AMA President Gives Prescription to Fix Ailing Healthcare System

Gerald Harmon, MD, says the United States has endured a twin pandemic—the health effects of COVID-19 and an erosion of trust in healthcare experts.

The president of the American Medical Association delivered a national address today marking the end of the second year of the coronavirus pandemic.

The pandemic has been the gravest public health emergency in generations. As of today, the pandemic has claimed 5,941,607 lives globally and 966,736 lives in the United States, according to worldometer.

"This month marks the two-year anniversary of the first known death to COVID-19 in the United States and there isn't a single person I know who isn't worn out, frustrated, or just physically exhausted. We've experienced trauma, lockdowns, economic difficulties, and at least five distinct viral surges," AMA President Gerald Harmon, MD, said today in an address delivered via livestream from the National Press Club in Washington, DC.

The pandemic will have a lasting impact on the country, he said. "It's my opinion, two years into this tragedy, that our nation is suffering a type of battle fatigue from our long fight with COVID, and the full impact of this pandemic on our national psyche may not be known until long after this difficult period ends."

Harmon said the nation has endured a twin pandemic—the ongoing struggle with the health effects of COVID-19 and an erosion in trust.

"COVID-19 will be with us for the foreseeable future, and we must understand what that means and make every effort to protect the most vulnerable among us. That means becoming fully vaccinated against the virus and receiving booster shots when eligible. And it means vaccinating our children, when they are eligible. I encourage anyone with questions to talk to their doctor or another trusted health professional about the safety and efficacy of COVID-19 vaccines," he said.

The erosion of trust in health professionals is nearly as damaging as the pandemic itself, Harmon said.

"Sadly, COVID-19 isn't the only pandemic we are fighting in America. The other pandemic is a profound loss of trust in the advice of experts, including doctors and scientists, to help us make sense of what's happening and make informed decisions about our health. This pandemic of mistrust was probably beginning before COVID-19, but the extreme polarization during this crisis has profoundly hampered our nation's ability to respond. It is a major reason why the U.S. has a far higher death rate from COVID-19 compared to other well-resourced countries," he said.

Six primary factors have contributed to the climate of mistrust, Harmon said.

• Inadequate funding of pandemic preparedness and public health agencies 
   
• Unclear lines of responsibility
   
• Uneven use of federal authority to produce masks and other personal protective equipment, as well as testing and supplies
   
• Mixed messaging on masks, social distancing, isolation, and quarantine
   
• Political and sometimes personal attacks on scientists and physicians
   
• An inadequate response to the omicron variant surge and a shortage of coronavirus tests more than 18 months into the pandemic

"Playing the blame game is an exercise in futility, but we do recognize these missteps. Our focus now should be learning from those mistakes and rebuilding the trust lost as a result," he said.

One of the main ways to restore trust in healthcare experts is to address misinformation and disinformation by a small number of healthcare professionals, Harmon said.

"Surprisingly to me, some of the loudest purveyors of misinformation and junk science during this pandemic have been a very small number of doctors and health professionals. These offenses are, in my opinion, the most egregious of all because they violate the ethics of our profession and each lie and untruth spread by the click of a mouse erodes the trust that is at the very heart of the patient-physician relationship—trust that is essential in our ability to provide care. This is why the AMA has called for state medical boards to respond swiftly when physicians spread falsehoods online and through the media, particularly disinformation relating to COVID-19," he said.

Fixing healthcare system, rebuilding trust, and responding to next major health crisis

Five steps must be taken to restore the U.S. health system and trust, as well as to prepare for the next colossal public health emergency, Harmon said.

• "The first is to enhance our state and federal stockpiles of medically necessary supplies and improve the system for acquiring and distributing them. The shortage of PPE and other essential supplies in the early months of this pandemic slowed our nation's response and needlessly put lives of physicians and our frontline workers at risk. Given what we have experienced in this pandemic, global demand can quickly outpace supply for even simple items, such as cotton testing swabs. This should never happen in a country as rich in resources and manufacturing as ours."
   
• "Second, we must significantly increase funding to bolster our nation's diminished public health infrastructure. Chronic disinvestment in government public health agencies puts lives at risk and has severely limited our ability to fight COVID-19. State public health spending has dropped 16% over the last decade, resulting in the loss of nearly 40,000 jobs at state and local public health agencies. It's gaps like these at the community level that contributed to a lack of widespread testing, resulting in more-rapid virus spread in the early stages of the pandemic."
   
• "Third, we must learn from the process that led to the rapid-scale production of several safe and highly effective vaccines. Operation Warp Speed is, quite simply, one of the greatest scientific achievements of our lifetime. We believe the public-private partnership and operational structure of this plan should be preserved in some form for future pandemics or any time vaccines and therapeutics are needed in an emergency."
   
• "Fourth, the rapid expansion and integration of telehealth and remote patient care has been a lifeline during this pandemic—not only for patients but for struggling physician practices during periods of intense lockdowns. The AMA has long championed telehealth and has provided expert guidance, support, and resources to help physicians implement it in their practices during the pandemic. But for telehealth to succeed the way patients and physicians want it to, we need the help of Congress.
   
• "Finally, we must pause to consider the extraordinary pressure our nation's physicians and healthcare workers have had to shoulder the last two years—men and women on the frontlines of our emergency departments and intensive care units who have gone above and beyond in their service to all of us. They have worked extremely long hours, often for days at a time—through every surge—at great personal risks to themselves and their loved ones."