Chapter 1 | Legacies of the crisis: the effect of COVID-19 on the public health industry

Throughout the pandemic, both before vaccines were developed and during their deployment and administration, the efforts of individuals and organizations in public health have saved many lives. But tackling the biggest health challenge in a generation did not leave public health organizations unscathed.

Political fallout creates a distraction

Public health’s response to the pandemic went further than the healthy-lifestyle campaigns and childhood vaccination drives of traditional interventions. It extended to legal restrictions and penalties to control public behavior. The political implications of such measures — measures that affected how Americans lived, behaved and assessed risk — led to a partisan public response.

Today, half of the respondents to our survey believe that public health needs to work hard to re-establish a neutral political role.

Only 19% disagree. This feeling is most apparent among those who lead public health organizations: 68% of the most senior respondents agree, and, among those involved in public health services decision-making, it rises to 78%.

Our findings are consistent with other research into the impact of COVID-19, in which more than half of Americans express concern that medical science is being used to support a political agenda.¹ Such attitudes undermine public health’s ability to deliver on its mission. A recent Lancet article, for example, found that worldwide trust in government institutions correlated with vaccine uptake.²

Figure 1. Public health decision-makers believe that the sector now needs to work hard to be seen as politically neutral

Long-term issues are flaring up

As well as creating partisan disputes, the pandemic showed that senior teams need to address pre-existing, deep-seated operational challenges — some of which may have been deprioritized during the peak of the crisis.

More than half (56%) of respondents believe that the pandemic revealed weaknesses in the infrastructure of public health and helped them understand how to improve for the future. Again, leadership teams are the most outspoken here: 77% of those in the C-suite and 85% of decision-makers agree.

Which weaknesses do they have in mind? One is the inability of public health organizations to prove how their activities create positive outcomes for constituents: 50% agree that public health is weak at demonstrating the cost-effectiveness of interventions. Among decision-makers, this rises to 75%.

But demonstrating return on investment is just one of the changes that respondents say are necessary for the future.

Positive change in these areas would be mutually re-enforcing. Modernizing approaches to public health and expanding the skills base could make it easier to demonstrate the benefits of specific interventions. This would also make it easier to win broad support for their implementation among harder-to-reach demographics.

Figure 2. Public health teams face multiple challenges