Federal public health infrastructure is being wrecked — Lancaster County needs a health department [editorial] | Our Opinion

THE ISSUE

“Lancaster County is exposed as whooping cough deaths nationwide hit a seven-year high last year and cases locally surged,” LNP | LancasterOnline’s Lucy Albright reported last week. “The elevated exposure for a whooping cough outbreak here is due to the fact that vaccination levels among seventh graders are below what is generally considered necessary to stop uncontrolled spread, a level commonly known as herd immunity. Herd immunity ‘is like a community’s invisible shield’ against contagious, vaccine-preventable diseases, said Dr. Banku Jairath, a pediatrician at Penn State Health Children’s Hospital. … To achieve herd immunity against pertussis, also known as whooping cough, 90% to 94% of the population must be immune, according to Jairath. But among Lancaster County’s seventh graders, vaccination levels are below 90%.”

Americans generally give anniversaries attention. Even tragedies tend to be remembered with thoughtful retrospectives. But there was a strange silence around the fifth anniversary last month of the start of the COVID-19 pandemic, which resulted in the deaths of more than 1.1 million Americans.

Maybe it’s because people are so preoccupied, understandably, by the Trump administration’s decimation of the federal government and economy-rattling tariffs. It’s as if we collectively decided that there’s enough going on, so we don’t need to wallow in the painful memory of what was happening five years ago, when Pennsylvania shut down March 16, 2020, Lancaster County declared a state of emergency March 17, the first case of COVID-19 was reported March 18 at Lancaster General Hospital and the county’s first COVID-19 death was recorded March 26.

Who wants to revisit that time, when schools, sports and music venues, theaters, restaurants and other businesses closed, ordinary life skidded to a halt and some of us had to bid farewell to loved ones from a distance?

It was an incredibly traumatic period, particularly for the health care workers who risked their lives to care for the ill and the small business owners who lost their livelihoods. So forgetting may seem to be a reasonable coping strategy.

We’re worried, however, that in determinedly locking the pandemic into a vault, we’ll forget some of its lessons.

It’s clear that we already have.

Five years on, Lancaster County still doesn’t have a public health department, and it shows in our pitifully low childhood vaccination rates, which leave us at risk of outbreaks of whooping cough, measles and other vaccine-preventable diseases.

Pediatricians, family physicians and the Lancaster County Immunization Coalition have sought valiantly to convince parents to get their children the safe and effective vaccines that would protect them against illness. But a county public health department could bring real resources to the effort — while also collecting valuable health data not available to the county now.

As LNP | LancasterOnline’s Lucy Albright reported last week, we might not even know if a case of measles — a highly contagious and sometimes life-threatening disease — emerged in Lancaster County.

“None of the four major health systems operating in the county indicated they would inform the public if they encountered a measles case,” Albright noted. “While health care practitioners and facilities are required to report cases of measles to the Pennsylvania Department of Health or ‘the appropriate local health authority’ — which includes local health departments, where they exist — within 24 hours, the state Department of Health does not always make cases public.” (Italics are ours.)

Lancaster County has no “appropriate local health authority.” By contrast, “The four Pennsylvania counties that have seen recent measles cases — Bucks, Erie, Montgomery and Philadelphia — all have county health departments, and all notified the public,” Albright reported.

This is how much an outlier Lancaster County is: Of the top seven Pennsylvania counties by population, ours is the only one without its own health department.

So consider this yet another plea to Republican county Commissioners Josh Parsons and Ray D’Agostino to work with Democratic Commissioner Alice Yoder on this. Because while we’re grateful to the volunteers who serve on it, the Lancaster County Health Advisory Council — which meets roughly six times a year — is an inadequate substitute for an actual health department.

And the need for a local health department, staffed by public health experts, has gotten exponentially greater because the federal health infrastructure is being nuked by Health and Human Services Secretary Robert F. Kennedy, a vaccine skeptic who lacks any medical training.

As NPR reported last week, termination emails were sent Tuesday morning to thousands of staffers within the Department of Health and Human Services, the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, as well as smaller agencies. Some employees reportedly are being reinstated, but the damage has been done.

“We rely on our CDC for things like tracking down disease outbreaks,” Dr. Ashish Jha, the dean of the Brown University School of Public Health, who served as President Joe Biden’s COVID-19 response coordinator, told NPR. “We rely on (the National Institutes of Health) for research into new treatments and tests and vaccines. … We don’t know what the implications of all of this will be. I’m worried that what we’re going to see is more people getting sick, more disease outbreaks and infrastructure that is going to be less and less capable of responding to those threats.”

Thousands of jobs are being eliminated just at the FDA and its top vaccine regulator has been forced out.

“The FDA as we’ve known it is finished,” Dr. Robert Califf, a former FDA commissioner, wrote on LinkedIn.

Inside the Department of Health and Human Services, the entire staff of the Low Income Home Energy Assistance Program was laid off. LIHEAP, as it’s known, helps more than 6 million low-income households, including some in Lancaster County, pay their utility bills.

Five years ago, we were woefully unprepared as a nation for the COVID-19 pandemic. As the pandemic dragged on, revealing glaring social disparities, medical experts were derided and science-based recommendations were ignored. Politics trumped public health. This is happening again at the federal level.

In a 2023 LNP | LancasterOnline column, Dr. Leon Kraybill, a Lancaster County geriatrician working in post-acute and long-term care, wrote that we must approach health crises “as medical dilemmas — not political battles.” He worried that “our current inability to talk constructively with each other does not position us well to face another pandemic.”

With the dismantling of our federal public health infrastructure, we’re in even more precarious shape now. We need to address that reality — and soon.