Issue Category: Public Health Funding

Nuevo análisis El presupuesto de los CDC se reduciría en un 53 % si se adopta el presupuesto propuesto por la Administración para el año fiscal 2026; más de sesenta programas de los CDC quedarían eliminados

Los programas estatales y locales de salud pública y preparación se verán considerablemente afectados

(Washington, DC – 18 de septiembre de 2025) – Los departamentos de salud en estados y localidades de todo el país están enfrentando severas reducciones presupuestarias debido a los recortes federales, recaptura de fondos, despidos y congelamiento de contrataciones, y reorganizaciones, tanto actuales como propuestos. Estas acciones debilitarán considerablemente el sistema sanitario y la preparación y respuesta ante emergencias de la nación y pondrá en peligro la salud y la seguridad económica del país. Estas son las conclusiones de un nuevo informe, Public Health Infrastructure in Crisis: HHS Workforce Cuts, Reorganizations, and Funding Reductions: Impacts and Solutions (“La infraestructura sanitaria en crisis: Recortes de personal del HHS, reorganizaciones y reducciones de financiamiento: impactos y soluciones”) publicado hoy por Trust for America’s Health (TFAH), una organización sin fines de lucro y apartidaria dedicada a la investigación y las políticas en materia de salud pública.

El informe, que incluye un análisis original de TFAH, calcula los impactos de las reducciones presupuestarias y de personal y las reorganizaciones hasta la fecha, así como también los cambios adicionales propuestos, y resalta las siguientes conclusiones:

  • El presupuesto plateado por el Presidente para el año fiscal 2026 para los Centros para el Control y la Prevención de Enfermedades (CDC) asciende al 53 % de reducción en comparación con el año fiscal 2024. Esta cifra refleja los recortes propuestos para los CDC y su hermana, la Agencia para Sustancias Tóxicas y el Registro de Enfermedades (ATSDR). Estas reducciones están pendientes de acción en el Congreso.
  • Además, dentro del recorte total propuesto, el Programa de Preparación ante Emergencias de Salud Pública de los CDC enfrenta una reducción de fondos del 52 %.
  • En total, el presupuesto presentado recorta poco más de la mitad del financiamiento para los CDC y la ATSDR y restaura alrededor de un cuarto de los fondos perdidos hacia dos divisiones del HHS recientemente creadas: la Administración para una América Sana y la Oficina de Estrategias.
  • Más de 100 programas de salud pública y líneas de financiamiento serían eliminadas bajo el presupuesto presentado por el Presidente para el año fiscal 2026, incluidos 61 programas de los CDC y 40 programas de la Administración de Salud Mental y Abuso de Sustancias. Entre los programas en riesgo de eliminación están los de prevención de cáncer, diabetes, enfermedad coronaria y accidente cerebrovascular; los de prevención de la obesidad; los de prevención del VIH/SIDA, tanto nacionales como internacionales; los de inmunización global; y los de recuperación y prevención del uso de opiáceos y otras sustancias.
  • La reorganización propuesta para las agencias del Departamento de Salud y Servicios Humanos de los Estados Unidos (HHS) reduciría en un 16 % la cantidad de personal que trabaja en programas de salud pública, incluso contando la creación de la Administración para una América Sana que se ha propuesto.
  • Este año la rescisión de fondos ya aprobados recapturó 12 000 millones de USD en subvenciones de la época de la covid-19; fondos que además de apoyar la respuesta a la pandemia estaban destinados a reforzar la infraestructura de salud pública más allá de las necesidades creadas por la pandemia, como el monitoreo de enfermedades infecciosas, la capacidad de laboratorio, la preparación ante emergencias y los servicios de salud mental.

El informe se concentra en los cambios en los CDC y otras agencias del HHS debido a su rol central en el apoyo de los programas de salud pública y la respuesta a crisis a nivel estatal y local. Alrededor del 80 % del presupuesto interno de los CDC va hacia estados, localidades, tribus y organizaciones tribales, sistemas de salud y actores comunitarios para apoyar iniciativas de salud pública estatales y locales. Los fondos federales representan cerca de la mitad de los presupuestos de los departamentos de salud estatales y locales, por lo que los recortes en el gasto federal son recortes en los presupuestos de salud pública.

