Five years ago, the World Health Organization declared the coronavirus outbreak a pandemic. Within days, travel was restricted, schools and businesses shuttered and social distancing was established. Still, about 24,000 people in the United States died from COVID-19 by April 15, 2020, and as the crisis lingered and the deaths piled up, the governmental response created deep divisions – particularly over mask and vaccine mandates.
Today, COVID is far from the front of most Americans' minds, though it still kills 2,000 people each month globally. Other specters have been circulating: Influenza has been surging, bird flu has passed to humans, and measles outbreaks show no signs of diminishing. And with a vaccine skeptic heading the U.S. Department of Health and Human Services, the U.S. withdrawing from the World Health Organization, federal research dollars being cut and vaccination rates declining, many Americans may be wondering how the nation would handle another pandemic.
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But the nation's political climate has left many health systems reluctant to publicly address the question. This culture of fear – couple with a diminished public appetite for vaccination and a growing "medical freedom" movement – make Americans more vulnerable to another pandemic, health experts say.
"The fear is that if you speak out against any aspect of the (Trump) administration, an administration that's willing to punish those who do that, then you would be at risk, especially in universities or colleges or hospitals that are seeking federal money," said Dr. Paul Offit, a national vaccination expert and director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
As the fifth anniversary of the COVID-19 pandemic approached, several Philadelphia-area health organizations either declined – or did not respond to – requests to comment on the nation's readiness for the next pandemic and the roles that vaccines might play. They included Main Line Health, Temple Health, Jefferson Health, the Black Doctors COVID-19 Consortium and Penn Medicine.
Offit said he has friends in the medical community who have told him they would like to comment on pandemic readiness and vaccination, but their hospitals or universities have told them not to.
"I think you have to stand up at times like this," Offit said.
Though the U.S. does not appear to be on the brink of another pandemic, it's facing several public health concerns caused by infectious diseases.
This flu season has been the worst since the H1N1 virus sparked the swine flu pandemic in 2009. Since Oct. 1, the Center for Disease Control and Prevention estimates the seasonal flu has caused between 480,000 and 1 million hospitalizations, and 21,000 to 100,000 deaths.
Avian influenza has caused 70 human illnesses – all transmitted from exposures to infected dairy herds, poultry or other animals – and one human death. At this point, there is no known person-to-person transmission of avian influenza, according to the CDC. But some scientists have feared the bird flu virus could mutate in a way that causes a pandemic.
Although vaccination efforts had eliminated measles in the United States by 2000, there were 285 cases last year, with more than 80% of the cases affecting people who were unvaccinated or whose vaccination status was unknown, according to the National Foundation for Infectious Diseases. Nearly 160 people have contracted measles in the Texas outbreak since January, and one child has died – the first American death from the disease since 2015.
Measles is so infectious that if one person has it, 9 out of 10 people nearby will get it if they are unvaccinated. The disease causes complications that kill between 1 and 3 of every 1,000 children who get infected.
Offit warned that the current measles cases and confirmed death may be the "tip of a much bigger iceberg."
Childhood immunization rates, including for the measles vaccine, fell during the pandemic and have continued to decline. A report published in November found that for the 2023-2024 school year less than 93% of all kindergarteners had received all state-required vaccines. That is lower than the 95% vaccination rate among kindergarteners in 2019-2020 – the school year immediately prior to the pandemic – and below the levels of the past decade.
And new HHS Secretary Robert F. Kennedy Jr. has been giving mixed messages about measles vaccination. In an op-ed for FOX News earlier this month, he said the "decision to vaccinate is a personal one" and promoted the use of vitamin A for "those with mild, moderate, and severe infection." Though vitamin A is used to treat some children with measles, the American Academy of Pediatrics and other health experts are working to debunk misinformation that vitamin A prevents measles, noting immunization is the only effective way to prevent the disease.
Part of the reason for the fall in vaccination rates is a backlash against federal mandates imposed during the COVID pandemic that "at least a reasonable percentage of the public saw as massive government overreach," Offit said.
With the "medical freedom" movement and legislation pushing back against mandates, "I think we will be less prepared" for another pandemic, the CHOP physician said.
Unlike national trends, vaccination rates in Philadelphia are stable or increasing – except for influenza inoculations – partly due to a program that offers free vaccines to uninsured and underinsured children, people experiencing homelessness and other vulnerable populations, according to the city's public health department.
In February, Arthur Caplan, of New York University's Grossman School of Medicine, wrote in the academic journal Science that "our attitudes about our duties to the global poor" who have a harder time accessing vaccines than the wealthy, and the "growing, dangerous adulation of unbridled free choice" mean that nationwide "vaccines are undeniably in trouble."
Caplan founded the Division of Medical Ethics and he previously created the University of Pennsylvania's Center for Bioethics and the Department of Medical Ethics. He said in a recent phone interview that "you have to fight your battles on terrain where you can win. This administration doesn't care about science. This administration is not going to change its policy."
The United States is a "very individualistic, self-oriented society," he said. "It's not one that is thinking hard about, 'What do I owe my neighbor? What can I do to help my community?' It usually begins these days with, 'What's good for me, and what do I want?' So if you're going to exist in a moral world where there's a lot of selfishness and egotistic thinking, that's where you've got to put your messages."
To push back against vaccine skeptics – to shift the system toward better preparation for the next pandemic – Caplan advised people to write to their U.S. representatives, because they "don't want angry memes of families with sick kids showing up all over social media," Caplan said.
"You vaccinate to protect the vulnerable who might live down the street, but you also have to say things like, 'Look, if measles gets out of control, your kid won't be able to go to school,'" he said. "'If measles gets out of control, you're going to risk being able to go to the ball game, or the theater, or the restaurant – not because someone's going to tell you you have to wear a mask. It's just going to get too dangerous … for you and your kids.'
"I want to see the messages spun so that it makes sense to people to think, 'This (opposing vaccination) could restrict my freedom, this could restrict my liberty.'"
The COVID-19 pandemic underscored the importance of public health officials partnering with community organizations and "trusted messengers' to amplify recommendations on testing and vaccination, said Jim Kyle, spokesperson for the Philadelphia Department of Public Health.
"One of the most important messages to communicate at the beginning and throughout any public health emergency is to let residents know where they can get accurate, credible, and timely information," Kyle said in an email. "Communicating uncertainty and the possibility for changes to guidance is also important, especially in situations when we are dealing with a novel pathogen and information is still evolving. We need to communicate what we do not know and what we are doing to get answers."
Caplan and Nathaniel Mamo, a program coordinator in NYU Grossman's medical ethics division, started the Give One Talk Vaccine Information Project, which has medical and health care students commit to giving one talk in a community space – like a church, recreation center or senior home – to address vaccine concerns and make science more understandable.
"Health professionals need to start talking to people as peers, not as patients – something that anti-vaxxers have been doing successfully for years," Mamo wrote in an essay published earlier this year.
Officials at Cooper University Health Care in Camden said pairing physicians with community leaders to talk about testing and vaccination during COVID helped reach groups that felt wary.
"At a national level and at a social media level, there can be mixed messages," said Louis S. Bezich, senior vice president and chief administrative officer of Cooper Health, and also a PhillyVoice contributor. "There can be contradictory messages. So if you can get somebody in person with medical experts and trusted leaders, that can sort of help to filter all that out."
The relationships Cooper fostered with other health systems, community leaders and local groups have continued to grow since COVID and will help if another pandemic occurs, Chief Medical Officer Joseph M. Montella said.
"It's individual conversations and taking the time to listen to people and address their concerns," Montella said, "because everybody's concerns are valid. Our job is to educate, guide, and hopefully people will make the decision that aligns with the science and what's best in medicine."
