The New England Journal of MedicineDéjà Vu All Over Again — Refusing to Learn the Lessons of COVID-19

Inadequate Preparedness and Legal Constraints May Hinder Future Pandemic Responses

The potential for an H5N1 avian influenza pandemic has raised concerns about the United States’ ability to respond effectively to future infectious disease threats. Despite previous pandemic preparedness plans, the initial response to H5N1 suggests that key decision-makers may not have fully incorporated lessons from the COVID-19 pandemic. This Perspective piece examines the challenges facing public health officials and healthcare professionals in addressing emerging infectious threats, highlighting systemic weaknesses and legal constraints that could impede future pandemic responses.

Key Points:

• The US government began developing pandemic preparedness plans after H5N1 was isolated in humans in 1997.
• Despite being ranked as the most prepared country for a pandemic in 2019, the US performed poorly during the COVID-19 pandemic.
• Current H5N1 response is repeating testing and surveillance problems seen during COVID-19.
• Genetic analyses suggest H5N1 circulated undetected in cattle for months.
• Actual number of H5N1 cases among agricultural workers is unknown due to inadequate testing.
• Fractured lines of jurisdiction among government entities continue to hamper coordinated responses.
• The CDC has not been granted greater authority to lead federal pandemic responses, despite expert recommendations.
• Current social, political, and fiscal environment is less conducive to public health efforts than in early 2020.
• Antivaccine sentiment and litigation may impair rapid scaling of pharmaceutical countermeasures.
• Congress may be less willing to invest in research, development, and social supports during future pandemics.
• Many states have enacted laws restricting health officials’ authority to respond to public health emergencies.
• Federal courts have become more skeptical of public health orders, limiting agencies’ ability to implement mitigation measures.
• The “major questions doctrine” requires explicit congressional authorization for federal agencies to issue regulations on major economic or political issues.
• Overturning of the Chevron doctrine may further impair health agencies’ capacity to respond to new health threats.
• Community-level mitigation measures, such as school closures, may face increased resistance in future pandemics.
• Health care professionals can advocate for new investments in public health preparedness and advise on evidence-based approaches to disease prevention.

“With fewer tools at the public health community’s disposal, a new pandemic could potentially spread even faster than COVID-19 did, overwhelming hospitals and morgues more quickly, putting more stress on health care workers, and causing more deaths — even if the causative virus isn’t more lethal than SARS-CoV-2.”

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