The legislature moved to address these by passing the Statewide Accelerated Public Health for Every Community (SAPHE) Act, signed into law by Gov. Charlie Baker on April 29, 2020. Comerford co-sponsored SAPHE 2.0, which Gov. Maura Healey signed in December 2024. It provides funding for local health departments; allows for the creation of a new statewide data collection system and shared services; and requires the development of uniform credentialing systems for public health workers. The new law is “next-generation” public health legislation, says Georges Benjamin, executive director of the American Public Health Association. He calls it “a model for other states seeking to provide the legislative basis for public health system improvement efforts.”

Harvard Public Health’s Maura Kelly conducted separate interviews with Comerford and with Oami Amarasingham, deputy director of Massachusetts Public Health Alliance, which helped develop SAPHE 2.0. The interviews were edited and condensed.

HPH: Why this legislation?

Comerford: There is a moral and ethical responsibility to ensure equitable services to all residents of the commonwealth. As a commonwealth, we are less strong if we have weak pockets of resilience. That weakness appeared not only where we have seen weak public health protection and public health inequities—immigrant communities, communities of color, low-income communities. We also saw real weakness in rural communities that did not have the infrastructure to launch a full-on response to the pandemic.

Amarasingham: Covid made the case clearly to every individual and to every elected official that public health infrastructure is really important. Local public health officials have been trying to solve the problem of a lack of public health infrastructure, staff, funding, and statewide minimum standards for decades. We have one state department of public health and 351 local departments of health, whereas most states have county- and regional-level departments. Each local health department has been funded by the town or municipality and many have pretty limited resources. The city of Boston has a really big public health department, but after that, every public health department is much smaller. In some places, public health departments are open a few hours a week.

HPH: Would this law have helped Massachusetts get through Covid better, with less loss of life?

Comerford: We have huge pockets without cell service here in western Massachusetts. We have almost no consistent internet service. We relied on unbelievably intrepid public health officials to go door to door [telling people about Covid, vaccines, testing, and so on]. At the time we weren’t logging our work in a way that was consistent and usable information. There were a lot of gaps in information sharing, which is terrible in a crisis. You can’t understand what you can’t measure and track. Now there has to be data collection, training, [and] the state has to help resource this.

Amarasingham: We were not in great shape to respond in the most effective, most equitable way. What public health officials had during Covid was a PDF [containing the latest statistics]. You needed someone to convert that to an Excel spreadsheet if you wanted to use the data. It was not useful for data scientists or anyone who wanted to produce something with that data. It didn’t track demographic data. When you have 351 separate entities reporting data, you want that data to be collected and compiled in a uniform way so that it can be combined and used. It was very frustrating not being able to quickly access and understand data in a rapidly evolving situation.

HPH: Public health workers and officials came under attack during Covid. Will this new law help to protect them?

Comerford: By having performance standards and requiring a credentialing process as indicated in the law, the state is raising the level of credibility associated with public health officials. They will now be better trained, better connected, better resourced. I hope that the workforce is much stronger as a result of this legislation.

HPH: MPHA helped to develop this legislation. Did you take any lessons from other states?

Amarasingham: We understand that other states have better systems for data collection. We are not talking about personal, identifiable data, [but, for instance,] how many food inspections have been done at restaurants, when, by whom, so that public health officials can have a full picture of who is responsible. The legislature appropriated nearly $100 million in ARPA [American Rescue Plan Act] funds to go towards building and maintaining a data system to integrate data collection between the local health departments and the state.

HPH: If there is a single public health challenge looming in the future for Massachusetts that this bill will help to mitigate, what is it?

Amarasingham: Almost anything you read about in the headlines has a local public health implication. So, for example, we’ve had these extreme weather events that dump a lot of water in a short period of time and overwhelm the sewer system—so then sewers get contaminated and it can be unsafe to swim on a beach or in a river. It can reach crisis level rapidly and you have to deal with it, and if you don’t have the public health infrastructure in place, then you are trying to build the infrastructure while addressing the crisis, which is what happened during Covid. And in a case like that, the toll on the human beings who work in these understaffed systems can be overwhelming, and they quit.

HPH: Did this bill pass at an especially timely moment?

Amarasingham: We know the health impacts of climate change are going to get worse. The spread of disease will get worse. [Add to that] the uncertainty of what will happen with the incoming administration—it is the right time. These challenges are bigger, they are unfolding more rapidly, and they are ongoing.

