Summary
According to the World Health Organization WHO (2009), all efforts to respond to a public emergency crisis should be served by a social contract coordinated by government or state systems, serving all citizens. The concept of a “purposive state” implies that a state or society pursues a particular purpose, minimizing the impacts of an emergency crisis such as a pandemic. The national government is the leader in pursuing this purpose, especially in public health crises such as the COVID-19 pandemic (WHO, 2009). However, enhancing preparedness and response to a pandemic requires a whole-of-society approach involving all sectors, individuals and families. While all these actors are engaged in preparedness and response, the government has a more central role in the overall coordination, targeting and allocation of resources and communication.
Furthermore, the healthcare services sector has a natural role in advocacy and leadership in preparedness and response to an influenza pandemic. The healthcare sector represents the public sector level of the social contract. In coordination with the government, the healthcare sector provides information to raise awareness about the risks and consequences of the pandemic (WHO, 2009). In addition, non-health sectors, including business, are crucial during pandemics to ensure essential services and goods continuity. Social and civil society organizations, communities, families, individuals and traditional leaders have a crucial role in enhancing pandemic preparedness at the local level. In particular, community-based organizations are critical in strengthening preparedness because they have close contact with the community.
The WHO emphasizes coordinated efforts between all levels of government, but states may have to surrender specific roles to the federal government to increase the effectiveness of preparedness and response. Response and preparedness to public health emergencies should be based on The International Health Regulations (2005). State parties under the IHR are obligated to notify the WHO of any public health emergency if it is severe, unexpected and has a risk of international spread (WHO, 2009). In addition, IHR obligates state parties to create public health capacities to detect, assess, and respond to public health emergencies. The WHO is also responsible for overseeing vaccine production and rapid containment of the initial emergence of a pandemic. Rapid containment follows compelling evidence that a virus has pandemic potential, which follows the mobilization of expertise and resources.
Furthermore, the American emergency management framework emphasizes an intergovernmental, cross-sector approach. Like the WHO approach to emergencies, all levels of government have a role in mitigating disasters in America (National Research Council, 2007). However, local and state governments have a fundamental role in saving lives and property because disasters are perceived to have a local impact. For more significant incidents such as pandemics, local and state governments may be obligated to seek inter-state, regional or even national support. This coordinated effort helps to assess damage and the resources needed. However, if the scope of the incident allows, the president may have to declare a national emergency and bring the federal resources to bear. Emergency responders at all levels of government have to be conversant with incident management, which is the collection of command and control systems to execute orders to facilitate recovery from the effects of an emergency (National Research Council, 2007). Incident management is accomplished through an incident command system, whose functions include authorizing an incident action plan, overseeing operations in the field, planning the collection, evaluation, processing, and dissemination of resource and situational incident information, logistics and financial management.
Federal and California Governments’ Performance
Degree of Preparedness
The American emergency management framework comprises response, recovery, mitigation and preparedness. Disaster preparedness determines the extent to which an emergency crisis affects social and economic life. Lewis (2020) argues that one can only know which vulnerabilities to mitigate if one appropriately plans a scenario with the vulnerabilities in mind. The American government faced difficulties in mitigating the pandemic in time because it had not adequately designed for it. Similarly, Jacobs and Fink (2020) observe that America was unprepared for the pandemic, citing the overwhelming healthcare facilities and resources as more and more people became infected. There were acute ventilator and health worker shortages to help mitigate the pandemic. These incidents indicate a low level of preparedness for the COVID-19 viral outbreak. The American emergency management framework requires the president to declare a national emergency when the incidents are more significant, such as pandemics (National Research Council, 2007). However, the virus had already spread by the time President Trump was declaring a national emergency. Despite having information about the spread of the virus from China, the American government did not put in place strategies to forestall its spread into the country (Gerstein, 2020). In addition, there was inadequate bio-surveillance data to develop the capacity to detect the presence of the disease despite prior efforts to improve the country’s bio-surveillance capacity. However, some news sources report that some quarters of the American government had information about the risk of the virus. Still, their efforts to prompt action from the president were futile (Lipton et al., 2020). Therefore, the president acted as an impediment to a higher level of preparedness for the pandemic. Based on WHO’s framework for preparedness in times of emergency, a whole-of-society approach is vital (WHO, 2009). Apart from the government, most local and state governments and other non-health sectors, including civil society organizations and community-based organizations, were not prepared, just like the federal government.
