Stephanie Zaza, MD, MPH, FACPM is the President of the American College of Preventive Medicine, a professional medical association of physicians dedicated to prevention and preparedness. She is a 25-year veteran of the US Public Health Service at the Centers for Disease Control and Prevention, where she participated in federal responses to the 2009 H1N1 influenza pandemic and the 2013 MERS coronavirus threat.
I’m incredibly proud to be part of a profession that leans in when people and communities need us most. As preventive medicine physicians we are trained for this, and we do it in such a wide variety of work settings. After 25 years in Federal public health, I find myself today having my first experiences volunteering with my own local public health department and trying to translate and interpret the situation for my family and friends via social media and virtual platforms. Whatever your leaning in looks like, please be safe and stay well!
I’m also proud to be part of ACPM’s leadership so that we can serve the needs of our members during this national response to COVID19. ACPM is, of course, a professional membership society, not a public health response organization, so we have had to think carefully about the role we can and should play to be of service to our members. And, we run a very lean operation – alas, no virtual war room!
ACPM should be a thoughtful, proactive voice to share our expertise and insights with other professional and public audiences. To that end, we’ve upped our tempo in outreach to media for interviews, op-eds, and podcasts and will continue to do that, calling on our board members and other experts to assist. Finding and sharing information is critical in an emergency so we’ve begun aggregating selected resources in one place and establishing a regular cadence for communicating with our membership. And in the interest of capturing preventive medicine stories from the field, we’ve created this blog and will be actively seeking your stories – we developed guidelines for your submissions and want to hear from all of you! Doctor stories are already pouring into blogs and social media accounts; given the range of settings in which we work, I’m betting that preventive medicine physicians will have the most varied stories of any medical profession.
The intent of these strategies is primarily to support our members and our organization during the response. In addition, we know that if we demonstrate our expertise now, we will be in a position of much greater influence to assure better preparedness for future public health threats.
Within this overall communication structure, we also know that it is important to craft specific, timely messages and use them with discipline. This situation and the media cycle continues to rapidly evolve, and so too will our messages. Over the past two weeks, we’ve focused on messages demanding that public health expertise and public health agencies be prominently included in both decision making and risk communication.
Here’s why:
I confess that I’ve been dismayed at the way CDC and the entire public health infrastructure have been treated and portrayed by our national political leadership and the media. There is no question that the early days of this crisis were mishandled at every level. But, my long experience as part of CDC preparedness and response infrastructure is that it is a learning organization and our CDC colleagues take every part of their mission very seriously. I know there are ways to do this better, and thus, I’ve tried very hard to make it clear that while my expectations are high, so is my trust.
I retired from CDC four years ago after a 25-year career. I don’t have a special “bat-phone” and have been very careful to not trade on my friendships to get information I am not otherwise entitled to as a member of the public. I have taken advantage of all the ways CDC reaches out to clinicians, health departments, and the public. And I dig deeply into their published guidance to get my information. Thus, part of our ACPM messaging has been to push for increased access to CDC’s information by making their experts a visible and uncensored part of the response and communication infrastructure.
I’ve also been using this time to lay the groundwork for ACPM to be a strong force for public health preparedness. For me, prevention IS preparedness. Have you ever heard of a situation where people with chronic diseases did better in a public health crisis? No. A situation where social vulnerability wasn’t exacerbated in a crisis? No. A pandemic where the key messages aren’t, “prevent, prevent, prevent,” and then “vaccine, vaccine, vaccine?” No. This is preventive medicine. This is preparedness. If we, American preventive medicine physicians, aren’t the loudest voice for prevention and public health preparedness, who will be? And if we aren’t, then why do we exist as a profession?
This coming week I will be working with my local public health department to assist them in planning ahead for expanded laboratory testing. Big issues that we are seeing play out at every level across the nation are related to supplies – supplies of lab tests, PPE, ventilators. In our rural, high-altitude community with small critical access hospitals and limited personnel for contact tracing, these issues bring additional challenges for public health and clinical care. And, so, my personal messaging on social and traditional media will be to amplify statements we made in conjunction with our sister professional societies through the Council of Medical Specialty Societies and the American Medical Association. These messages make strong calls for Federal assistance in materiel production and distribution, and for economic assistance to mitigate the long-term impact on health and well-being. I will also use my social and traditional media platforms to highlight the excellent local work of our housing authority to quickly provide increased safeguards for physical safety and stable housing.
Finally, when this crisis is over, ACPM will lead the charge for big systemic change in our nation’s thinking and priority for preparedness. What I want:
1. Robust public health funding, not just for pandemic preparedness, and not just for one year as a reactionary measure after a crisis, but for all aspects of prevention and with an eye to the long game that is prevention and public health. I ask every single candidate in my jurisdictions – regardless of party – what they know about public health and how they will support CDC and public health infrastructure funding. I will specifically ask them to not reiterate their rehearsed lines about health care insurance. If they don’t understand what public health is and what it is not, I will do everything I can to educate them and make it clear I will vote for the person who best understands what public health is and why it is a priority.
2. A complete restructuring of U.S. Department of Health and Human Services (HHS) preparedness infrastructure that removes operational elements from the HHS Office of the Secretary, puts it at CDC where it belongs, and installs competent leadership at CDC that understands that prevention is preparedness, preparedness is power, and both are a priority. I will continue to make it my mission to identify and advocate for competent physician-leaders to serve as CDC’s director, preferably trained in preventive medicine.
3. An end to overly complicated and bureaucratic rules that stymie innovation and prevent governmental public health from effectively partnering with the private sector – clinical care, business, industry – to get things done. HHS Leadership that ends interagency squabbling about laboratory tests, the Strategic National Stockpile, and risk communication, and finds solutions and implements them through exercises and legally mandated protocols resistant to political maneuvering.
I said earlier that ACPM itself can’t be a response organization. In addition, I have been adamant that we not engage in offering solutions that cannot be informed without much deeper situational awareness - awareness we have no way of getting from outside; that go far beyond our mandate as a professional membership association; and that contribute to the chaotic public conversation about what society should and should not be doing. Instead, we are doing exactly what we should be doing: providing information resources to our members; interpreting how our clinical work should adapt to this situation; acknowledging where mistakes have been made and pushing for solutions not blame; and demonstrating support for our members and colleagues at CDC and state/local public health to be full participants in making public health recommendations.
Thank you for the leadership you provide in your communities and for leaning into the challenges facing communities across our nation. I’m proud to be part of this wonderful profession. Be well. Stay safe.