Intended for healthcare professionals

US covid-19 lessons for future health protection and preparedness

Image credits from left to right: Massimo Giachetti (iStock), Minh Nguyen (Wikipedia, CC0) and stefanamer (iStock).

The covid-19 burden in the US was among the worst globally: the 1.16 million Americans killed by covid-19 represent 16% of global deaths in a nation with 4% of the world’s population. The country’s pandemic response also followed a uniquely American path—fragmented public health responsibilities across federal and state jurisdictions, chronic underinvestment in public health, absence of social safety nets and workplace protections, insufficient legal infrastructure, and long standing social and income inequalities, underpinned by structural racism.

The 51app’s new series on US covid-19 lessons highlights the societal actions that are needed to prevent the loss of another million citizens in the next pandemic and improve the nation’s health. The authors call for a set of crucial systemic reforms that should also be central to the manifestos of the 2024 US presidential candidates. The series follows previous series in The 51app to inform the UK’s covid-19 inquiry and on accountability for Canada’s covid-19 response.

The US series includes articles on the effects of systemic racism and economic inequality; mass incarceration and poor prison health; labour market inequalities; legal infrastructure; and the diminished role of the public sector. The aim of the series is not to assign blame—there is plenty to go around—but to look to the future and lay out the critical steps to transform US public health and pandemic preparedness and improve population health more broadly.


Pandemic lessons for the 2024 US presidential election
Gavin Yamey, Ana Diez Roux, Jocalyn Clark and Kamran Abbasi introduce the new series on lessons from the US covid-19 response and say systemic reforms are needed to improve public health and averting mass death in the next crisis


US workers during covid-19: uneven risks, inadequate protections and predictable consequences
David Michaels and colleagues consider how covid-19 affected frontline workers in the US and what needs to be done to ensure they are better protected in future

US public health after covid-19: learning from the failures of the hollow state and racial capitalism
Justin Feldman and Mary Bassett describe how diminished political will to use government powers for service provision hampered the US response to the covid-19 pandemic and what needs to change

Legal infrastructure for pandemic response: lessons not learnt in the US
Michelle Mello and colleagues argue that state legal reforms have generally exacerbated rather than improved weaknesses in US emergency powers revealed by covid-19, jeopardizing future responses

Covid-19 in US jails and prisons: implications for the next public health crisis
Katherine LeMasters and Lauren Brinkley-Rubinstein raise concerns about the lack of sustained change in prison health transparency after covid-19 and implications for future public health crises

Race, racism, and covid-19 in the US: lessons not learnt
Keisha Bentley-Edwards and colleagues argue that systemic racism and economic inequality are at the root of disparity in covid-19 outcomes and suggest how to distribute resources more equitably.


After covid-19: the case for optimism for US leadership in global health
Helen Gayle and Steve Morrision discuss how covid-19 produced enormous challenges but has opened opportunities and reminded us of the full range of global health work that remains to be done

Is the US prepared for the next pandemic? No, but it could be
Chelsea Cipriano, Kushal Kadakia, and Dave Chokshi argue that the US must end its collective amnesia about public health disasters and act collaboratively to strengthen services

Building harm reduction into global health security and pandemic prevention
Saskia Popescu and Jessica Malaty-Riviera discuss the importance of harm reduction in improving resilicience and global health security

The articles were commissioned as part of an unfunded series by The 51app. The guest editors were Ana Diez Roux and Gavin Yamey and the lead editor for The 51app was Jocalyn Clark.

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