For months, Dr. Jennifer Abeno, director of the New Orleans Health Department, has seen the threat approach. Louisiana led the US with the country’s first death from avian flu, with seasonal flu cases rising sharply for the first time in 15 years. A fatal outbreak of measles occurred in nearby Texas. The number of Louisiana school children who were exempt from the vaccine requirements doubled in one year.
During the COVID pandemic, Dr. Abeño worked with state authorities to maintain high infection rates and promote vaccines. But after taking office last year, Gov. Jeff Landry began to fulfill his promise to remake public health after the state community responded.
Republican Landry appointed former MP Dr. Ralph Abraham, who created the status of the state’s surgeon general and opposed the state’s “tyrannical” symbiotic response, claiming that the actual risk was not the virus itself, but a vaccine against it.
So, when Dr. Abraham announced last month that Louisiana would “no longer promote large-scale vaccinations,” it wasn’t entirely surprising.
For Dr. Abeno, it was a dull reminder of how the late political period of the pandemic made her field worse and worsened her field to fight the next one.
“We’re in a very different world right now,” she said. “We are now ready to throw the baby out in the bath water and leave it incredibly vulnerable.”
Local public health officials like Dr. Abeno are the frontlines for responding to any disease outbreak. Five years after the pandemic began, many say that Covid’s entrenched politicization leaves fewer tools to respond and fresh challenges remaining.
Questions about the Covid vaccine have created hesitancy around all vaccines, leading to loose requirements. The number of children exempt from school vaccination requirements increased in 41 states with the highest recorded levels. In at least 36 states, measles vaccination rates have fallen below 95%. This is the level required to maintain immunity in the herd.
New laws in many states limit local officials’ authority from issuing broader masking and vaccine orders, as well as taking more targeted actions, such as isolating people with tuberculosis and highly contagious viruses.
The Trump administration has vowed to cut budgets with the Centers for Disease Control and Prevention, which fires hundreds of workers, provides most funding to local departments, coordinates data collection on outbreaks, and provides expert guidance.
The administration also withdraws the US from the World Health Organization, which communicates about outbreaks around the world, reducing communication from federal health agencies. Local officials say these efforts are important to combat the chaos and disinformation that sparked so much rage during the pandemic. Some local health departments say CDC employees they have been communicating for years will be gathering at the meeting.
Trust in public health has declined sharply. A January KFF poll found 54% of Americans and 46% of Republicans trusted local and state health officials to “make the right recommendations,” falling 10 percentage points in each case two years ago. A new Axios/Ipsos poll found that 62% of Americans trust CD health information from 88% in March 2020.
Janet Hamilton, executive director of the State Council and Territorial Epidemiologists, said mistrust of public health has made it difficult to deal with early. She compared the outbreak of battles with the flames, saying that lower vaccination rates provide a way for them to spread.
“The gas lines there exist in ways that didn’t exist in 2019 so that the fire could move along,” she said.
Local health officials no longer need police protection or sleep away from home, as they did when the public was rebelling against mask mandates and other community restrictions. In an interview with 20 local and state health officials last month, many admitted that they made mistakes as public health officials tried to deal with the novel and ever-changing virus. They say they learned from those mistakes.
Many have ruled out future lockdowns, closures, or other blanket mitigation strategies.
“The ship was completely sailing,” said Dr. Anne Zink, Alaska’s chief medical officer during the pandemic. “And perhaps for the best.”
Instead, she and others said public health agencies should be “really agile” and respond with targeted interventions, such as tracking individuals with infectious diseases, identifying contacts and working to reduce the risk of further spread. This requires ample resources and detailed updates on threats.
But Dr. Sanmi Arora, director of Nashville’s Metro Public Health, worries that the widespread passage of laws in response to the Covid-19 pandemic will limit their ability to combat the rapidly moving threat. Tennessee, like several other states, now has a law that allows only the governor to order infected patients to isolate or expose them to quarantine during the pandemic. This year, several states have proposed banning the type of mRNA vaccine used against Covid, based on false claims that they would change recipients’ DNA.
