With the advent of antibiotics in the first half of the last century, traditional public health went into hibernation.  Communicable or infectious diseases surfaced only occasionally, and usually only in small outbreaks of old foes such as TB, leprosy and polio. Most of these outbreaks were contained and in relatively inaccessible locations subject to a small mention in First World media and several hundred unreadable WHO reports, but no political mileage in developed economies.

Health isn’t a condiment and can’t just be added at the end.

The mid-century shift of public attention to non-communicable diseases awakened the public health bear.  Smoking cessation, cardiovascular prevention and obesity moved public health back out of the medical cave onto the political plains. Media messages replaced prescription pads as the treatment of choice. Even then, there were divisive debates over vaping and nicotine substitutes as alternative to combustible tobacco, how to manage the global crisis of bacteria resistant to existing antibiotics, and the explosion in the abuse of opioids.

The UK went first to divorce public health from health care by moving public health funding out of the health coffers into local government budgets, with resulting plunges in expenditures. Competing for limited currency with garbage collection and potholes, public health couldn’t win, particularly since public health experts were no match for the micro politics of local government. Public health returned to hibernation. In the US, taxed with an unpleasantly run  election, public health morphed into political health. 

On both sides of the Atlantic, COVID was the perfect incubator to complete the inoculation of the political virus into public health. Never could two decision-making disciplines diverge so sharply and lead to such antithetical and dangerous outcomes.

Public health deals with data and that takes some time to collect and digest. Politicians and pandemics won’t wait.  Today’s politics feeds on misinformation and the 24-7 news cycle demands quick action. Politics does not necessary improve public health. At most, politics applies a dash of short term health added for spice. But public health considerations are not condiments and can’t just be added at the end of a political process. When they are, the results are disastrous. At best, the public can be misdirected, and at worst, people will polarize along entrenched political lines. The edicts directing the use of masks and premature approvals of vaccines are two examples. 

The unfortunate truth is that the public health response to COVID-19 was too little, too late. April this year, months into the pandemic, the majority of Twitter posts still blamed Bill Gates, the Chinese Communists, the Deep State or 5G for the virus. 

COVID-19 was already politicized by the time the sleeping bears led by Fauci woke up and presented a quasi-unified front. 

That kind of mistrust the public health vacuum has allowed is as difficult to eradicate as the virus itself. Coupled with the increasing realization that COVID-19 can’t be wiped out nor cured in the short term – even in rich, populous nations, and probably not in our lifetime in poorer ones, is a legacy that our generation will have to live with.