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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
00;01;03;20 - 00;01;30;10
Chris Fleming
Hello and welcome to Health Affairs This Week, the podcast where editors of Health Affairs and guests talk about the health policy news of the week. I'm Christopher Fleming. We're recording this on Thursday, May 11th, the expiration day for the U.S. Public Health Emergency Declaration associated with the COVID-19 pandemic. To talk about what this means, what happens now, and how we might move forward, we're excited to be joined by Larry Gostin.
00;01;31;00 - 00;01;58;10
Chris Fleming
Larry is the O'Neill professor of global health law and the director of the World Health Organization Collaborating Center on National and Global Health Law at Georgetown University in Washington, D.C.. Larry is also a professor of medicine at Georgetown and a professor of public health at the Johns Hopkins University. And this morning in Health Affairs Forefront, Larry published an article with Abby Gluck titled, “Why the End of the Public Health Emergency Really Matters”.
00;01;58;25 - 00;02;06;28
Chris Fleming
We'll discuss some of the thoughts in that article. But we'd also encourage listeners to click on the link in the show notes and read the whole article. Larry, welcome.
00;02;07;10 - 00;02;09;04
Larry Gostin
Thanks, Chris. It's great to be with you.
00;02;09;13 - 00;02;27;29
Chris Fleming
Well, great, we're very glad to have you. Well, let's start with the basics. Can you remind our listeners what we mean when we talk about the emergency declaration or I guess really declarations, plural? How this works legally? What were some of the things that were allowed under the declaration that wouldn't have been allowed otherwise?
00;02;28;11 - 00;03;07;29
Larry Gostin
Yeah, it's important to realize that today President Biden has concluded the public health emergency declaration, and we'll talk a lot about what that means. But essentially it means that a lot of the health and social safety net that we've come to accustom during the COVID-19 pandemic is going to either end now or will end gradually, including, you know, cost free tests and ultimately cost free treatments
00;03;07;29 - 00;03;47;02
Larry Gostin
and vaccines, which will come later. But there are also other emergency acts which continue in place. So two of them would be the Federal Food Drug and Cosmetic Act, which enables the Food and Drug Administration to issue an emergency use authorization. We've come to know that term because it's for treatments and vaccines for COVID and also on the Public Readiness and Emergency Preparedness Act, so called the PREP Act, which gives a liability protection to health care workers and others in an emergency.
00;03;47;03 - 00;04;00;18
Larry Gostin
Those will stay, but the public health emergency ends today. And of course, just about a week ago, the World Health Organization declared the end of the public health emergency of international concern globally.
00;04;01;13 - 00;04;30;22
Chris Fleming
So it sounds like I mean, today obviously is, as you say, is an important date and there are important legal consequences and health policy consequences tied to it. But there's sort of a staggering of, you know, some things have started to unwind already, the states with the Medicaid unwinding. There are some flexibilities in telehealth, etc., that have been extended sort of, you know, at least for the foreseeable future, will remain.
00;04;31;08 - 00;04;34;07
Chris Fleming
Is that sort of a good description of what's going on?
00;04;34;17 - 00;05;12;14
Larry Gostin
It is a very good description, Chris. I mean, essentially the ending of the public health emergency will mean that as of today, a few things will be gone. Like not necessarily being able to access cost free tests, the way we've come to think about that. But the way I like to think of it is, is that America is not a very safe place to live in terms of our health and social safety net compared to other peer countries that provide a much more generous health and social safety net.
00;05;13;06 - 00;05;59;13
Larry Gostin
But that safety net really swelled during the emergency. The COVID emergency was a galvanizing effect. It helped people get health care. 20 million more on the rolls. It prevented people from being evicted from their homes. It had food assistance. It provided flexibility for hospitals. And while all of that isn't going away on the dime today, make no mistake about it, we're seeing the gradual but absolutely certain unraveling of the health and social safety net that COVID era brought to Americans,
00;05;59;13 - 00;06;05;19
Larry Gostin
and we've come to believe in and rely on, particularly for the most vulnerable among us.
00;06;05;26 - 00;06;44;18
Chris Fleming
Well, and I wanted to pick up on that because I was really struck by the way you talked in your article. You and Abby mentioned, as you said, the galvanizing nature of an emergency. But, you know, you also pointed out and you just sort of alluded to that here, that the explicit emergency may be gone, but certainly the urgency remains from, you know, the day to day issues that you mentioned, that plague our health care system in terms of the way we don't meet the needs of the most vulnerable to the preparedness for the next pandemic, which unfortunately will assuredly come at some point.
00;06;45;07 - 00;07;07;14
Chris Fleming
You talk about sort of the way that, you know, we get excited briefly about public health and then, you know, now we're already seeing the sort of familiar signs of neglect. So, you know, what are your sense? What's your sense? Are we just sort of doomed to repeat this cycle? Is there any, do you have any hope that we might be able to retain this sort of galvanizing spirit that we experienced during COVID?
00;07;08;02 - 00;07;43;23
Larry Gostin
You know, I'm afraid not. I mean, I had a recent book called Global Health Security and the whole thesis of that book was how we lurch from panic to complacency and back to panic and back to complacency. We are absolutely in a position of complacency now. You know, a lot of people see COVID in the rearview mirror, but it's important to emphasize that COVID is still taking, you know, over a thousand lives in America a week, much more than influenza.