“Los grandes cambios que ocurren en las agencias federales de salud pública afectan a todas las comunidades y tienen impacto sobre la vida de toda la ciudadanía. Los departamentos sanitarios estatales y locales, que están en la primera línea de protección de la salud de sus residentes, dependen del gobierno federal, en particular de los CDC, para obtener financiamiento de la salud pública, experticia y asistencia técnica. Con la pérdida de fondos, personal y programas, nuestro país estará menos preparado para futuras emergencias sanitarias, la salud de la ciudadanía sufrirá y aumentarán los costos de la salud”, dijo J. Nadine Gracia, M.D., MSCE, presidenta y directora ejecutiva de Trust for America’s Health.

El informe incluye entrevistas con dos responsables de oficinas de salud pública —el Dr. Scott Harris, Responsable de la Oficina de Salud Estatal de Alabama, y la Dra. Katherine Wells, Directora de Salud Pública de la ciudad de Lubbock, Texas—, quienes describen los impactos y los desafíos creados en el territorio por las acciones federales, tanto las que están en curso como las que se proponen. Ambas oficinas están luchando con reducciones presupuestarias de por lo menos la mitad de su presupuesto anual como resultado de los recortes federales.

El informe también reconoce que el sistema de salud pública tiene áreas por mejorar. Necesita modernizarse y fortalecerse para satisfacer los desafíos sanitarios tanto actuales como emergentes de la población. El informe hace un llamamiento a la colaboración entre la administración, el Congreso y las oficinas de salud pública para reforzar el sistema con acciones basadas en datos. Algunas de las acciones que recomienda son:

  • El Congreso y la administración deberían restaurar las agencias federales de salud, los fondos y el personal que se recortaron en 2025.
  • La administración y el Congreso deberían mantener y reforzar la estructura y las capacidades de las agencias federales de salud, que tienen roles específicos, complementarios y distintos y cuentan con experticia en la protección de la salud de la nación.
  • El Congreso, en colaboración con agencias federales y especialistas y actores externos, debería llevar adelante un proceso deliberativo bipartidista de revisión de propuestas para la reestructuración de las agencias federales de salud o el desarrollo de nuevas agencias.
  • El Congreso y la administración deberían fortalecer el CDC como una agencia de salud pública integral nacional con responsabilidades en materia de detección, prevención y mitigación de las principales causas de muerte prevenible, enfermedades y lesiones.
  • Las agencias federales deben gastar todos los fondos asignados por el Congreso, conforme a la ley, y la Oficina de Administración y Presupuesto debería liberar hacia las agencias fondos para todo el año luego de la promulgación de la ley de asignación.
  • El Congreso debería garantizar el mejoramiento continuo de las capacidades de salud pública y los servicios esenciales de la nación, como el personal, los laboratorios y los sistemas de datos en todos los niveles.
  • El Congreso debería restaurar el Fondo de Prevención y Salud Pública, un fuente crucial de fondos sostenidos para la prevención de enfermedades y actividades de promoción de la salud en cada estado y territorio, así como también en localidades y comunidades tribales, y prevenir futuros recortes.

El informe completo puede leerse en: https://www.tfah.org/report-details/funding-report-2025

 

New Analysis: CDC’s Budget Would be Reduced by 53 Percent if the Administration’s Proposed FY 2026 Budget is Adopted; Over Sixty CDC Programs Would be Eliminated

State and local public health and preparedness programs will be significantly impacted

(Washington, DC – September 18, 2025) – Health departments in states and localities nationwide are facing severe budget reductions due to current and proposed federal cuts, funding clawbacks, layoffs and hiring freezes, and agency reorganizations. These actions will weaken the nation’s public health system and emergency readiness and response and will put the country’s health and economic security at risk. So concludes a new report, Public Health Infrastructure in Crisis: HHS Workforce Cuts, Reorganizations, and Funding Reductions: Impacts and Solutions released today by Trust for America’s Health (TFAH), a non-partisan, non-profit organization focused on public health research and policy.

