With 70 million eligible Americans still unvaccinated and the delta variant continuing to drive more than 115,000 new infections a day, our nation finds itself back to the grim task of counting hospital beds and ventilators. And while there are many factors contributing to COVID-19’s resurgence and unrelenting hold on communities nationwide, there is one consistent and common thread that has undermined America’s ability to adequately prepare for and respond to this ongoing public health crisis.
A disjointed, chronically underfunded public health data infrastructure stymied our efforts to gather, interpret and act on early vital warning signs that could have helped prevent immeasurable personal and economic suffering and saved hundreds of thousands of lives. Throughout this pandemic, the dearth of reliable community data forced a reliance on guesswork and assumptions to guide the pandemic response, which too often lacked direction and nuance. Accurate, comprehensive and real-time data that reflect the needs of every community has never been more clear or urgent.
This entire pandemic is a monument to our failed data systems. The majority of our grocery stores have more sophisticated IT systems than our public health departments. Early on in this pandemic, life-saving decisions, such as where to send ventilators, PPE and support teams were based on inconsistent, outdated and incomplete information. Critical choices on the closing or reopening of schools and businesses, managing hospital capacity and supplies and imposing or lifting rules about mask use and public gatherings demand detailed and verified data in real time. While important steps are being taken to better predict ongoing threats, a comprehensive national data infrastructure is needed to inform our pandemic response within local communities and the nation as a whole.
America has been relying for decades on dysfunctional and antiquated public health data systems for tracking emerging threats and mitigating the spread of chronic illness and infectious disease. In the absence of sophisticated data on race, ethnicity and language, we consistently fail to address our most urgent public health disparities. Imagine if your doctor’s diagnostic tools had all been taken away and you were told, “You have cancer, but I just can’t tell you what kind or where it is exactly.” That’s how imperceptive our public health data is to the well-being of our communities.
While calls for enhanced data-gathering tools to strengthen public health have been consistently ignored, the clinical sector, in contrast, has benefited from substantial investments in precision health diagnostics. Take the $27 billion investment to ensure hospitals and providers have access to patient electronic health records, through the Health Information Technology for Economic and Clinical Health (HITECH) Act. Now compare this to the Biden administration’s request for $150 million to support the Centers for Disease Control and Prevention’s Public Health Data Modernization Initiative. Of course, this is a step in the right direction, but it’s not nearly enough. In fact, this stands as a glaring example of how our nation’s public health continues to get short-changed, even amid a deadly pandemic. It’s time America’s public and private sectors join forces to demand a HITECH Act for public health.
To be clear, this is not a technology problem. The systems we need are largely commercially available and immediately deployable. The challenge lies in our ability to muster the political will to secure adequate funding for a massive data systems overhaul — one that not only guides emergency response but tracks day-to-day community vital signs to inform routine public health decisions at the federal, state and county levels. In the event of another pandemic, this newly fortified infrastructure will support more targeted testing, vaccinations and community outreach efforts. It will also deliver the socio-demographic and behavioral data that will help address the deep-seated racial and social inequities that exist within our communities. Precision, real-time data gathering will give us a much deeper understanding of how our social determinants of health — the non-clinical factors that contribute to illness — impact the health and well-being of communities nationwide.
When Americans face foreign threats, we ensure that our troops have the resources needed to protect our country. It is time to adopt the same mindset to safeguard our communities from the ongoing impact of COVID-19 and future potentially catastrophic public health crises. A modern, real-time, nationally aligned public health data infrastructure will be our most vital tool to track the pulse of our collective public health and ensure we are better prepared for the next pandemic. With more than 685,000 American lives now lost to this virus, at an estimated $16 trillion cost to the economy, the price of continued inaction will be staggering.
Brian C. Castrucci, DrPH, MA, is the president and CEO of the de Beaumont Foundation. William J. Kassler, MD, MPH, is the chief medical officer, USG at Palantir Technologies and member of the Global Chief Health and Medical Officer Network.
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