00;07;44;21 - 00;08;19;21
Larry Gostin
And not only that, but we face future crises that are all but certain to occur. And we've seen this time and time again, from SARS to MRSA to Ebola, you know, through the Zika and novel influenzas. And right now we're seeing avian influenzas and things like that. So we're not prepared. You know, and in many ways, we're less prepared than we were before the pandemic.
00;08;19;21 - 00;08;52;21
Larry Gostin
And the reason is, is twofold. One, the public has literally lost trust in public health and science, and they're just not complying with public health orders. That's not going to, we're not going to fare well if we have such huge amounts of distrust in CDC and other public health agencies. And then the second reason is, is that state and local governments have been curtailing, rapidly curtailing public health powers and particularly emergency powers.
00;08;53;12 - 00;09;27;09
Larry Gostin
So we've got less than we did before. And then finally, there's litigation over a thousand cases challenging things like vaccine mandates, masks or trying to require hospitals to give bogus treatments like ivermectin. So we're really not in a good place now when the next epidemic or pandemic hits, but it's very likely that it will affect us and we need to do much more.
00;09;27;22 - 00;09;56;11
Chris Fleming
You mentioned earlier on the W.H.O. direct declaration of emergency. And as I said, you've been very involved on the global side. I want to get to that in a second. But I do want to just before that touch very briefly on one of the sort of I know one of the things that you and Abby noted in your article, which I thought was very interesting, which was sort of thinking about how different things would have been if COVID had hit before the ACA was enacted rather than after.
00;09;56;19 - 00;10;09;03
Chris Fleming
You know, we think about sort of the ACA is sort of a covered, day to day coverage expansion, but it really did have pretty marked effects on how we dealt with the pandemic. Could you talk a little bit about that?
00;10;09;13 - 00;10;56;04
Larry Gostin
Yeah, you know, I'm glad you asked me that question because, you know, the ACA was the unsung hero of the pandemic in so many ways. It allowed for cost free prevention services like COVID vaccines. It was flexible enough to swell by over 20 million people on Medicaid and ACA subsidies. It really came to the rescue. You'll remember, just like COVID vaccines are controversial now, the ACA was hugely controversial.
00;10;56;04 - 00;11;44;14
Larry Gostin
Congress tried to repeal it countless times, and it wasn't very popular at the beginning. But boy, did it play this superhero role in COVID-19. I also wanted to mention one other thing that we haven't touched upon yet, which is surveillance and data. It goes to your question, Chris, about the issue of being prepared for the next one and also being prepared for the ongoing number of deaths and possible variants that are going to surprise us with COVID-19, the vulnerable are still very much in the grip of this pandemic.
00;11;45;21 - 00;12;23;03
Larry Gostin
CDC got emergency level authorities to be able to gain data, for example, requiring laboratories to report COVID data. And even during the height of the pandemic, much of the knowledge we had about, say, emerging variants or genomic sequencing data or whether vaccines or treatments work, the CDC didn't know the answers to those. We got them from the UK, Israel, South Africa.
00;12;23;25 - 00;12;47;14
Larry Gostin
And that was a time when data was freely available to the CDC. Now, the CDC is scrambling to try to be able to maintain its surveillance. So also surveillance and data systems are very important for future preparedness, not just for COVID, but for other pandemic risks.
00;12;48;07 - 00;13;09;16
Chris Fleming
Well, thanks, Larry. And as I mentioned, in addition to what's been going on in the U.S., of course, there's been a lot happening internationally in an attempt to put the global health community on a better foot, although it sounds a little bit pessimistic based on what you just said, but trying to put us on a better footing for the next pandemic than we were for this one.
00;13;10;02 - 00;13;26;24
Chris Fleming
You were the lead author on a recent piece for us just a couple of days ago that talked about the pandemic treaty that's being negotiated under the auspices of the W.H.O. and in particular, the attempt to achieve greater equity than we saw during COVID. Can you talk about that a little bit before we end?
00;13;27;12 - 00;14;13;28
Larry Gostin
I can, yes. Yes, I've been very active in Geneva helping to draft the pandemic treaty and also reform of the international health regulations. From what the world has suffered through this pandemic is unfathomable. It's not just health, it's social isolation and mental health. It's huge educational deficits. It's economic catastrophe. And in many parts of the world during the pandemic and throughout, there was one prevailing narrative, both in the United States and globally, which was the deep inequities.
00;14;13;28 - 00;15;00;19
Larry Gostin
We saw that with vaccine distribution, which was very inequitable around the world. And so the World Health Assembly has charged the W.H.O. and governments with negotiating two major reforms. One is the pandemic treaty, and another is a reform of the international health regulations. We’re at a pivotal moment, after all the suffering we can either go back to complacency or do what we all know we need to do, which is really fortify our ability to prevent, protect and respond to global health risks and emergencies, and do so in an equitable and fair way.
00;15;01;02 - 00;15;10;09
Larry Gostin
So what I call global health with justice. Shame on us if we don't prepare now and do better next time.
00;15;11;26 - 00;15;23;29
Chris Fleming
Well, you know, there's always a lot more to talk about and certainly on this subject, even more so. But we're reaching the end of our time, so we'll have to leave it there for now. Larry, thank you so much for joining us.
00;15;24;10 - 00;15;27;07
Larry Gostin
Thank you very much for having me, Chris. It's a real privilege.
00;15;28;01 - 00;15;34;24
Chris Fleming
And thanks as well to our listeners for joining us. Be sure to subscribe wherever you get your podcasts and we'll see you next week.