Giants On Clay Feet – COVID-19, infection control, and public health laboratory networks in England, the US, and (West-)Germany (1945-2020)

Abstract

COVID-19 has exposed significant differences in public health systems’ ability to mount effective test and trace responses. This article analyses the historical and structural reasons behind the relative success of Germany and the problems experienced in Britain and the US during the first wave of the pandemic. It also asks why recent international surveys overestimated Anglo-American preparedness. The article argues that the answer lies in the different evolution of public health systems as well as varying public health capacities at the local level. In Germany, post-1994 reforms of the decentralised public health system managed to overcome decades of political neglect and underinvestment and strengthen federal integration without compromising public health capacity at the state and communal level. This joint strengthening of the centre and hinterland allowed the Robert Koch Institute to function as an effective coordinating hub for locally tailored COVID-19 responses. By contrast, the decades after 1970 saw world-renowned Anglo-American public health systems face increasing challenges posed by funding cuts, privatisation, overambitious reforms, and increasing loss of political autonomy. Both the US Centers for Disease Control and Prevention and Public Health England retained significant prestige, which resulted in an overestimation of capacity by international reviews. However, once centres in Atlanta and Colindale had been overwhelmed, there was little local and state public health capacity to fall back on.

Make it new: reformism and British public health

“…The years between 2015 and 2020 saw substantial cuts to local government and PHE budgets, resulting in a public health system that was performing at a high level but running on fumes, a fact made painfully obvious by COVID-19. 1 So how can British public health be reformed? Looking to Germany might not provide all the answers.…”

How can Environmental Health Practitioners contribute to ensure population safety and health during the COVID-19 pandemic?

“…Additionally, there are reports that public health has been chronically underfunded. There is a global trend of decreasing funding for public health with the curative approach given precedence over the preventative approach (Moran, 2016;Kirchhelle 2020;Sen-Crowe et al 2020). In some countries, such as in the U.S. since the 2008 recession (Trust for America's Health, 2020), in England with policies of austerity that have led to a retreat to statutory functions (Dhesi, 2019) where, for example, Public Health funding has been cut by 700 million since 2015/16 (Local Government Association, 2019 and in Australia (https://www.aihw.gov.au/).…”