The Evolving Pandemic – A National Perspective on the Effectiveness of Our Public Health Response

Joining me today is Dr. Marcus Plescia, Chief Medical Officer at the Association of State and Territorial Health Officials.  Dr. Plescia provides medical leadership and expertise across the agency and helps coordinate ASTHO’s work with the Centers for Disease Control and Prevention and each of its other affiliated partners. 

Transcript

This is Public Health Speaks.  I’m Robert Jennings   

As our nation continues its slow recovery from the COVID-19 pandemic, public health professionals are now assessing the effectiveness of our public health interventions and what can be improved to address current and future health threats.      

Public Health Speaks is a podcast series brought to you by the National Public Health Information Coalition.  With each episode, we explore the successes and challenges in public health communications and ways to tackle the most pressing issues facing federal, state, and local jurisdictions.     

Joining me today is Dr. Marcus Plescia, Chief Medical Officer at the Association of State and Territorial Health Officials.  Dr. Plescia provides medical leadership and expertise across the agency and helps coordinate ASTHO’s work with the Centers for Disease Control and Prevention and each of its other affiliated partners. 

Robert Jennings: Welcome Dr. Plescia. It's great to have you here today. Can you tell us a little bit about ASTHO, who it represents and its mission? 

Marcus Plescia:  Sure. ASTHO is a membership organization. We represent the leadership of state public health through state and territorial public health departments. And those are the state health officials, but also their deputies and members of the executive team.  We represent them with professional support. We also do a lot of technical assistance for states through grants from the CDC, and then we have government affairs piece of ASTHO that represents and lobbies for them in the federal government. 

Robert Jennings: Well, thank you for laying a foundation for us and Dr.Plescia. It has been a long journey in our nation's public health response to COVID-19 and the public seems to be tiring of COVID 19 public health interventions as the variant rages. What advice would you give to those who say enough is enough? Let's just move on. 

Marcus Plescia: Well, you know, we, we just moving on would come at a significant cost to become a significant human toll. And you know when people really think about it, nobody wants that. So. Yes, we're tired of this. It's been a travail. It's been a very difficult time but you know, it's a times like these when societies and individuals share their strength and we really are at a place now where that's what it's going to take.  And then we have the strength as a society to see our way through this. The end is instilled is that there is light at the end of the tunnel. I would say, I mean, this is going to be with us for a while, but things are getting better and, you know, we're in a much better position.

And so that should give people some hope but we've got to stick with it a little bit longer or the, you know, we're really going to see some, you know, sort of dire consequence. 

Robert Jennings: So on that thought, uh, public health has been careful not to conflate COVID-19 with the seasonal flu. Yet as we inch closer to an endemic phase of the virus, should the public prepare for annual vaccinations for the emerging variants of COVID-19 much like the flu.

Marcus Plescia: It's a little hard to say exactly what the vaccination schedule is going to look like in the future. But yes, we, we anticipate that COVID will be circulating in our world for some time now. And everybody's seen how, once you think you've got the upper hand, you have a variant and it deludes a lot of the things we have in place.

So, and, but we can, you know, we know how to do that. We know how to do that with influenza. And so yes. Probably is going to be a scenario where we have to have another vaccine on a regular basis, just like we do with influenza. Those will probably be reformulated vaccines that are a little different. So they match up with whatever is circulating a little bit better, but that's the part where it's difficult to say, right?

Despite all of the concern about Omicron and vaccine effectiveness right now, the vaccine does still appear to be working very well, even against Omicron to prevent people from having severe illness. 

Robert Jennings: Well, on top of all of that misinformation and disinformation has become a significant public health threat.

What strategies have you noticed that have at least been somewhat effective in neutralizing some of this harmful information? 

Marcus Plescia: I think that when it comes up, you need to w we've we try to find ways to very succinctly and effectively communicate that it's just not true. And give a brief reason why. I think if you get drawn into a longer argument, you're almost playing into, uh, what, what those groups are trying to accomplish.

Um, I also think that. You know, w w w I'm not suggesting we could ignore it, but one has to keep putting all of this kind of behavior into context. I mean, you know, this is really a very small proportion of the population still, and it's bigger than it than we might think, but it's still by far a minority of the population that  is Spreading these, this disinformation, and even the people who are following the disinformation, I mean, that's also a named minority of the population. So keep in mind, you know, 70% of our society is doing what we asked them to do and they understand 

Robert Jennings:  When public health guidance changes as it has throughout this pandemic, it tends to give fuel to our skeptics. Why might it be important for public health to change previously issued guidance?

