What is the United States’ single greatest weakness in its pandemic preparedness?

By Janel Miller
Helio Primary Care
March 24, 2020

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, declared COVID-19 a pandemic on March 11, citing “alarming levels of spread and severity” and “the alarming level of inaction.”

Healio Primary Care asked experts in infectious disease, public health and epidemiology what the greatest weakness is in the country’s capacity to counter an infectious disease threat like COVID-19.

COUNTER. Socioeconomic inequities constitute the greatest weakness in pandemic preparedness.

Amanda M. Simanek

The United States’ greatest weakness to pandemic preparedness is the socioeconomic inequities that exist in our country. Socioeconomic disadvantage is a key determinant of many of the chronic health conditions that we are seeing put people at greater risk for poor outcomes once infected with coronavirus. Living in socioeconomic disadvantage also creates extra barriers to participate in the public health measures being recommended.

For example, low-income families face extra challenges engaging in one of the most important things we can do to slow the COVID-19 outbreak: social distancing. Lack of paid sick leave, which is typical of many hourly, low-paying positions, as well as the inability to cope with loss of wages, may give people no choice but to continue working, even if they or family members become ill. In addition, many workers at lower paying service industry jobs, if the job isn’t being lost to business closure, require social contact and do not have the option to work from home. The living conditions experienced by many disadvantaged individuals in our country, such as overcrowded housing and homelessness, also make social distancing difficult.
Without immediate legislation that serves to strengthen the social safety net such as the expansion of unemployment benefits and paid sick leave, as well as longer term efforts aimed at improving conditions for disadvantaged populations, our ability to manage COVID-19 and future pandemics will be limited.

Amanda M. Simanek, MPH, PhD, is associate professor of epidemiology at the Joseph J. Zilber School of Public Health University of Wisconsin-Milwaukee. Disclosure: Simanek reports no relevant financial disclosures.

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