The report, which includes original analysis by TFAH, tallies the impacts of budget and staff reductions and proposed agency reorganizations to date as well as additional proposed changes and highlights the following findings:

  • The President’s proposed FY 2026 budget for the Centers for Disease Control and Prevention (CDC) amounts to a 53 percent reduction in funding as compared to FY 2024. This figure reflects proposed cuts to CDC and its sister agency, the Agency for Toxic Substances and Disease Registry (ATSDR). These reductions are pending Congressional action.
  • In addition, within the total proposed cut, CDC’s Public Health Emergency Preparedness program faces a 52 percent funding reduction.
  • Overall, the proposed budget cuts CDC and ATSDR funding by slightly more than half and then restores about one-quarter of the lost funding to two newly proposed HHS divisions: the Administration for a Healthy America and the Office of Strategy.
  • Over 100 public health programs and funding lines would be eliminated under the President’s proposed FY 2026 budget including 61 programs at CDC and 40 programs at the Substance Abuse and Mental Health Services Administration. Programs facing elimination include cancer, diabetes, heart disease, and stroke prevention programs, obesity prevention programs, global and domestic HIV/AIDS prevention programs, global immunization programs, and opioid and other substance use prevention and recovery programs.
  • The proposed reorganization of U.S. Department of Health and Human Services (HHS) agencies would reduce the number of staff positions working on public health programs by 16 percent, even when accounting for the creation of the proposed Administration for a Healthy America.
  • This year’s termination of already-approved funds clawed back over $12 billion in COVID-19 era grants – funding that in addition to supporting the pandemic response was intended to strengthen public health infrastructure beyond the needs created by the pandemic, including infectious disease monitoring, laboratory capacity, emergency preparedness, and mental health services.

The report is focused on changes to CDC and other select HHS agencies due to their central role in supporting public health programs and crisis response at the state and local level. About 80 percent of the CDC’s domestic budget flows to states, localities, tribes and tribal organizations, healthcare systems, and community partners to support state and local public health initiatives. Federal funding accounts for about half of state and local health department budgets so cuts to federal spending are cuts to local public health budgets.

“The consequential changes occurring in federal public health agencies impact every community and the lives of every American. State and local health departments, which are on the frontlines of protecting the health of their residents rely on the federal government, particularly CDC, for public health funding, expertise, and technical assistance. With the loss of funding, workforce, and programs, our country will be less prepared for future health emergencies, Americans’ health will suffer, and healthcare costs will rise,” said J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health.

Included in the report are interviews with two public health officials – Dr. Scott Harris, State Health Officer of Alabama, and Dr. Katherine Wells, Director of Public Health, City of Lubbock, Texas – describing the on the ground impacts and challenges created by the recent and proposed federal actions. Both are grappling with budget reductions of at least half of their annual budget due to federal cuts.

The report also acknowledges that the public health system has room for improvement. It needs to be modernized and strengthened to meet ongoing and emerging population health challenges. The report calls for collaboration between the administration, Congress, and public health leaders to strengthen the system through data driven actions. Some of the policy actions it recommends are:

  • Congress and the administration should restore federal health agencies, funding, and workforces that were cut in 2025.
  • The administration and Congress should maintain and strengthen the structure and capabilities of federal health agencies, which have specific, complementary, and distinct roles and expertise in protecting the nation’s health.
  • Congress, in collaboration with federal agencies and outside experts and partners, should lead a bipartisan, deliberative process of reviewing proposals for federal health agency restructuring or development of new agencies.
  • Congress and the administration should strengthen CDC as a national, comprehensive public health agency with responsibilities across the detection, prevention, and mitigation of the leading causes of preventable death, illness, and injury.
  • Federal agencies must spend all funds appropriated by Congress, as required by law, and the Office of Management and Budget should release full-year funds to agencies after enactment of appropriations legislation.
  • Congress should ensure continuous improvement of the nation’s public health capabilities and essential services, including workforces, laboratories, and data systems at all levels.
  • Congress should restore the Prevention and Public Health Fund, a critical source of sustained funding for disease prevention and health promotion activities in every state and territory, as well as in localities and tribal communities, and prevent future cuts.

Pain in the Nation 2025: The Epidemics of Alcohol, Drug, and Suicide Deaths

Watch Trust for America’s Health’s (TFAH) for a national webinar and congressional briefing on our recently released report, Pain in the Nation 2025: The Epidemics of Alcohol, Drug, and Suicide Deaths.