Since the virus broke out in China at the beginning of 2020, many state governments did not start emergency response early enough. The California state government started implementing proactive emergency responses such as stay-at-home orders earlier. For instance, it was the first American state to declare a lockdown (Singh, 2020). These strategies indicate that California was better prepared for the pandemic than the federal government. However, the events following the first lockdown demonstrated that California was also ill-prepared for the Covid-19 pandemic. The number of infections overwhelmed the capacity of the state’s healthcare facilities. Towards the end of 2020, hospital bed capacity was nearly zero, and the positivity rates were rising. The level of unpreparedness in California was demonstrated on Thanksgiving Day as residents suffered from COVID-19 fatigue. Many of the infections reported towards the end of 2020 resulted from the Thanksgiving (Caldwell, 2020). Had the government been better prepared for the pandemic, it would have restricted gatherings during the thanksgiving. According to the National Research Council (2007), disasters have local impacts, and therefore, the state and local governments are responsible for enhancing preparedness. The California state government did not establish a timely intervention to improve community preparedness.
Incident Action Plan
Furthermore, the pandemic was a more significant incident that required the federal government’s input in incident management. The incident action plan implements the command and coordinates all activities for the staff, coordinates key people and authorizes the release of information to the news media (National Research Council, 2007). The federal government, through the president, provided the command for responding to the pandemic. However, the federal government failed to coordinate activities and stakeholders in the healthcare system, leading to fragmented implementation of directives and commands. The president’s acts, such as disbanding the task force during the pandemic and reorganising its leadership, disconnected the relationships in the healthcare system that would have been essential to wage a fight against the pandemic (Gerstein, 2020). In California, the state government tried to have a centralized command. Still, due to a lack of coordination from the federal government, it was challenging to coordinate all staff and activities. Other states had different rules and regulations that undermined efforts in California, a highly decentralized state.
The federal government also lacked coordination of operations to allocate resources, which is crucial to meet emergency response objectives. The decline of hospital bed capacity, lack of enough healthcare professionals and lack of ventilators in the federal and Californian governments indicates a lack of coordination of operations. There were also inconsistencies in the enforcement of emergency response measures in California as some public officials flouted established containment rules. Operations such as those highlighted here are facilitated by a planning process (Ho and Pengelly, 2020). The federal government utilized geographic assets, including state and local government health facilities, private health facilities and social services sectors, to combat the pandemic with relative success. However, there was poor planning at both federal and California government levels, although California had a robust plan initially for containing the pandemic. However, the federal government neglected rural and disadvantaged areas in terms of logistics, including support needs, supplies, facilities, transportation, communications, food, and medical support (Jacobs and Fink, 2020). There was similar neglect in California, as demonstrated by structural inequality in allocation of resources in response to the pandemic. In addition, the congress took time to release funds to facilitate response measures, delaying response across the country. The delay in releasing funds forced the state government to use its resources to acquire masks and other supplies (Lipton et al., 2020). The WHO requires states parties to develop capacities to prevent or delay the spread of an influenza pandemic through coordinated efforts at all levels of the government (WHO, 2009). As such, the government at federal and state levels generally failed to fulfil the WHO guidelines for containment of a public emergency such as a pandemic.