Comerford: The Office of Senator Jo Comerford
Amarasingham: Mario Quiroz / Courtesy of MPHA

The post Massachusetts tackles flaws that cost lives during the pandemic appeared first on Harvard Public Health Magazine.

Our national insistence on not thinking about the pandemic could be especially costly as we move toward a new presidential term.  We seem determined to learn little from our losses, even after the deaths of 1.2 million Americans from COVID-19. Journalists, in particular, are doing essentially nothing about this. These observations are not partisan; they would have been valid no matter who prevailed at the polls. They arose from a course I teach about the press to graduate students at Harvard, most in public health.

Yes, we are probably still collectively angry and grieving, but in grief we have become paralyzed, which is dangerous. The press, it seems to me, has been very much a part of this problem, and could be a big part of the solution as we at least turn some of our attention back from politics to policy.

A consensus on inaction

What I see is this: Pretty much everyone who understands the system believes that public health administration in this country needs to be significantly reorganized, both at the federal level, where the Department of Health and Human Services remains a collection of competing fiefs, with White House coordination limited and fading, and between the federal and state and municipal levels, where information flows are haphazard and poorly coordinated, where local disparities have not been adequately considered and where localities remain left to compete when critical resources become scarce.

Yet, after the greatest public health crisis in a century, nothing of genuine importance has been done about these problems. The Biden administration came and went without proposing the necessary reorganization. The administration and a Congress that could agree on precious little did agree that we shouldn’t seriously study what went wrong in 2020, steadfastly refusing to appoint a national commission when we so badly needed one. Neither Republicans in the House nor Democrats in the Senate sought to upset this equilibrium of passivity. Neither of the two presidential nominees talked about the issue; neither seems to have put any significant effort into preparing to work more effectively if elected.

The appalling boom-and-bust cycle of public funding for public health that has followed previous crises with AIDS, anthrax, H1N1 and Ebola has been permitted to recur, even when the cost in human life has been so much greater. (U.S. AIDS deaths have been fewer than 800,000 over 44 years, compared with 1,200,000 for COVID in less than five years.)

At the level of politics, I confess that I simply don’t understand this. Even if Donald Trump was given an apparent pass on his gross mismanagement of the pandemic, with most voters seemingly concluding that it was just colossal bad luck that the disease struck on his watch, does anyone think that the American people would be so forgiving if we confronted another deadly public health crisis anytime soon? I certainly do not. Yet, the politicians seem unconcerned about this potential vulnerability.

And such a crisis is surely possible—with the chances enhanced by the continuing globalization of risks, including in the insufficiently regulated interaction between humans and animals, in the movement of people across borders, in unevenly overseen biological research, and in the opaqueness of many governments, especially China and Russia.

A failure also of the press

What about the press? On public health, “news avoidance” seems to have extended even into newsrooms. The public didn’t want to read about politics or surely about policy debates until Biden’s withdrawal heightened the drama, but the press provided the coverage anyway. At the same time, even with the widespread outbreaks of H5N1 in U.S. cattle herds, and a persistent if muffled drumbeat of possible cases in humans, we couldn’t seem to rouse ourselves.

I can’t recall a single question to either candidate about pandemic preparedness in any forum, and certainly not in a debate or any network interview. The considerable stores of knowledge amassed in newsrooms about such matters in 2020-21 seem to have been happily cast aside, as if they had amounted to learning about the deployment of mounted cavalry rather than the likely terrain of the next war as well.

All of this is potentially greatly complicated by any significant role in public health matters to be played by Bobby Kennedy. But even in its coverage of him, the press needs to up its substantive game. His suggestion of ending fluoridation of municipal water supplies, for instance, may be something about which reasonable people can differ, as has been recognized for years. (I think it would be a mistake.)

On the other hand, if Kennedy, perhaps speaking from a White House podium, were able to dissuade a sufficient number of parents from the routine vaccination of their own children to undo herd immunity, the result in a few years could be millions of cases of measles and thousands of child deaths. (There were 136,000 deaths from measles worldwide in 2022, most in young children we had failed to vaccinate.) These are the sorts of distinctions about which the political reporters covering him need to be informed—and unafraid to report.

The presidential transition has now run through 13 of its 75 days. We need to start doing better, to insist on placing the public health questions we know the American people will again urgently care about one day on the news agenda now—when something might usefully be done. Simply put, that is what journalists do.

Image: magnetcreative / iStock

The post Could the media stop avoiding public health, please? appeared first on Harvard Public Health Magazine.