TFAH’s Pain in the Nation 2025 report found that over 200,000 Americans died from alcohol, drugs, and suicide in 2023. While this marks a decline from 2022, deaths remain more than double what they were two decades ago. The report highlights improvements in alcohol and drug-related mortality, but disparities persist. Only white Americans saw a drop in overdose deaths, and rates of such deaths remained highest in communities of color. Furthermore, while the reported data represents real progress, current and potential federal funding cuts, public health workforce reductions, and proposed federal agency reorganizations could undermine it.

The briefing included time for Q&A from the audience.

Deaths Due to Drug Overdose and Alcohol Are Down Nationally, But Progress is Uneven Across Population Groups and at Risk Due to Cuts in Federal Health Programs

How can progress be sustained and extended to all communities?

(Washington, D.C. – May 28, 2025) – Deaths due to drug overdose and alcohol misuse were down in the United States in 2023 according to Centers for Disease Control and Prevention (CDC) data and newly released CDC 2024 provisional data predict an unprecedented 27 percent one year drop in overdose deaths. These reductions are encouraging and were likely related to a number of factors including investments in primary prevention, mental health, harm reduction, and overdose prevention programs. However, current and proposed federal budget cuts, public health workforce reductions, and proposed federal agency reorganizations are likely to undermine this progress, according to a new report.

Pain in the Nation 2025: The Epidemics of Alcohol, Drug, and Suicide Deaths, released today by Trust for America’s Health, reports that the combined number of deaths from alcohol, drugs, and suicide in the United States declined in 2023 for the second straight year—after two decades in which such deaths increased at an alarming pace.  Still over 200,000 Americans died due to alcohol, drug overdose, or suicide in 2023, twice the rate of such deaths 20 years ago.

The new data highlight the value of investment in mental health and substance use prevention programs – such as ensuring adequate mental health, substance use disorder, and crisis intervention services, access to overdose reversal drugs, and investing in children’s mental health and resilience. The data however also show that much more needs to be done to ensure that the progress against alcohol, drug overdose, and suicide deaths is sustained and that reductions in such deaths are occurring in every community and among all population groups.

“Data show that decades of investment and capacity building in substance use prevention, harm reduction programs, and mental health services have helped reduce associated deaths. The challenge now is to build on these investments and sustain this progress. These programs save lives; their funding should not be cut,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.


Drug overdose rates are declining but still at tragic levels.

In 2023, 105,007 Americans across died from drug overdoses. After precipitous increases in the rate of drug overdose deaths in 2020 and 2021, the 2022 overall overdose mortality rate was virtually unchanged and the 2023 mortality rate was 4 percent lower. Provisional mortality data for 2024 show an unprecedented one-year 27 percent decrease in overdose deaths nationally. Seven states (Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, and Wisconsin) and Washington D.C. saw the greatest reductions, with declines of 35 percent or more in overdose deaths for the year.

According to public health experts, improved data systems which allow for real-time tracking of substance use and its impacts, the expansion and effectiveness of overdose prevention strategies such as programs to ensure access to naloxone, buprenorphine, and drug-checking tools all played a significant role in bringing down mortality rates.

The improvement was, however, not consistent across all population groups or regions of the country. In 2023, white people were the only racial/ethnic population group that experienced a statistically significant decrease in drug overdose deaths; other population groups had nonsignificant changes or increases. Drug overdose death rates in 2023 were highest among American Indian/Alaska Native people (AI/AN) (65.0 deaths per 100,000 people), adults ages 35 to 54 (57.3 deaths per 100,000 people), Black people (48.5 deaths per 100,000 people), and males (45.6 deaths per 100,000 people).

Alcohol-induced deaths are down.

In 2023, 47,938 Americans died from alcohol-induced causes. The overall age-adjusted alcohol-induced mortality rate decreased by 7 percent from 2022 to 2023 (from 13.5 to 12.6 deaths per 100,000 people). This decrease built on a 6 percent reduction the year prior and crossed nearly all demographic and geographic groups, but such deaths still disproportionately impact some groups. Alcohol-induced death rates in 2023 were highest among AI/AN people (61.5 deaths per 100,000 people), adults ages 55 to 74 (32.5 deaths per 100,000 people), adults ages 35 to 54 (20.2 deaths per 100,000 people), and males (18.1 deaths per 100,000 people).