What Governments Should Do Different
The responses by the federal government and the Californian state government were largely ineffective since the pandemic devastated the lives of citizens. In the case of future pandemics or other disasters, the federal government should improve emergency preparedness through an overhaul of the healthcare system governance. This step is crucial because the core problem that undermined response efforts to the pandemic was lack of coordination among federal and state actors and other non-governmental stakeholders (Gerstein, 2020). It is therefore important to have clear chain of command and understand who is responsible for each of the activities involved in emergency response from the federal to state and local governments. There is a need to create a centralized health security enterprise at the federal level that will ensure greater coordination among federal, state and local governments. In addition, a centralized health security enterprise will close disconnects between public health agencies and create a more coordinated chain of command (Jacobs and Fink, 2020). This aspect would facilitate coordinated flow of information about potential emergency scenarios, which would enhance a more effective preparedness and response at all levels of government and public health system. However, despite the creation of a more effective health security enterprise, it may be difficult to predict its effectiveness when one considers the nature of the individual occupying the presidency. President Trump may have been receiving early reports about the impending pandemic, but he decided to downplay these reports. There may be the need for a review of presidential powers and responsibilities in the face of a public emergency to enhance a proactive presidency.
Furthermore, National Research Council (2007) explains that disasters are managed through a federal structure of responsibilities and resources and requests for resource support travel upwards. A centralized health security enterprise with better coordination will enhance a smooth flow of resources from the federal government to the state and local governments. Financial and human resources are essential in the preparedness, response, mitigation and recovery in the case of a public emergency. However, the deployment of these resources must be based on proper prediction of public emergencies. The federal and state governments need to activate the use of bio-surveillance data to detect potential disease outbreaks and allocate resources in preparation for a response. Bio-surveillance data should be shared among federal and state and local governments and public health emergencies to increase alertness on potential emergency situations and facilitate a cross-sector, intergovernmental rapid response (Gerstein, 2020). In addition, there is need for the federal and state governments to facilitate the training and professional development of more healthcare staff to increase capacity for preparedness and response in public emergency situations.
Conclusion
From the articles and other information sources used in this unit, I have learned that emergency response, such as during pandemics, requires coordinated efforts across all levels of government, non-health organizations, individuals and families. However, the government has a greater role to play not only in allocation of resources, but also in enhancing preparedness and effective response through capacity building and coordination of operations.
References
Caldwell, T. (2020). ‘We are getting crushed.’ What’s behind the alarming rise in California’s Covid-19 cases. Retrieved from:https://edition.cnn.com/2020/12/18/us/california-covid-surge-alarming-rise/index.html
Gerstein, M. (2020). Epic fail: Why the US wasn’t prepared for the coronavirus pandemic. Retrieved from:https://thebulletin.org/2020/04/epic-fail-why-the-us-wasnt-prepared-for-the-coronavirus-pandemic/
Ho, V., & Pengelly, M. (2020). Millions of Californians put under strict Covid lockdown. Retrieved from:https://www.theguardian.com/world/2020/dec/06/california-covid-lockdown-us-new-cases-hospitalisations-deaths-stay-at-home-order
Jacobs, A. & Fink, S. (2020). How Prepared Is the U.S. for a Coronavirus Outbreak? Retrieved from:https://www.nytimes.com/2020/02/29/health/coronavirus-preparation-united-states.html
Lewis, W. (2020). Disaster response expert explains why the U.S. wasn’t more prepared for the pandemic. Retrieved from:https://dornsife.usc.edu/news/stories/why-u-s-wasnt-better-prepared-for-the-coronavirus/
Lipton, E., Sanger, D., Haberman, M., Shear, M., Mazetti, M., & Barnes, J. (2020). He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus. Retrieved from:https://www.nytimes.com/2020/04/11/us/politics/coronavirus-trump-response.html
National Research Council (2007). Emergency Management Framework – Successful Response Starts with a Map: Improving Geospatial Support for Disaster Management, National Research Council, Washington, DC: The National Academies. Retrieved from:https://www.nap.edu/read/11793/chapter/5#57
Singh, M. (2020). How California went from a leader in the Covid fight to a state in despair. Retrieved from:https://www.theguardian.com/us-news/2020/dec/28/how-california-went-from-leader-covid-fight-despair
World Health Organization (WHO) (2009). Pandemic Influenza Preparedness and Response: A WHO Guidance Document, Chapter 3, World Health Organization. Retrieved from:https://www.ncbi.nlm.nih.gov/books/NBK143067/.
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