Nearly 15 years ago, during a ceremony in the Centers for Disease Control and Prevention’s Atlanta campus auditorium, I was promoted to rear admiral in the Commissioned Corps of the U.S. Public Health Service. My father, a veteran of World War II and the Korean War, positioned my new gold epaulets on the shoulders of my service dress blue uniform while my mother, a cultural anthropologist, observed the ritual from the audience. I said to the people gathered, “Public service is a privilege. For me, it has also been a joy.” Thirty-three years later, I’m retiring from the agency, and that’s the same message I would like to send to the American public.
My father, like many in his generation, enlisted in the U.S. Navy after the attack on Pearl Harbor. Another call to national service, for another generation, followed President John F. Kennedy’s inaugural address. My route to public service was more private and less intentional than those. I initially planned to apply my medical training to clinical practice. But the C.D.C.’s disease detective program — the Epidemic Intelligence Service — got me hooked on public health.
Public service is difficult. The past year and a half left many among our ranks exhausted, threatened, saddened and sometimes sidelined. The Covid-19 pandemic is not the first time the U.S. public health system has had to surge well beyond its capacity, but with the worst pandemic in a century and, initially, a heavily partisan political context, the virus collided with a system suffering from decades of underinvestment. A recent report from the National Academy of Medicine revealed that state and local public health departments have lost an estimated 66,000 jobs since around 2008.
With prior responses — including the hantavirus outbreak and bioterrorist anthrax, pandemic H1N1 influenza and the Ebola and Zika epidemics — the public health front line has been the little engine that could. For each of those responses, state and local public health departments absorbed the initial shock until emergency funding came through — and then repeatedly watched resources ebb as the crisis abated. Over the past few decades, public health experienced a progressive weakening of our core capacities while biomedical research and development accelerated into the future. With Covid-19, we were the little engine that couldn’t.
Infections, hospitalizations and deaths are declining in the United States, thanks to extraordinary vaccination efforts. These recent improvements might make it too easy to forget just how much we have collectively been through. But I hope that it has become clear to the nation and its policymakers that when we don’t invest in public health, everyone is vulnerable.
The nation’s public health system needs major upgrades. We need to modernize our data systems, enhance our laboratory capacities for detection and genomic sequencing of infectious threats like viruses and better integrate public health’s information and response efforts with clinical, commercial and academic sectors. America needs a renewed and expanded public health work force that reflects advanced skills as well as the diversity of the communities we serve.
The C.D.C. and public health departments are now receiving critical financial resources on an emergency basis. But these investments and improvements must be sustained. Long-term commitments to resources and innovation are essential. The Covid-19 pandemic will not be the last major threat our nation will face.
Public service is deeply meaningful. In my first several years at the C.D.C., I conducted surveillance and epidemiologic studies of an infection, group B strep, that harms newborns. It is passed to infants from women during childbirth. Although research during the 1980s identified the benefit of providing antibiotics to high-risk women during labor, the practice was not put in place. I spearheaded the C.D.C.’s efforts, leading to the 1995 meeting where we brought together obstetric and pediatric organizations as well as parents who had lost babies to the infection. In 1996, the C.D.C., the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics issued the first consensus guidelines that made prevention of group B strep a standard of care for the nation.
Because of this new practice standard and the updated guidance requiring prenatal group B strep screening of all women during pregnancy, over 100,000 of those life-threatening infections have been prevented. A generation of babies has been born since then, and public health efforts (not a new biomedical discovery) protected most of them from this condition. I was lucky early in my career to meet several parents whose personal losses reminded me why our work matters and how urgently our progress is needed.
Public service is also joyful. Ask the people who have been administering Covid-19 vaccinations what they feel as one recipient after another experiences the relief of getting an immunization that offers high-level protection and the promise of getting their lives back. The teams carrying out data analysis and field investigations and launching communication drives or laboratory studies have experienced the joy of knowing their collective efforts can achieve something none of them could do on their own.
I have experienced that kind of joy over and over — where my limited skills were complemented by team members with the full breadth of disciplines that public health requires — and where we eventually achieved so much progress. I felt this joy when, with the College of Medical and Allied Health Sciences in Sierra Leone, our team successfully carried out a clinical trial in Sierra Leone called STRIVE to introduce a vaccine to protect against Ebola during the devastating epidemic that began in 2014.
Public health successes usually take place out of the spotlight and under the radar, which for most of us in this field is just fine; victory often means preventing something bad from happening. If no one knows about it, that is often an indication of success. I was not a student athlete, though we have some superstars at the C.D.C. who were. Being part of the public health team provided the most cherished aspect of my 33 years at the C.D.C. We did not always win, but we always showed up. We celebrated one another’s efforts and remained humble in the face of threats to the public’s health, some opponents, like SARS-CoV-2, proving more devastating than others.
The Covid-19 pandemic has been as large a disrupter as a world war, and its effect on life expectancy exceeds any threat we have faced since the last “great” pandemic of 1918. Nevertheless, I hope this is also a moment when a new generation is called to action, to experience the difficulty and meaning and joy of public service. Our world needs you.
Anne Schuchat led immunization and respiratory efforts at the Centers for Disease Control and Prevention for a decade before becoming its top career employee in 2015. She was a key voice for the agency during the 2009 H1N1 pandemic and retired from the U.S. Public Health Service Commissioned Corps as rear admiral after 30 years of service.
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