Suicide deaths unchanged.

The U.S. overall suicide mortality rate remained virtually identical from 2022 to 2023 (14.2 and 14.1 deaths per 100,000 people, respectively). In 2023, 49,316 Americans died from suicide. Age-adjusted suicide rates in 2023 were highest among AI/AN people (23.8 deaths per 100,000 people), males (22.7 deaths per 100,000 people), and adults ages 75 and older (20.3 deaths per 100,000 people).

Budget rescissions and future cuts to prevention programs will cost lives.

While these data demonstrate real progress, the public health community is united in its concern about progress reversals due to cutbacks in federal investment in health promotion, crisis intervention, and overdose prevention programs. For example, staff and funding for the CDC Injury Center have been drastically reduced, and the Center is proposed for elimination in the Administration’s budget request for fiscal year (FY) 2026. The Injury Center conducts research and collects data. Approximately 80 percent of its funding goes to states and other entities for prevention of overdoses, suicide, and adverse childhood experiences (ACEs). Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has experienced major staffing reductions including staff working on the 988 Suicide & Crisis Lifeline, and a potential $1.07 billion funding cut for FY 2026. The Administration has proposed folding some remaining SAMHSA and Injury Center programs into a new Administration for a Healthy America.  These actions followed the Administration’s claw-back of billions of dollars in public health funding already at work in states and communities across the country, including for suicide prevention.

The Pain in the Nation report calls for sustained investment in prevention and harm reduction programs and includes recommendations on actions federal and state policymakers should take including:

  • Protect and bolster investment in public health and behavioral health systems and injury and violence prevention programs to improve mental health and well-being for all Americans.
  • Continue to improve programs, like CDC’s Overdose Data to Action, to track emerging trends by geographic, demographic, and drug type metrics to guide local, state, and national responses and to prevent overdoses and deaths in real time.
  • Focus on underlying drivers of substance use disorder through early intervention and prevention policies including expanding resiliency and substance use prevention programs in schools and increasing access to social and mental health services for children and families.
  • Maximize harm reduction strategies and substance use disorder treatments to reduce overdose risk, and support efforts to limit access to lethal means of suicide.
  • Bolster the continuum of crisis intervention programs and expand the mental health and substance use treatment workforce. Build community capacity to ensure access to mental health and substance use treatment for anyone needing such services.

Read the full report

 

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Trust for America’s Health (tfah.org)

 

 

FY 26 Budget Reconciliation Proposal Threatens Americans’ Health and the Nation’s Economic Security

Statement from J. Nadine Gracia, M.D., MSCE, Trust for America’s Health President and CEO

The budget reconciliation legislation being considered in the House of Representatives would have detrimental consequences for the health and economic security of our country. Access to healthcare, nutrition, and clean air are essential to the health of every family and community and are being jeopardized by proposed program cuts.

The proposed budget savings in the bill would result in millions of Americans losing access to healthcare, including through Medicaid. The nonpartisan Congressional Budget Office estimates that the legislation would increase the number of uninsured people by at least 13.7 million by 2034 compared to the status quo — ultimately resulting in a 30 percent increase in the nation’s uninsured rate. This reversal would come after 15 years of progress in increasing coverage rates since the implementation of the Affordable Care Act.

These changes will lead to needless increased health risks for numerous population groups including children, older adults, people with disabilities, pregnant women, and people with behavioral health conditions. Taking away health insurance means fewer people have access to primary care and preventive services, such as cancer and blood pressure screenings. Preventable and manageable health conditions will lead to acute emergencies which will not only increase suffering but will also increase healthcare spending. Furthermore, additional healthcare facilities in rural areas will close due to higher rates of uncompensated care, and cuts to Medicaid will threaten access to pediatric care at children’s hospitals. More people will face medical bankruptcy. The costs of coverage losses are borne by all of us through higher individual payments and increased national spending on healthcare.

