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Why U.S. COVID Policy Should Start With U.S. Data

rendering of world map with covid data

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Meghan Fitzgerald, RN, MPH, DrPH, is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor. She has decades of experience working in the healthcare field, ranging from frontline patient care to advising prominent healthcare firms. Here, she shares her take on why the United States so urgently needs to update its public health infrastructure and make its own policy decisions.

A year and a half into the pandemic, United States public health officials continue to create COVID-19 policy inspired by data from outside the U.S., rather than make decisions heavily weighted on domestic data. The reason: U.S. public health data systems are outdated, patched with duct tape, and don’t communicate with each other.

National public health policy depends on a rollup of real-time, reliable state-level data which we don't have. Instead—and perhaps tellingly—we're borrowing data from countries with centralized health systems.

Our data delinquencies have been on display when it comes to tracking COVID-19 testing, case rates, hospitalizations, and deaths by demographics in America. Many state health departments do not have systems that can flag or share COVID-19 outbreak risk with each other. Several states stopped contract tracing as their small staff counts couldn’t keep pace.

In Israel, 98% of the population has been using the same linked electronic medical record system for decades.

The Biden administration paints the use of Israeli data as a way of forecasting what's to come in America. General COVID-19 trends in the United States have largely mirrored those in Israel and the U.K., but on a one-month lag time. So when data published in an August preprint showed the effectiveness of Pfizer-BioNTech booster shots in older adults in Israel—even in the face of the Delta variant—the U.S. was quick to establish a booster plan for as soon as September 20.

But general trends shouldn't beget general guidance. We need a healthy scientific debate in the U.S. with our experts and national data, allowing for a transparent policy-making process about vaccines. That process can help determine certain priority groups that may need a booster in the U.S.

Many health organizations and scientists, however, think the evidence for booster shots at this time is lacking:

  • The World Health Organization has been very consistent in its view that we should vaccinate the world’s poor with a first dose before giving boosters to the world’s rich. In an August statement, the WHO said that while factors like waning vaccine effectiveness and variants could necessitate booster shots, "to date, the evidence remains limited and inconclusive on any widespread need for booster doses following a primary vaccination series."
  • Two departing Food and Drug Administration (FDA) officials co-authored a paper published in The Lancet on Monday, stating current evidence does not support boosters in the general population. The authors, including U.S. and U.K. scientific leaders, argue that for most people, vaccine efficacy against severe disease remains high. They encourage experts to study variant-specific boosters and use the limited global vaccine supply for people who are at high risk of serious disease and have not yet received a vaccine.

How Can the U.S. Boost Its Data Capabilities?

The U.S. must be honest about its long history of omitting public health as a worthwhile investment. The U.S. healthcare budget has historically allocated less than 5 cents on the dollar toward public health. Data published by Kaiser Health News shows more than three-quarters of Americans live in states that spend less than $100 per person annually on public health, equating to less than 1.5% of most states’ total spending.

As part of its response efforts, the Biden administration has committed $7.4 billion from the American Rescue Plan to hire public health workers. But the investment is really needed to modernize our technological systems too.


Despite $500 million of funding last year to modernize public health data, it wasn't until last month that the Centers for Disease Control and Prevention (CDC) announced plans to develop the country's first forecasting and outbreak analytics center to analyze data in real time.

To transform the nation’s public health surveillance capacity, experts from the Council of State and Territorial Epidemiologists (CSTE) have called for a “public health data superhighway” that facilitates automatic data exchange. They say this is best done through public and private partnership. 

Rapid Improvement Is Possible

From internet speed and accessibility to artificial intelligence research, the U.S. is a global powerhouse when it comes to data. But that power hasn't been applied to public health.

The U.S. helped develop lifesaving vaccines in less than a year, so upgrading American health data infrastructure to meet the needs of this century is possible.

Our vaccine achievement was supercharged through public and private partnership by leveraging legacy companies who had teams, resources, incentives, and experience to accelerate innovation timelines. The CDC must consider a similar approach supplementing their high-profile working groups with healthcare business and technology leaders.  

In the meantime, the U.S. needs to triage and organize around what data matter most. Specifically, we must transparently report on breakthrough infections, boosters, and pediatric data.

The U.S. was once a leader in collecting systematic federal data on population health, and it has the bipartisan support to do it again. While we should continue use COVID-19 data from outside the U.S. as point of reference, that data should be used to inform or add to our own body of science. It's what good researchers do.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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