This follow-up post makes 2022 predictions on the Covid-19 pandemic and public health. A previous post predicted the economy, politics, and drug pricing reform in 2022.
The Covid-19 pandemic is leaving an indelible mark in the U.S. and across the globe. There have been more than 847,000 deaths in the U.S. alone, with tens of thousands more fatalities projected in 2022.
Even when armed with the best models, it’s impossible to forecast the course of the Covid-19 pandemic with accuracy and consistency.
Many, myself included, predicted wrongly last year that the pandemic would fade in 2021, as the vaccine rollout took shape. Yet, 2021 was worse than 2020 in terms of deaths. The emergence of the highly transmissible Omicron variant further complicates matters.
Omicron won’t be the last variant of concern. With very high levels of infection worldwide, mutations are inevitable, and so is the emergence of new variants of concern.
And therefore, while it’s possible that Covid-19 could shift from being pandemic to endemic at some point in 2022, it’s going to be a bumpy road, especially in the U.S. In the U.S., a crude indicator of Covid-19 having reached the endemic stage would be if and when the nation goes below 100 deaths a day. The 7-day moving average is approximately 1,400 deaths, and this is very likely to increase this month given the current high levels of hospitalizations.
During the Delta wave – which, to some extent, is still ongoing, coupled with the arrival of Omicron – the U.S. has seen less decoupling between cases, hospitalizations, and deaths, than its peers.* Moreover, comparatively low vaccination and booster rates as well as a fractured public health system will likely lead to the pandemic dragging on longer in the U.S.
For the nation as a whole, perhaps the most difficult period of the pandemic may be upon us in January when not only are many healthcare systems at a breaking point, the functioning of society and parts of the economy will be temporarily disrupted, not by way of lockdown, but rather due to Covid-19 absences and staff shortages.
The Covid-19 crisis has exposed major defects in the patchwork U.S. public health system. Here, public health is defined as the practice of preventing disease, prolonging life, and improving quality of life through the adoption of population-wide preventive measures, regulatory efforts, and messaging concerning informed choices of society, communities, and individuals. Compared to peer nations the U.S. deals poorly with public health crises that require a systematic, coordinated response across agencies, regulators, federal, state, and local governments; whether it’s an infectious disease like Covid-19 and HIV, or a population-wide problem, such as opioid misuse, abuse, and diversion.
Besides Covid-19, other major public health issues affecting the U.S. include drug overdoses, particularly illicit fentanyl. 2020 was the worst year on record for drug overdoses. I suspect that when the tally is done, 2021 will have been even worse. And, there will be no let-up in 2022.
Alcoholism, suicide, gun violence, a population-wide obesity problem that shows no signs of abating, and infant mortality, contribute to a decade-long stagnancy and even decline in life expectancy in the U.S.
Problems related to access to healthcare, including persistent socioeconomic inequalities, exacerbate the life expectancy gap between the U.S. and its peers.
One would have hoped that there would be a silver lining to the Covid-19 pandemic. Namely, the crisis revealed flaws in the American public health infrastructure as well as messaging systems, which legislators and policymakers would now seek to redress. Alas, they haven’t, and, judging from public pronouncements, they won’t. If anything, the situation has gotten worse, with more than half of states curtailing public health powers.
From a public health perspective, it’s unfortunate that the infrastructure and budget reconciliation bills do relatively little to improve certain public health components, including comprehensive plans on how to equitably distribute and provide access to developed and procured medical technologies, as well as ways to improve outreach and information campaigns. Even the federal government’s pandemic preparedness plan considers public health an afterthought, and not an integral part of the solution.
Not all is doom and gloom on the public health front, however. The federal government is pursuing initiatives that have had (and will have) a positive impact on public health.
For instance, the Centers for Medicare and Medicaid Services (CMS) are making some some incremental changes that could indirectly impact public health, including design and implementation of new payment models for treating a number of diseases and conditions.
In 2022, CMS will be streamlining payment models for demonstration projects that focus on equity. So, for example, CMS will explore:
– Maternity bundled payment models that include prenatal care, delivery, and postnatal care;
– Substance use dependence payment models that support novel medication-assisted treatments, such as suboxone and methadone;
– Chronic disease models for diabetes, asthma, and autism spectrum disorders.
Further, the Covid-19 pandemic has spurred a revival of the public-private partnership, specifically as the federal government has allocated funds towards development and procurement of medical technologies – treatments and vaccines – that address Covid-19.
The big question is whether this will occur in other therapeutic areas in which there is substantial unmet need? The ability of governments and the pharmaceutical industry to collaborate successfully on vaccine development in an incredibly short span of time could reinvigorate cooperation: HIV vaccines and treatments for neglected tropical diseases come to mind.
With Robert Califf at the helm at the Food and Drug Administration (FDA), there may be more impetus for public-private partnerships. Califf is on record as being a strong proponent of such partnerships.
Moreover, by way of public-private partnerships, the pharmaceutical industry has gotten a much-needed public image boost from its all-out effort to develop Covid-19 therapeutics and vaccines. Dozens of firms have been active in Covid-19 therapeutic and vaccine development.
At the same time, the drug industry continues to churn out lots of novel products unrelated to Covid-19. FDA approvals for non-Covid-19 indications are humming along. In 2021, there were 50 new approvals, the majority of which are orphan and cancer drugs. This follows a now sustained long-term trend in these disease categories. If deal-making and the sheer amount of R&D being poured into orphan and cancer drug development are any indication, this trend will continue.
Covid-19 is not going away any time soon. And, even in the aftermath of the pandemic, the U.S. isn’t fully committed to essential building blocks of public health, including an equitable distribution of medical technologies, and ways to improve outreach and information campaigns. Yet, the public-private partnership has been revived, and this has led to an astonishingly rapid development of Covid-19 vaccines and treatments. Perhaps this will form a foundation for future collaboration between the government and industry to address widely prevalent diseases and conditions with unmet need.