Two years ago, when a mysterious respiratory illness appeared in China, the danger to American shores seemed remote. Much of the world was preoccupied with holiday plans and resolutions of good intentions for 2020.
Now, as COVID-19 enters its third year of upending life around the globe, with deaths in the United States hitting the 800,000 mark Tuesday, the country is still not applying hard-earned lessons from the pandemic as it continues to fight what seems like a never-ending battle.
Amid an onslaught of misinformation and political sparring over vaccines, roughly 40 percent of the population is not fully vaccinated, leaving millions vulnerable to serious illness and death. (Massachusetts, however, stands as one of the most vaccinated states in the country.)
Access to rapid COVID tests is scarce in many places. Vaccine mandates are contentious and all three of President Biden’s attempts — targeting federal contractors, health care workers, and employers with more than 100 workers — remain mired in legal challenges. Meanwhile, a centralized system for verifying vaccinations is elusive and many are relying on dog-eared paper vaccination cards.
But the country has made significant strides on other fronts: It can more quickly detect and monitor dangerous shifts in COVID and future viral invaders, and it has pledged roughly $1 billion to shore up a patchwork public health system, which was vital in educating those infected and tracing their contacts.
A new report, the Global Health Security Index, concludes that while the United States and many countries were able to rapidly develop capacities to address COVID-19, all nations remain dangerously unprepared for future epidemic and pandemic threats.
“We are really worried about political leaders deciding whether they want to maintain these [advances], because without that, these things could easily evaporate,” said Jennifer Nuzzo, a senior scholar at Johns Hopkins Center for Health Security at the Bloomberg School of Public Health in Baltimore.
Nuzzo is coleader of the health index, which measures each country’s capacity for emergency preparedness. While the United States ranked first overall, as it did in 2019 when the index was first released, its overall score was the equivalent of a C. And, adding to Nuzzo’s frustration: The United States scored near the bottom on key metrics, particularly access to health care.
“We started this pandemic with more tools than most,” Nuzzo said. “But what is deeply disturbing is we actively chose not to use many of them.” Included in that list is the country’s clear ability yet continued failure to create a comprehensive testing strategy, she said.
Biden recently unveiled a plan he hopes will make at-home rapid COVID-19 tests more widely available by requiring private insurers to reimburse patients for their cost. That provoked a cascade of criticism from many public health experts who said the process would be cumbersome, especially in low-income communities that could least afford the upfront costs.
“We have not taken seriously that this [lack of tests] is a public health crisis,” said Dr. Jonathan Levy, chairman of the department of environmental health at Boston University School of Public Health. “Many countries have appreciated that it is part of the public health armamentarium, and it should be free or cheap and available everywhere you turn.”
Governor Charlie Baker announced Monday that Massachusetts will distribute 2.1 million free at-home COVID-19 tests this week to 102 communities with the highest percentage of families living below the poverty level. The administration also is negotiating with manufacturers to buy more tests in bulk so that other municipalities can obtain them at discounted prices, using federal pandemic relief money.
Over the past two years, the ability of government leaders in the United States to “react in a coordinated, functional, non-corrupt, and humane manner” to a major health crisis declined, the Global Health Security Index report found, ranking the country 69th among 194 other nations.
The report’s authors considered several factors, including the public’s perception of corruption in the government, as well as vested interests and cronyism, and the accountability of public officials.
“If you have low public confidence in government, the best plan in the world probably won’t overcome that,” Nuzzo said.
In access to health care, the United States is ranked 183rd in the world, close to dead last in the index. That measure takes into account the United States’ balkanized system of health coverage that leaves many citizens unable to afford to see a doctor for preventive care or when they’re ill.
“The inability to guarantee free access to health care has been crippling in our [COVID] response,” Nuzzo said.
That system also undermines the ability to track COVID trends across the country. That’s why, for information on such crucial questions as the effectiveness of vaccines and boosters, the United States has had to rely on Israel and the United Kingdom, countries with much more robust health care systems that can swiftly mine data and trends, Nuzzo said.
And yet COVID keeps crashing down on the United States in waves. Every time it appears to be waning, a new, more transmissible variant roars to life. So that now, as the Omicron variant bears down, federal health officials are once again having to urge people to get vaccinated and receive a booster shot.
“When [vaccines] were first rolling out . . . it seemed like everybody was running to get a vaccine as fast as they could,” said Jordan Barab, a former top official at the Occupational Safety and Health Administration. “There was a general assumption that [boosters] would be much more welcomed than they have been.”
The lack of a single rule or public health protocol for all 50 states has resulted in a patchwork of responses to fill the void.
So, with Biden’s vaccine mandates mired in challenges, for example, a growing number of businesses and schools have enacted their own. For instance, Framingham-based TJX Companies, the parent company of Marshalls and TJMaxx, is now requiring its office workers to get booster doses. And several large schools, including Bentley University, Boston College, Emerson College, and the University of Massachusetts Amherst, will require a booster shot for the spring semester.
Even within a single community, such as Boston, some businesses require proof of vaccination to enter, while others do not.
And with no universal method for verifying vaccination status, as there are in other countries, a hodgepodge of approaches have popped up.
Perhaps the closest to a more comprehensive system in this country is the SMART Health Card, which provides vaccination verification via a QR code that can be displayed on a smartphone or printed out on paper. The technology was developed about a year ago by a group of technology and health care companies that formed the Vaccination Credential Initiative.
JP Pollak, cofounder of The Commons Project, a nonprofit involved in the VCI vaccination initiative, said when the Centers for Disease Control and Prevention opted to forgo a standard digital health pass and instead distribute paper vaccination cards, the consortium approached individual states.
“The paper CDC card, you can buy the cardstock on Amazon,” Pollak said.
So far, 10 states have signed on, including New York and California, and Pollak expects another 20 to come in the next couple of months.
All states maintain their own immunization registry, which compiles records of residents’ vaccination history from early childhood shots to the COVID-19 vaccines. These registries could help people verify their vaccination status on their SMART Health Card.
Baker said last week that Massachusetts will soon roll out a QR code-based COVID-19 vaccine certificate, but has declined to say whether it is part of the SMART card system. Baker said he doesn’t plan to implement the technology as a “vaccine passport,” which people would need to show before entering work, stores, or events.
Amid still-gaping holes in the state’s and country’s response to COVID, there has been progress.
The pandemic exposed a dire need to rebuild the nation’s fractured public health system and $1 billion of federal money is earmarked to do that. In Massachusetts, $200 million of it is expected to be used over the next five years to update the state’s antiquated online system for tracking COVID cases and other public health data, as well as improved training and technical assistance, especially to struggling local health departments in underserved communities that experienced some of the highest COVID infection rates.
The upgrades will allow health departments to more quickly identify outbreaks of infectious diseases and provide critical staffing, such as a public health nurse, for the many departments that don’t have one.
“We have been screaming about the need to do this for so long and saying people will die if we don’t do something about this, and people died because we didn’t do something,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association. “So this is a moral imperative that we act, and certainly this funding is a big step in that direction.”
But infectious disease specialists and public health leaders say the country is not heeding clear-cut information and acting with urgency as it grapples with yet another COVID surge, rising hospitalizations, a lack of rapid tests, and too few vaccinated.
“We are often playing a game of wait and see, when the precautionary principle should dominate,” said Yonatan Grad, assistant professor of immunology and infectious diseases at Harvard’s T.H. Chan School of Public Health. “Being prepared early and starting to take early action seems to be one of the important lessons we should have learned from all of the previous waves, but it seems like we’re not.”
Felice J. Freyer of the Globe staff contributed to this report.