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Opinion | The U.S. is more equipped than ever against covid. Thank you, Ashish Jha.

Leana Wen Opinion
Thought Leader: Leana Wen
June 21, 2023

The United States is in a better position to respond to emerging covid threats than it was a year ago. That’s in no small part because of the efforts of Ashish Jha.

When the physician and Brown University academic began his role as the White House’s covid-19 coordinator in April 2022, the United States was just emerging from the massive winter surge of coronavirus infections. Treatments were still difficult to obtain, and there was great uncertainty about how Americans were going to live with the ongoing threat of covid-19.

A year later, there are many reasons to be hopeful. As Jha explained to me in an interview during his final days on the job last week, excess deaths have remained close to zero for several months and overall mortality from covid has plummeted. This is a large reason President Biden announced Jha’s departure and the closure of the White House’s covid response team, which will be folded into a newly established office on pandemic preparedness.

“I think most Americans feel like we’re in a much better place,” Jha told me.

Key to this progress is his team’s work in expanding treatment access. Jha explained to me that when he began, it was clear that if someone infected with the coronavirus took the antiviral pill Paxlovid, their “chances of ending up in the hospital or dying were cut dramatically.” Yet he estimated that there were only 3,000 to 4,000 courses of Paxlovid prescribed a day. Within about three months, that number jumped tenfold thanks to aggressive efforts to educate providers, expand “test to treat” programs and ensure medication access in lower-resourced communities.

Jha also said the government is much better prepared for future variants because of significant improvements in the surveillance of the coronavirus through wastewater. Because many tests are now done at home, monitoring virus levels in sewage is a better way of detecting community infection levels than through case numbers and test positivity. Today, Jha said, this surveillance covers most of the country.

This will likely be put to the test this winter. Jha said he’s anticipating a rise in covid cases in the coming months, along with the usual rise of other respiratory diseases such as the flu and respiratory syncytial virus (RSV). The key, he said, includes preparing with a proactive vaccination campaign.

This is already happening. Last week, advisers to the Food and Drug Administration voted to replace the existing bivalent vaccine with an updated booster that targets XBB omicron subvariants. This week, I expect the Centers for Disease Control and Prevention will recommend the updated booster as part of a broad fall vaccine campaign. With the recent FDA approval of two RSV vaccines for people 60 and older, older individuals will probably be able to receive the updated coronavirus booster, the flu shot and the new RSV vaccines this fall.

So, yes, older Americans will have to receive multiple shots in the coming months. But as Jha put it, “If it protects you through the winter and prevents death and serious illness that kills literally tens of thousands of seniors, that’s totally worth it.”

Though he said the United States is now better prepared for a future pandemic than when he started, he expressed worry about the loss of trust in public health, which he says needs “rebuilding.” As he returns to his position as dean of the Brown University School of Public Health, Jha said he wants to think about how to “train the next generation of public health leaders” to engage with a broader swath of Americans, including “across the political spectrum.”

I share his deep concern about trust; after all, vaccines and treatments don’t make a difference if people don’t use them. Public health hinges on public trust — and restoring that should be the top priority, not only for experts in the field but also for everyone who cares about how we will respond to future health crises.

Nevertheless, I feel reassured by Jha’s optimism. We will indeed enter this next winter better equipped than we’ve ever been against covid-19. Jha and his team at the White House deserve credit for that.

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