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More than any global catastrophe in living memory, the COVID-19 pandemic has prompted much broader attention on deficiencies in public health law and policy on both a domestic and international scale. For experts, however, the issues now capturing the attention of the general public are not new. What may have changed is the extent to which governments are willing to devote resources toward correcting problems that significantly impaired responses and worsened outcomes for communities worldwide during the pandemic.
What can be done? We asked two distinguished New England Law alumni to weigh in on what’s wrong and what needs to change. Michael Curry ’05 is president and CEO of the Massachusetts League of Community Health Centers and past president of the Boston branch of the NAACP. Michele Forzley ’76 is a practicing global public health lawyer, editor-in-chief of UN Health Update, and Adjunct Professor of Law and Public Health Pandemics at New England Law. Although these two experts operate within different spheres of the public health realm, they share the same sense of urgency and opportunity in the midst of the current crisis.
Consequences and capabilities
“Any type of emergency can have public-health consequences,” says Forzley, “and a public-health emergency can have consequences beyond health. Unfortunately, our lack of attention to defining and monitoring for national risks has left us unprepared to respond efficiently and effectively when crises arise.” An effective international response to COVID-19 was doomed by the lack of a coordinated mechanism for detection and response. Given the absence of such a mechanism, plus weaknesses in national systems, she says, “we won’t be able to prevent the next pandemic.”
Forzley notes that two bodies of law must evolve in tandem if global responses to the next pandemic are to succeed where the COVID-19 response failed. “International regulations must do more than simply enable local and national health systems to collect information. Officials must be obligated to share relevant data in a timely fashion so that global health experts can identify and head off emerging threats in a coordinated fashion.” At the country level, she emphasizes that the international community must support the development and maintenance of surveillance systems that protect privacy while ensuring that accurate and comprehensive data is obtained. “Many countries’ capabilities weren’t in good operational order at the beginning of this pandemic, and some countries had none at all.”
In 2005, the World Health Assembly approved revisions to the International Health Regulations (IHR), which required countries to put in place the legislation and operational capacity to detect, prevent, and respond to outbreaks. “Unfortunately, many countries have not completed this work,” Forzley says. “Moreover, the IHR doesn’t provide for the international mechanism we need to coordinate across countries. That’s why a pandemic treaty has been proposed. None of the steps to be taken are impossible. We just need the political will and resources to put the necessary mechanisms in place.”
Nothing about me without me
For Michael Curry, witnessing the disparately negative health outcomes for Black and brown individuals, members of immigrant and non-English speaking communities, and people with lower incomes was déjà vu all over again. “COVID-19 time-warped the general public’s understanding of the crisis in the standards of care available to historically underserved communities,” he says. “What is manifest in this pandemic ties back to issues that health activists have been raising for years. In fact, most of these systemic problems are what inspired the creation of the community health center system during the Civil Rights Movement and the war on poverty in post-WWII America.”
Curry notes that several years of anti-immigrant policies and rhetorical attacks on people of color coincided with defunding of initiatives for community health centers in many regions of the country. “We failed to expand access to primary care and specialty care in communities we knew to have less access to clean water, fresh air, and healthy food,” he explains. “And those same communities have greater exposures to physical violence and mental health trauma. It took the pandemic to wake people up to the fact that if individuals lack proper care anywhere, it’s a threat to public health everywhere.”
The good news in Massachusetts, according to Curry, is that health equity advocates have allies in state government. “We have a saying here that if you’re not at the table, you’re on the menu. Our goal is always to have voices that are representative of affected communities directly involved in regulatory and policy discussions. That is imperative in this moment when we are contemplating dramatic shifts in how we incentivize, provide, and pay for care at the community level.”
Curry sees the beginnings of progress in 2021. New leadership at the Massachusetts Budget and Policy Center had led to the inclusion of a racial justice lens on health data analyses. And Massachusetts Governor Charlie Baker recently increased reimbursement rates and funding for community health centers (CHCs) that will help expand their services. “CHCs are not only models of effective primary care delivery but engines of economic growth,” says Curry. “We’re among the largest employers in many Massachusetts communities. These recent developments are a direct result of the revelations of the pandemic, and our state’s response to the crisis can serve as a model for the rest of the nation.”
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