We must build up public health systems to better deal with this pandemic ... and the next.

COVID-19, the pandemic that will last well into 2021, is playing out in a way that those of us in public health understand, but most Americans don’t. It provides an excellent public-health example of learning by doing, or flying the plane as you build it.

This is not totally foreign to public health; most of the tools were already used in our daily work. Contact tracing is an art and science; the same knowledge and skills used to track the church-social foodborne outbreak are used in tracking the spread of the novel coronavirus. Our risk communication for COVID-19 resembles our efforts to assure adult vaccinations for influenza. With COVID-19, we have had to scale it up on a real-time, emergency basis, but the tools are familiar.

As with any learning process, sometimes we fail, and if we do, we must learn from those failures and not dismiss them or sweep them under a rug; having to discuss failure is not a fun thing to do, but we often learn more from our failures than our successes.

We tell students that public health is the nexus of science and politics, and that good science should drive good policy that can be implemented by evidence-driven science. We should not allow politics to drive policies that are not based in science.

The COVID-19 epidemic will end with herd immunity gained through “exhausting the susceptibles” as they get the virus and develop an immunity, or by vaccinating them. However, there will be another epidemic like this one, sooner or later, and we must learn from this experience how to better manage the next one.

By definition, the next pandemic will be worldwide, so we will need international capacity to manage it, something like the World Health Organization. While our president appears ready to withdraw from the WHO, we need to remember that the WHO led the eradication of smallpox, and will likewise lead the eventual eradication of polio. There must be a worldwide body to assure that international transmission is reported, and appropriate attention is given to outbreaks that have potential to spread worldwide. We don’t need to drop out of the WHO, but instead strengthen its capacity to do its job.

In our own country, an infrastructure must be in place to deal with the next pandemic, and that infrastructure works best when it exists in place, rather being built from scratch.

Since the Great Recession in 2008-09, public health at the state and local levels has lost funding. Progressive cuts have reduced its ability to do the job we want it to do, protecting us from disease and assuring that services are adequate to protect our population. We have left our state and local health departments with staff inadequate to deal with day-to-day public-health problems, and certainly understaffed to manage a major disaster, whether a flood or a pandemic. Resources must be allocated to public health to assure its capacity to manage these occurrences.

In Kentucky this year we reorganized our public-health system to make sure local health departments could provide foundational services to every citizen. We encouraged them to identify local needs and develop the assets for intervention, but we didn’t provide the resources that will assure success of this new, developing model.

At the local level, community assessments and identification of assets are foundational to seeing that everyone has access to good health and that public-health issues of concern to the community can be addressed. As the late Dr. Gil Friedell suggested on numerous occasions, if the problem is in the community, the solution is in the community. Let’s assure that the capacity to deal with those communities is available to establish and pursue good health for all of Kentucky’s citizens by providing it with adequate funding to do its job.

F. Douglas Scutchfield is professor emeritus of public health at the University of Kentucky; Al Cross is professor of journalism at UK and editor-publisher of Kentucky Health News.