Mr Berger brings extensive experience in public health, with a focus on emergency preparedness, mental health and substance use disorder integration, and addressing health disparities, including work on human immunodeficiency virus (HIV) for federal public health agencies. Prior to joining the federal government, Mr. Berger served as a Public Health Planner for local health departments. He remains actively engaged in shaping public health strategies and policies, while also providing insights on critical health issues.
The 9/11 Commission Report, more formally the Final Report of the National Commission on Terrorist Attacks Upon the United States, noted the “unprecedented shock and suffering” associated with the September 11 attacks on the United States. Perusing headlines even the day before, it is hard to envision what occurred the next day. While the public health impacts of 9/11 were extraordinary, that they were followed in September and October by anthrax-contaminated mailings and five deaths emphasized to all the challenge and necessity of public health preparedness. Roughly 20 years later, COVID-19, which has led to more than 1 million deaths and a reduction in US life expectancy, further highlighted the importance of bolstering public health preparedness.
Shortly after September 11th and the anthrax attacks, the federal government started to in earnest support hospital and state, local, and territorial public health agency preparedness. The 9/11 Commission endorsed incident command system and management principles and these approaches have been adopted over time within the public health sector, though perhaps not seamlessly.
Not surprisingly, many gaps remain in public health preparedness, some of which were laid bare during the recent COVID-19 public health emergency. The Government Accountability Office, among others, has recognized the need for enhanced coordination and collaboration.
COVID-19 highlights the importance of what the Federal Emergency Management Agency rightly calls a Whole Community response and nowhere perhaps is that more necessary than in public health-related emergencies. Even today public health as a whole accounts for roughly four percent of overall US health spending and public health emergency planning, preparedness and response comprises only one piece of those resources.
While 9/11 was perceived as having brought people together, however briefly, COVID-19, manifestly, has not done that. Debates continue about the nation’s response to COVID-19, including (among many other topics) alleged failures of risk communication, the role of public health authorities and tensions associated with balancing civil liberties and perceived public health response needs, the duties of essential workers and equity needs within and outside the United States. COVID-19, in short, raises ethical, medical, scientific and policy quandaries that will not soon be resolved. The need to implement “lessons observed” from COVID-19 is reflected in recent (reemerging) concerns about avian influenza.
In stark contrast to 9/11, no national commission yet has been empaneled in the US to consider COVID-19’s impacts and potential lessons, though such efforts, with various degrees of success, have been launched in other nations, reports completed by some federal agencies, and efforts supported under the auspices of various nongovernmental entities. Legislative proposals within the US for a national COVID commission have been introduced. Whether such a commission would serve a resource for future planning and enhance preparedness or constitute yet another point for post-COVID controversies is hard to predict. But perhaps a bipartisan national commission, if not resolving all disagreements, at least could help to heal some of COVID-19’s enduring civic wounds.
September 11th also serves as a reminder of importance of disaster behavioral health as part of public health emergency planning. Survivors experienced post-traumatic stress, anxiety and depression years after the 9/11 disaster. So too did those who support disaster response. We have since seen protracted behavioral health impacts in hurricanes, mass violence, COVID-19, drought, extreme heat, and wildfires. COVID-19 in particular has highlighted the importance of trauma-informed disaster planning, preparedness and recovery. FEMA in its 2021 initial assessment of COVID-19, for instance, noted that “pandemic conditions will continue to have behavioral and mental health implications.” As well, the opioid overdose crisis, responsible for more than 100000 overdose deaths per year, first declared a public health emergency in October 2017, continues to be renewed even as the COVID-19 emergency declaration has expired.
A British poet once said of a prime minister that he ‘failed in foresight, because he failed in insight.’ Though there had been crises before September 11th, we perhaps lacked the insight to fully understand their breadth, scope and consequences and the whole-of-society commitment needed to mitigate and prevent these disasters. Post-September 11th and post-COVID while many gaps remain in preparedness and response, including within the public health sector, we have both the insight and foresight needed to work together as a nation to prepare for future disasters and emergencies.
Disclaimer: The opinions expressed are solely those of the author writing in his private capacity and should not be imputed to other individuals nor to any public or private entities.