Almost 15 years ago, at a ceremony in the campus auditorium of the Centers for Disease Control and Prevention in Atlanta, I was promoted to Rear Admiral in the Commissioned Corps of the United States Public Health Service- United. My father, a WWII and Korean War veteran, placed my new gold epaulettes on the shoulders of my blue uniform while my mother, a cultural anthropologist, observed the ritual from the audience. I said to those gathered, “Public service is a privilege. For me it was also a joy. After 33 years, I am retiring from the agency, and this is the same message I would like to convey to the American public.
My father, like many of his generation, enlisted in the US Navy after the attack on Pearl Harbor. Another call to national service, for another generation, followed President John F. Kennedy’s inaugural address. My journey to public service was more private and less intentional than these. I had originally planned to apply my medical training to clinical practice. But the CDC’s disease sleuth program – the epidemic intelligence service – got me hooked on public health.
Public service is difficult. The past year and a half has left many of our ranks exhausted, threatened, saddened and sometimes sidelined. The Covid-19 pandemic is not the first time that the American public health system has had to leap well beyond its capacities, but with the worst pandemic in a century and, initially, a strongly partisan political context , the virus collided with a system suffering from decades of underinvestment. A recent report from the National Academy of Medicine found that state and local public health departments have lost about 66,000 jobs since about 2008.
With past responses – including the hantavirus and bioterrorist anthrax outbreak, the H1N1 pandemic influenza, and the Ebola and Zika outbreaks – the public health frontline has been the little engine that could. For each of these responses, state and local public health departments absorbed the initial shock until emergency funding arrived – then repeatedly saw resources dwindle as the crisis subsided. In recent decades, public health has seen a gradual weakening of our core capabilities as biomedical research and development accelerates in the future. With the Covid-19, we were the little engine that couldn’t.
Infections, hospitalizations and deaths are on the decline in the United States, thanks to extraordinary vaccination efforts. These recent improvements might make it all too easy to forget everything we’ve been through collectively. But I hope it has become clear to the nation and its decision makers that when we don’t invest in public health, everyone is vulnerable.
The country’s public health system needs major upgrades. We need to modernize our data systems, improve our laboratory capabilities for the detection and genomic sequencing of infectious threats like viruses, and better integrate public health information and response efforts with clinical, commercial and academic sectors. America needs a renewed and expanded public health workforce that reflects the advanced skills as well as the diversity of the communities we serve.
The CDC and public health departments now receive essential financial resources in the event of an emergency. But these investments and improvements must be supported. Long-term commitments to resources and innovation are essential. The Covid-19 pandemic will not be the last major threat our nation faces.
The public service is deeply meaningful. During my early years at the CDC, I conducted surveillance and epidemiological studies on an infection, group B streptococcus, which harms newborns. It is transmitted to infants by women during childbirth. Although research during the 1980s identified the benefit of providing antibiotics to high-risk women during labor, the practice has not been established. I led the efforts of the CDC, leading to the 1995 meeting where we brought together obstetric and pediatric organizations as well as parents who had lost babies to the infection. In 1996, the CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics released the first consensus guidelines that made prevention of group B strep a standard of care for the nation.
As a result of this new standard of practice and updated guidelines requiring prenatal screening for group B streptococcus in all women during pregnancy, more than 100,000 of these life-threatening infections have been prevented. A generation of babies has been born since then, and public health efforts (not a new biomedical discovery) have protected most of them from this disease. I was fortunate at the start of my career to meet several parents whose personal losses reminded me of why our work is important and how urgent our progress is.
The public service is also happy. Ask people who have administered the Covid-19 vaccines how they feel when one recipient after another feels the relief of receiving a vaccination that offers high level protection and the promise of their life back. Teams carrying out data analysis and field surveys and launching communications campaigns or laboratory studies have experienced the joy of knowing that their collective efforts can achieve something that none of them could do alone.
I have experienced this kind of joy time and time again – where my limited skills were complemented by team members with the full breadth of disciplines that public health demands – and where we have finally made so much progress. I felt this joy when, together with the Sierra Leone College of Medical and Paramedical Sciences, our team successfully conducted a clinical trial in Sierra Leone called STRIVE to introduce a vaccine to protect against Ebola during the devastating outbreak. which started in 2014.
Public health successes usually take place out of the spotlight and under the radar, which is fine for most of us in this area; victory often means preventing something bad from happening. If no one knows, it’s often a sign of success. I was not a student athlete, although we have CDC superstars who were. Being part of the public health team has been the most cherished part of my 33 years at the CDC. We didn’t always win, but we always showed up. We celebrated each other’s efforts and remained humble in the face of threats to public health, with some opponents, such as SARS-CoV-2, proving more devastating than others.
The Covid-19 pandemic has been as big a disruptor as a world war, and its effect on life expectancy exceeds any threat we have faced since the last “great” pandemic of 1918. Nonetheless, I hopes this is also a time when a new generation is called to action, to experience the difficulty, meaning and joy of public service. Our world needs you.
Anne Schuchat led immunization and respiratory efforts at the Centers for Disease Control and Prevention for a decade before becoming its primary career employee in 2015. She was a key voice for the agency during the 2009 H1N1 pandemic and took on his retirement from the US Public Health Service Commissioned Corps. as rear admiral after 30 years of service.
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