By Jennifer D. Oliva
Americans are no doubt conditioned to expect spectacular failure in the face of public health crises.
In fact, the most striking similarity between our failed public health responses to the COVID-19 pandemic and the drug overdose crisis is our resolute refusal to learn from our mistakes and the rest of the world and make overdue adjustments.
The United States had been ravaged for decades by a shape-shifting drug overdose crisis before the emergence of COVID-19. Between 1999 and 2020, nearly one million Americans succumbed to drug overdoses.
Our drug overdose debacle not only persists; it continues to worsen. Just as COVID-19 deaths in the U.S. are likely undercounted, drug overdose deaths, too, are not tracked and reported in a timely manner. In both contexts, these reporting failures make it difficult to mount a competent public health response to prevent unnecessary mortality. The Centers for Disease Control and Prevention’s May 2022 provisional data estimates that the United States suffered 107,622 overdose deaths in 2021, which translates to an overdose death every 5 minutes and is the highest number of such deaths ever reported in a calendar year in American history. The previous record was set in 2020 and, before that, in 2019. Moreover, and despite the dominant narrative that centers white rural and suburban Americans, the drug overdose crisis has disparately impacted Black and Indigenous populations for the last several years.
While the National Institute on Drug Abuse Director characterizes America’s drug overdose mortality as “truly staggering” and the White House calls “the accelerating pace of overdose deaths ‘unacceptable,’” our government refuses to make meaningful changes to reverse course.
Instead of abandoning our expensive, morally bankrupt, and entirely ineffective War on Drugs, for example, we continue to double down on punitive law-and-order approaches to problematic drug use. As more of our neighbors die every year from polysubstance use and our toxic illicit drug supply, we continue to ignore the anti-carceral, public health-centric approaches to substance use implemented by conservative nations, like Portugal, which have been wildly successful at reducing drug overdose deaths, drug use prevalence, and drug use-related infectious diseases.
The U.S. COVID-19 public health response has been correspondingly disastrous and embarrassing. America has distinguished itself globally by amassing the highest COVID-19 mortality rate of any large, wealthy nation, as more than 400 people continue to die from the disease every day. As is apparently the American way, the privileged among us survived (while routinely complaining about relatively minor hardships) while our most vulnerable populations — the elderly, people who live in poverty, communities of color, individuals with disabilities, and people who use drugs — continue to be ravaged by the virus.
Our inequitable disease management system, outdated public health and long-term care infrastructure, and failure to competently track and report the virus’ ever-evolving transmissibility and virulence in real time has made it nearly impossible for public health agencies to either understand the full extent of COVID-19’s public health impacts or advance policy proposals to successfully mitigate negative health outcomes. We also remain in the dark about the causes and chronic health outcomes attendant to long-COVID. While the U.S. Government Accountability Office concedes that “[t]he full magnitude of [long-COVID’s] health and economic effects is unknown but expected to be significant,” the agency estimates that up to 23 million Americans have contracted long-COVID and approximately 1 million people have left the workforce as a result.
The country’s leaders continue to repeatedly make the same mistakes by, for example, dropping even basic mitigation measures on every variant’s downcycle and, thereby, greasing the skids for the next variant’s success. We also refuse to implement the strategies of other nations, like Singapore, which has vaccinated 94 percent of its citizens and kept its COVID-19 death count down to just 1,490 people. A recent New Yorker article perhaps captured COVID-era America best in observing that, “[e]ven in dying, we couldn’t manage collective action. It seemed so finally, depressingly American—a mistrustful, poorly led, decentralized, and historically libertarian country that couldn’t even put on a cloth mask without making a national political fight about it.”
Perhaps worse yet, the United States has squandered time throughout the COVID-19 pandemic, leaving us even less prepared for the next pandemic. A country that has rarely hesitated to go to war, implement widespread and intrusive surveillance, dramatically increase military and police budgets, and enact draconian criminal laws in response to far less dangerous threats than COVID-19, simply seems incapable of developing the public health infrastructure it needs to protect its people. Almost a year ago and in response to a Congressional proposal to slash a $30 billion pandemic preparedness plan in a reconciliation package, journalist Robinson Meyer queried as follows:
What reforms, if any, will the federal government make to its public-health agencies after their significant failures over the past 16 months? After 2,977 people were murdered on September 11, 2001, Congress started a war and revised the country’s approach to policing, surveillance, and national security within six weeks; it opened a new federal agency and commissioned a bipartisan fact-finding panel within 14 months…. Yet Congress has demonstrated little haste so far in determining what went wrong and how the country’s public-health institutions can prevent it from happening again.
Meyer’s musings were prescient. Not only are the COVID-19 and drug overdose crises ongoing, America is in the midst of yet another record-setting infectious disease disaster. The United States already has the highest number of monkeypox cases in the world, and the CDC has anticipated a rise in cases over the next several weeks as our children head back to crowded classrooms. It is frustrating to continue to make a case that appears increasingly futile, but it is beyond time for the United States to learn from our global neighbors and invest in infrastructure and evidenced-based strategies to prevent, detect, and rapidly respond to infectious disease and other public health emergencies.
Jennifer D. Oliva is Professor of Law at University of California Hastings College of the Law.