Without the authority that public health officials once had, “The public perception is a very important piece of work, whether it’s right or wrong. You need to invest in creating a message and explaining the benefits.”
According to many health officials, the biggest lesson is the importance of clear communication.
Many are investing in new outreach campaigns. North Dakota Public Health Administrator Erin Ourada said each of her agency’s approximately 30 staff will travel to at least one community meeting each month to share updates on departmental work.
In Clackamas County, Oregon, the Health Department tapped trusted community members to talk to certain groups, including Hispanic and Eastern European immigrants. When Oregon fought its biggest measles outbreak in decades last year, they incited to address vaccine skeptics.
Still, county health officer Dr. Sarah Present is worried that she described it as a moral injury to the field. Angry national conflict, threats, tolls taken by friends who ousted them. Like everyone else, she stopped telling strangers what she was going to do.
“I think we’re a little bit prepared because of people’s fatigue and the burnout of public health,” she said.
In Pima County, Arizona, including Tucson, Dr. Teresa Cullen has established the state’s largest free COVID-19 testing program and a mobile vaccination clinic that serves local residents. But after Gov. Katie Hobbs appointed her to lead the state’s health department, she soon became what one friend called a “voodoo doll” for public health.
At her confirmation hearing in 2023, one state senator condemned her for a student recession and suicide during school closures. One testified that Dr. Karen’s agency “terrorized” local businesses.
“I was surprised at how ferocious it was,” Dr. Karen said in an interview. “Because I know why I wanted to do the job and why it was a service.”
The governor retracted her appointment and Dr. Karen stayed in Pima County. Others have left the stress away. They had a lot of experience. One study found that almost half of public health employees who worked for state and local agencies in 2017 had left by 2021.
“There are a lot of people out there for 20 years, those who have been there or seen measles outbreaks, those who have worked through Ebola in the past, a lot of people are gone,” Dr. Zink said.
At the same time, public health challenges are increasing. Extreme heat and disasters like hurricanes and wildfires require responses from local departments that are also facing the outbreak of measles, pertussis, syphilis, HIV and tuberculosis.
The federal government has sent billions of dollars in pandemic funds to state and local health departments. But all of that emergency funds are running out, with local departments having fewer resources to strengthen staff, track new viruses and expand vaccine campaigns.
“People don’t question the police and the fire budget. Dial 911 and they’ll come,” said Renae Mock, a public health officer in North Dakota. “Public health is similar, but we don’t give the same respect. We’re open 24/7. Why do we have to continue to show our worth?”
Dr. Eric Chow, interim health officer with the Seattle Department of Health, said the spread of avian flu from farm to farm to human is the most concern. Vaccines are available, but it will be difficult to spread.
“We’ll give information to people so that we can launch an access point,” he said.
When the pandemic began, the CDC had not shared any data on the outbreak. They were entrusted to universities and private companies to create public dashboards.
In 2023, the CDC created the Prediction and Emergency Analysis Centre, a network of centres that collect and distribute data and information. But there is fear that it will be a victim of budget cuts.
“We’ve seen a lot of people who have had a lot of trouble with the disease,” said Dr. Lauren Gardner, an infectious disease expert at Johns Hopkins. In January 2020, Dr. Gardner created an interactive Covid dashboard. This quickly became dependent on civil servants and health authorities members around the world.
The local health department needs to network “everything is overseeing things at a higher level, that’s the CDC,” she said. And given the uncertainty around the agency, she added, “The CDC will have a hard time playing that role now.”
Local officials say it’s difficult to act on the lessons they’ve learned from Covid without coordination with the federal government.
“The reliability of public health came out of the window right away when the public could see that we weren’t in the loop from time to time,” said Ouda of North Dakota. “It’s like we brought us where we are today and we no longer trust our community members.”