Marcus Plescia: Well, we have to, we have to respond to the science and the science changes. And I think it's not challenges. Not that we do that. The challenge is we probably need to get better. Explaining and articulating that. That's what we're doing. Uh, you know, I think the worst thing that happens is when people at a pride or arrogance, you know, stick to their, to their view and refuse to budge, even when there's a lot of heaviness and knowledge that begins to suggest that was wrong.

You've got to be, if you're a good scientist, you've got to be able to step forward and say, we were wrong about that. You know, here's why we were misled, but you know, here's why we've realized it was, it was not the correct action, right.  What we're going to do. And I said, just every time you do that, you say this isn't going to be the last time that we're going to have to change things, because, you know, in some ways this approach of ever being on the change and ever making refinements is probably the best way to come at a problem.

Robert Jennings: Well, you've touched on your experience, uh, in the past, and it appears this pandemic has forged a closer Alliance between clinical medicine and public health. And what ways have you seen this change?

Marcus Plescia: Well, I think there's a lot more, well, first of all, I, you know, there is a sense of comradery. I mean, we are doing very different things. I think that those of us work in predominantly in public health really respect the people doing clinical medicine, particularly those in more intensive hospital-based settings where they're really, you know, sort of on the front line of dealing people who are very, very.

And encountering a lot of human suffering. So we certainly respect that role, but I think there's a similar respect that this is a situation that the way out is not to just treat your patient until they get better, because you're going to the patients just keep coming. This is something where we need to kind of go upstream, as we like to say and try to solve the problem, you know, at its Genesis and prevent it from continuing to happen.

And I think that. The clinical medicine has really come to appreciate that more and more. Um, and the result of that is, you know, we've certainly seen a lot more participation in things that we need them to do. You know, some of the problems we've had with not having very good data. Um, you know, one of the things I focus most on is this real lack of.

Race and ethnicity data when we're trying to make sure everybody gets treated the same way. It's hard to do that when you don't know the race and ethnicity of various people that you're treating. Uh, I, I think the clinic community has really began to rally and understand why we need that and making it a little bit more of an effort to report that data and report it well.

So some of the, those are some of the kinds of things that are occurring there. We've also seen clinical leaders step up into public health positions, and that's very helpful people who have that clinical experience. You know, have a great deal of ability to, um, they, they captured the public's attention.

They have a lot of credibility. 

Robert Jennings: Let's hope that, uh, this new found Alliance just continues to, to grow even beyond this pandemic. And so I'm going to ask one final question. What should public health be prepared to address from a population health standpoint? Once COVID 19 is no longer a significant threat.

And are there some vulnerabilities we need to be on the lookout for? 

Marcus Plescia: Well, there are lots of things that we have to shift our attention back to that we just weren't able to. Deal with an in the, in the kind of depth that anybody wanted. I mean, we had significant problems going on with addiction first with opioids.

Now with a wide range of substances, we have major chronic disease issues. That's, you know, continue to be probably the biggest killers in our nation. But the thing that really has been brought into the public spotlight is health equity and health disparities. Uh, I mean the, the, the. The difference in how COVID has affected and brought suffering and brought death to populations who are of different racial and ethnic groups to people who are lower income.

I mean, I think that has caught a wide range of the public's attention. I think it's gotten the attention of policymakers. So. We have this, uh, it's an opportunity. I mean, sometimes you can find opportunity and really bad things. And there is an opportunity now to really address that. And I think that, you know, some of it is our data systems and really being able to track how different groups of people are fairing so that we can react to that.

But we also need to figure out what is, you know, how are the interventions. Programs or policies or activities that we put into place. How do those impact different groups? It's just because something works for the mainstream white population doesn't mean it's going to be effective for everybody else.

And I think there's a lot. Understanding of that and a lot more commitment to go forward and really try to understand some of those nuances so that, um, you know, so, so that everybody can fare a little bit better the next time something like this happens. And then all of this is, is deeply seated in socioeconomic situations and people who are poor and have lower socioeconomic status.

I mean, they don't do as well in any kind of, uh, difficult. Conflict or situation. Um, but they've done. We've done. I mean, we've done particularly badly with this. I mean, we expect they won't do as well, but it shouldn't be this kind of really significant disparity between people who have resources and people don't, who don't have resources.

And those are, these are societal issues that public health is very interested in and is tries to be articulate about because of the implications. On health, but these are societal issues are going to have to be solved at the societal level. Um, and so it's public health is going to be advocating for this, but it's going to go beyond public health.

Robert Jennings: Well, let’s hope that progress continues to be made on that front, Dr. Plescia.  And thank you so much for joining us today. 

Marcus Plescia: Thanks for having me. 

Robert Jennings: Thanks for listening to public health speaks. Please join us next time as we continue to address timely issues relevant to public health communication professionals around the country.

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