As a child growing up in the 1950s, some of my deepest and most painful memories were about the ravages of polio. Thousands of children my age or younger were paralyzed by this scourge and lived their lives in steel tube respirators called iron lungs. Many had nerve damage and wore leg braces and had to use crutches.
Imagine the celebration when we were able to line up a get a vaccine. It was even on a sugar cube. Polio cases diminished rapidly worldwide.
As a medical student, we received little exposure to the science of public health, beyond some epidemiology courses that bored us to death with statistics. As a practicing family doctor, I’ve come to realize the power of public health on our society. Prevention at a community level is usually more powerful than treatment at an individual level.
Yet public health is an “invisible discipline,” according to Dr. Lainie Rutkow of Johns Hopkins School of Public Health. We don’t notice it until a crisis like COVID shows fault lines in the system.
Public health measures we take for granted include sanitation, safe food and water supplies, widespread immunization programs, quit smoking campaigns and containment of epidemics like AIDS, SARs, malaria, cholera, yellow fever, tuberculosis and more. These measures have lengthened quality and quantity of life throughout the world.
Smallpox, now officially declared eradicated by the World Health Organization, almost made a brief and threatening comeback in New York City in 1947. Because of the courage of Dr. Israel Weinstein, the city’s health commissioner, over 6 million New Yorkers were reinoculated against this dread, disfiguring disease in under two months.
Smallpox has a mortality rate of 30 percent, much higher than COVID, and it is easily transmissible by a cough, sneeze or touch. The coherence of public health messaging and public awareness of the importance of inoculation supported a rapid response blunting what might have been an outbreak worse than COVID.
Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, offers how we prepare the world for the inevitable next pandemic:
“Public health systems worldwide need much better tracking systems to sound an early alarm, as well as laboratory networks to find new diseases, detectives to investigate them, rapid-response teams to tackle them, and legal, communication and financial frameworks to make all that possible. We will also need better primary care worldwide to deliver vaccines and manage chronic conditions. ... Every dollar spent on global health security could save $100 or more in the costs of future pandemics. Like earthquakes, we know they are coming, even if we don’t know where or when. We were caught unprepared this time; that shouldn’t happen again.”
We’ve faced public health crises before and will no doubt do so in the future. Pulling together as we have done before to defeat polio, smallpox and other diseases will require us to reimagine our public health care system, invest in it, to trust it and to roll up our sleeves.