The legislation also would enact the largest cut to the Supplemental Nutrition Assistance (SNAP) program in history. Shifting additional benefit costs to states will lead to states either cutting program benefits or substantially limiting eligibility. Not only is SNAP a successful nutrition and food security program, it is also an effective anti-poverty program.

Finally, the bill would loosen pollution standards, eliminate block grants for communities to reduce pollution, and cut pollution monitoring programs while pulling back investments in clean energy. Air pollution is linked to stroke, aggravated asthma, and poor birth outcomes. The health-related spending from pollution and climate change is estimated to cost the U.S. $820 billion per year.

These cuts alone would bring more harm to the health and well-being of our nation, but when paired with the weakening of public health infrastructure due to recent federal budget and workforce reductions, they will lead to increased healthcare spending, higher individual healthcare costs, and worsening health. We urge all Representatives to vote no on this legislation and work in a bipartisan manner to assure the health of the nation.

 

COVID-19, Five Years Later: Will We Heed the Public Health Lessons?

(Washington, DC – April 17, 2025) – March 2025 marked the five-year anniversary of the declaration of COVID-19 as a pandemic. This milestone offers an opportunity to reflect on the heroic work of healthcare providers and the public health workforce in limiting the pandemic’s impact on Americans’ health. Public health professionals across the country worked tirelessly on the frontlines—often facing unprecedented challenges, personal risk, and even harassment—while providing essential services such as contact tracing, coordinating testing, distributing and administering vaccines, and offering life-saving guidance to communities. Their dedication and expertise were vital to the national response and demonstrated the indispensable role of public health infrastructure in protecting American lives during a crisis.

It is also a time to remember the pandemic’s toll in illness, lives lost, and social and economic disruption. Finally, this anniversary presents an opportunity to consider what can be learned from the pandemic and how those lessons can be applied to protect the nation’s health and economic security during future emergencies.

According to the World Health Organization, COVID-19 deaths worldwide have exceeded seven million. In the U.S., at least 1.2 million people have died from COVID-19, according to the Centers for Disease Control and Prevention (CDC).

While the public health emergency has ended, COVID-19 infections are still occurring, albeit at a much lower rate. Staying up to date with vaccination remains one of the most effective tools to prevent severe illness, hospitalization, and death from COVID-19—especially when combined with other preventive measures, as appropriate, based on current community transmission levels and individual risk factors.

We continue to face numerous public health risks that demand action, including a multi-state measles outbreak, a tuberculosis outbreak, bird flu, and environmental threats. All of this is happening as federal budget cuts threaten the capacity of federal, state, and local public health departments to respond to emergencies, while workforce reductions risk the loss of sorely needed public health expertise and experience.

COVID-19 Funding Ended the Emergency and Strengthened Public Health Readiness

The COVID-19 pandemic demanded an unprecedented public health response, including funding to modernize the nation’s public health infrastructure and expand its workforce. New funding for CDC’s Data Modernization Program increased the number of healthcare facilities using electronic case reporting (eCR) to report infectious disease cases to public health agencies—from 153 in January 2020 to over 50,000 in February 2025. eCR enables real-time disease tracking, allowing for a faster response to outbreaks. Additional examples include the Public Health Infrastructure Grant, which provides funding to health departments nationwide to support innovative investments in workforce, systems, and services tailored to meet their communities’ specific health priorities and challenges; the establishment of a new Center for Forecasting and Outbreak Analytics at the CDC to model and predict outbreak trends; and the expansion of CDC’s National Wastewater Surveillance System, now implemented in 46 states and the District of Columbia. These critical new capacities are at risk due to federal budget cuts.

What the Pandemic Taught Us

The lessons of the pandemic are numerous and should be applied to strengthen the public health system. Doing so would help ensure that the nation is better prepared for future risks. These lessons include:

  • Protecting CDC’s mission—including its comprehensive focus on both chronic and infectious diseases—is essential, because healthier communities, particularly those with a lower burden of chronic disease, are more resilient during emergencies and recover more quickly.
  • A modernized and interoperable health data infrastructure is critical for real-time disease tracking. Such systems allow healthcare and public health officials to target resources where they are needed most. The progress made in data modernization since 2020 must be sustained.
  • Public health and healthcare readiness, along with surge capacity, are critical in an emergency. Healthcare workforce shortages during the acute phases of the pandemic placed tremendous strain on the system’s ability to manage the surge of patients. The emergency readiness of the healthcare delivery system must be fortified. State public health laboratories were also vital in identifying cases and tracking disease spread. Most states have laboratory surge plans that helped them expand testing capacity during peaks in pandemic transmission. Telehealth was a critical platform for healthcare access during the pandemic, and reimbursement for telehealth services should be preserved.
  • A strong emergency preparedness system is vital to the nation’s economic security. The COVID-19 emergency led to major economic disruptions and the largest employment loss in the U.S. since World War II. A 2023 study by a team of economists estimated that the pandemic’s impact on the U.S. economy through the end of 2023 was $14 trillion. Going forward, protecting the nation’s economy will require systems and capacities that can prevent a small number of disease cases from escalating into an outbreak—and eventually a pandemic.
  • The pandemic highlighted the nation’s health and economic disparities and their impact on health outcomes during emergencies. While all communities may face health emergencies, the impacts are not felt equally. Communities with higher rates of chronic disease and underlying health conditions often experience worse outcomes—disparities rooted in systemic barriers such as income inequality, housing instability, discrimination, poor air and water quality, and gaps in healthcare access. Advancing health equity by addressing these challenges is essential to building a more resilient and prepared nation.
  • The COVID-19 vaccines saved lives and reduced the severity of illness. The rapid development of the vaccines, along with an expansive system to administer them, played a critical role in the national response. According to a Commonwealth Fund study published in December 2022, COVID-19 vaccines prevented an estimated 18.5 million hospitalizations, 3.2 million deaths, and at least $1 trillion in healthcare spending in the U.S. during the first two years of the vaccination program (December 2020 through November 2022). Continued investment in vaccine development, manufacturing and distribution readiness, and other medical countermeasures is essential. mRNA vaccine technology is well-positioned to quickly produce effective vaccines against future virus variants.
  • The pandemic exacerbated misinformation and disinformation about vaccine safety, particularly on social media. Vaccine education that shares accurate information and builds confidence is essential. These programs should acknowledge that some people—while open to learning more—have questions and want space to make their own decisions. Healthcare and public health officials should seek opportunities to listen and respond to individuals’ questions and concerns.

We Need to Act on the Pandemic’s Lessons

  • Increased, sustained, and flexible public health funding is essential. The pattern of boom-and-bust funding cycles has left the system with serious preparedness gaps. Funding levels must be increased, and flexible funding is critical because it allows state and local health officials to quickly target and deploy resources where they are most needed. Investment in workforce growth and retention is also crucial.
  • Invest in prevention to improve health and reduce healthcare spending. As a nation, we don’t spend enough on public health and prevention. Investments in these areas yield healthier communities and significant long-term savings. Typically, less than five percent of the nation’s nearly $5 trillion in annual health spending is directed to public health and prevention programs.
  • Numerous sectors have a role to play in improving the public’s health. These partnerships should include public health, healthcare, educators, community–based organizations, faith leaders, the business community, and others. Strong relationships established before a crisis are central to an effective emergency response.
  • Public trust in government is critical during health emergencies. The politicization of public health has weakened the system and threatens its ability to respond effectively to future crises. Upholding scientific integrity—empowering public health experts to make recommendations based on the best available information—is essential for effective emergency response. Public health authorities must be preserved, and public health agencies must be effective communicators who can clearly explain the rationale behind their guidance. Timely and transparent communication with the public is essential. Public health officials also understand the importance of maintaining strong, ongoing relationships with community organizations and leaders—not just during emergencies. A diverse public health workforce that reflects the communities it serves is also key to building trust.

Closing Thoughts

The COVID-19 pandemic was a tragic event, worsened in part by an inadequate early response. Failing to learn from the pandemic experience would only compound the tragedy. The task now facing policymakers at all levels is to invest in policies and programs that will fortify our public health system—ensuring it is fully prepared to respond quickly to future emergencies—and to restore trust in the system so it can function effectively when lives are on the line.

TFAH’s annual report series, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, identifies key strengths, areas for improvement, and recommendations to enhance the nation’s emergency preparedness.

To learn more about TFAH’s recommendations for a stronger public health system, read our 2024 report: Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress.