Dr. Peter Kilmarx: Distrust in Public Health in America “Is One of Those Wicked Problems”

In episode #119, Dr. Peter Kilmarx, Fogarty International Center, discusses the struggle to advance contact tracing. Efforts early in 2020 to create a national Covid-19 Response Corps – at least 100,000 needed – were not successful. Instead a “hunger games scenario” ensued in which each jurisdiction scrambled to make its own solution. In our federalized system, each state, and in some instances county, has had to build its own public health workforce while balancing the budget. The lack of an integrated data system made it difficult to track progress. Contract tracing has made only marginal progress in curbing transmission. Experiments in the use of new technologies have not gotten off the ground in most places. New York City is one shining exception where 90% of cases are tracked, and 75% of their contacts. Success in places like New Zealand, Taiwan, and Viet Nam relies on robust, fast testing systems, consistent social support for those in quarantine, and a tradition of public health workers in the communities. Public health in America has entered a period of crisis, in the face of politicization, distrust, and abuse. In the Biden administration, executive orders and the American Rescue Plan have made major commitments towards contact tracing, testing, and strengthening the public health workforce. In the meantime, foundations, civil society alliances, and public health professional associations have played an expanded role. “Contact tracing does work” if the right pieces can be put in place.

Dr. Peter Kilmarx is the Deputy Director of the Fogarty International Center, at the National Institutes of Health and is a Rear Admiral (retired) in the US Public Health Service.