentally through policy change. And because of that, it’s fundamentally always been about convincing resource allocators and political leaders, and the public, to move together collectively to solve problems,” he said.

Benjamin said messaging about important public health issues has become infinitely more challenging because social media has left people with a sense of detachment from their comments, so they don’t necessarily see the consequences.  

Benjamin, 69, is a Chicago native and former Army physician who served in the military for nine years, including as chief of emergency medicine at the Walter Reed Army Medical Center in 1983.

He said the biggest difference in shifting from the ER to public health was learning how to step back and view things from a wider perspective.

“When you have one patient in front of you, you’re focused like a laser on that one individual. When in public health, you’ve got to think of a much broader group, you’re thinking about the health and wellbeing of the whole population,” Benjamin said. “So when you’re vaccinating someone, yes, you’re protecting that one individual, but when you vaccinate enough people you get herd immunity. Now you’re protecting the community, or at least you’re moving in that direction.”

Benjamin said one lesson the public health establishment should take away from the pandemic is to make sure the front-line responders become the public face of the issue.

“There was a time when the only people in public health that spoke to the media, were engaged with policymakers, were the senior most people. That’s no longer the case anymore. People want to hear from the epidemiologist on the ground, the person actually out doing the work, and not necessarily the manager, the top person in the shop,” he said.

Benjamin said he’s not surprised at the relatively poor U.S. response to COVID-19, and he’s worried the nation is positioned to fail again whenever the next pandemic comes, saying “we really have not built the health system … that we really need.”

“Our ability to move patients from point A to point B — not well done. Our ability to move data around and information around — it’s terrible. And it impacts our everyday practice of improving our health and everyday practicing medicine.”

Benjamin said the signs of a troubled response came early, but officials did not react in time. Now, he’s concerned those same problems still haven’t been fixed.

“When we ran out of toilet paper, which should have been a first indication that was going to be a problem for other things like nasal swabs and therapeutics,” Benjamin said. “I mean, if you can’t keep toilet paper on the shelves, keeping some of these more exotic therapeutics on the shelf clearly was going to be a problem.”

Fixing the problems is more than just a matter of money, Benjamin said. It’s about putting the right people in the right place and then making sure those people have the resources they need.

 “Until we build a health system that can foresee bad outcomes and big events happening and get ahead of them, we’re not going to be successful. We’ve been chasing this pandemic since the beginning. And we’re just beginning to understand it. We still haven’t caught it,” he said. “The Biden administration, I think, has done a wonderful job at playing catch up. But you still got a ways to go.”

One of the administration’s ideas to advance biomedical research is a new agency called the Advanced Research Projects Agency for Health, or ARPA-H.  

The White House has requested $6.5 billion to fund the agency, which is modeled after the Pentagon’s Defense Advanced Research Projects Agency, or DARPA. The idea is for the group to deliver breakthrough treatments for cancer, Alzheimer’s, diabetes and other diseases.

Benjamin said the program has enormous potential, if it can get off the ground.

“I think that the more important goal is to get it up and running and making sure that its mission … is different from the historical way [the National Institutes of Health] works. We want ARPA-H … to be more risk-taking, we want it to be there to solve big problems,” he said.

The House this summer passed legislation allocating less than half the funding requested by the Biden administration, and it’s not clear if the Senate will even include the program in its massive social infrastructure bill.

“Does it take money? You bet. And are we going to have failures and debt, and I think my biggest concern about what would happen with ARPA-H is the historical intolerance with failure,” Benjamin said.

Big ideas can fail, Benjamin said, but it shouldn’t discourage people from having them.