The End of the U.S. COVID-19 Public Health Emergency: Q&A with RAND Experts


(The RAND Blog)

Repeating pattern of blue surgical masks, photo by Dmitriy Sidor/Getty Images

Photo by Dmitriy Sidor/Getty Images

May 8, 2023

On March 13, 2020, as COVID-19 began claiming lives worldwide at a frightening pace, the U.S. government declared a public health emergency. That declaration is set to expire on May 11.

We asked RAND experts to reflect on the past three years: What were the effects on this country and around the world, what has changed, what are the most important takeaways, what was done right, and what was done wrong? At the same time, they looked ahead to what might be done to mitigate the health and geopolitical impacts of future pandemics.

The SARS-CoV-2 virus was first identified in China in late 2019; in January 2020 the World Health Organization declared a “public health emergency of international concern.” By the end of last month, more than 750 million cases and nearly 7 million deaths had been reported. The true number of cases and deaths probably far exceeds these official counts.

While acknowledging that the pandemic remains a significant public health priority, the Biden administration said in announcing the end of the emergency that “we have come to this point in our fight against the virus because of our historic investments and our efforts to mitigate its worst impacts.”

Over the past three years, RAND has produced dozens of reports and commentaries examining the pandemic's effect on public health, the economy, employment, education, national security, international affairs, and other areas.

The researchers in the Q&A below focused on many different aspects of the pandemic, and they were unanimous in their belief that while the official government-declared emergency may be over, the legacy of the disease will long endure.

  • Mahshid Abir is a senior physician policy researcher at the nonprofit, nonpartisan RAND Corporation.
  • Jennifer Bouey is a senior policy researcher, Tang Chair for China Policy Studies, and an epidemiologist at RAND.
  • Ray Block is the inaugural Michael D. Rich Distinguished Chair for Countering Truth Decay and a senior political scientist at RAND.
  • Anita Chandra is vice president and director of RAND Social and Economic Well-Being and a senior policy researcher at RAND.
  • Melissa Kay Diliberti is an assistant policy researcher at RAND and a Ph.D. candidate at the Pardee RAND Graduate School.
  • Laura Faherty is a physician policy researcher at RAND, professor of policy analysis at the Pardee RAND Graduate School, and attending physician at Maine Medical Center.
  • Courtney Gidengil is director of RAND's Boston office and a senior physician policy researcher at RAND.
  • Daniel M. Gerstein is a senior policy researcher at RAND.
  • Brian Michael Jenkins is a senior adviser to the president of RAND and the author of Plagues and Their Aftermath: How Societies Recover from Pandemics.
  • Krishna Kumar is vice president, international; Distinguished Chair in International Economic Policy; and a senior economist at RAND. He is also a professor at the Pardee RAND Graduate School.
  • Ryan McBain is a health policy researcher at RAND.
  • Andrew Parker is a senior behavioral and social scientist at RAND and a professor at the Pardee RAND Graduate School.
  • Marek N. Posard is a military sociologist at RAND and an affiliate faculty member at the Pardee RAND Graduate School.
  • Carter Price is codirector of the Center for Scalable Computing and Analysis, research quality assurance manager for the Homeland Security Research Division, and a senior mathematician at RAND.
  • Jessie Riposo directs the Disaster Management & Resilience Program within the RAND Homeland Security Research Division, and is a senior operations researcher at RAND.
  • Howard Shatz is a senior economist at RAND and a professor at the Pardee RAND Graduate School.
  • Elizabeth D. Steiner is a policy researcher at RAND and a member of the Pardee RAND Graduate School faculty.
  • Christopher Whaley is a health economist at RAND and professor at the Pardee RAND Graduate School.
  • Douglas Yeung is associate director of the Management, Technology, and Capabilities Program within the RAND Homeland Security Research Division, a senior behavioral and social scientist at RAND, and a member of the Pardee RAND Graduate School faculty.

Is the emergency truly over?

Brian Michael Jenkins The scheduled end of the national and public health emergencies on May 11 is purely an administrative step. Viruses do not answer to government decrees. History shows that pandemics have ragged endings, and some tend to return again and again.

The scheduled end of the national and public health emergencies on May 11 is purely an administrative step. Viruses do not answer to government decrees.

Brian Michael Jenkins

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Ray Block It is accurate to say that we can move beyond thinking of COVID-19 as a public-health emergency. It is also simultaneously true that COVID-19 still exists and that we must deal with it from now on. So, the announcement that the emergency has ended is really a declaration that we have moved from the “pandemic” to the “endemic” phase of living with the coronavirus. We want this to be over, but the coronavirus is a fact of life now—and something we should collectively remain vigilant against.

Daniel M. Gerstein Perhaps the best answer is “yes and no.” We have had many observed lessons during COVID-19, but not necessarily lessons learned or acted on. So, while May 11 marks the end of the emergency, until a fulsome accounting has been conducted, much work remains to address and remediate these shortfalls to be better prepared for the next pandemic.

Mahshid Abir With the combination of protection from COVID-19 vaccination and herd immunity, the emergency phase of the pandemic is over. However, it is possible that other variants may result in pockets of outbreak across the United States particularly among at-risk populations.

Jennifer Bouey I'd say we reached a milestone: COVID-19 is no longer an uncontrollable pandemic that will alter people's daily life. Even though variants are still spreading, in the United States, India, and many other parts of the world, it is not causing health care system disruptions and significant mortality.

Courtney Gidengil We certainly are in a different phase of this pandemic than we were in 2020, or even just one year ago. We have fairly broad immunity from both vaccines and infection, and morbidity and mortality have come down substantially.

Jessie Riposo While the “storm” of COVID-19 may have passed, and as the emergency declarations subside, long-term recovery efforts are just beginning. The full extent of the damages from the COVID-19 disaster are still being measured and assessed. The implications of COVID-19 to society, the economy, individuals' health, educational attainment, and our culture could take years to fully understand and address. The recovery from COVID-19 is in its infancy.

Melissa Kay Diliberti The day-to-day crisis may have faded in K–12 schools, but the emergency is not yet over. Students of all backgrounds—but especially Black students, Hispanic students, and students experiencing poverty—lost critical opportunities to learn and experienced trauma that affected their academic learning and social and emotional development. Teachers and principals also suffered poor well-being and adverse working conditions, which led to increased job dissatisfaction.

What are some key takeaways from the pandemic?

Gerstein Here are five specific takeaways: We are using 18th-century legal frameworks with 19th- and 20th-century processes to respond to 21st-century global issues. We remain challenged to identify, assess, communicate, and mitigate risks. Policy without science is fantasy, but science without policy is also problematic. The basic research of yesterday led to key technologies such as messenger RNA vaccines—investment in R&D matters. And, innovation during all phases of the pandemic remained imperative.

Krishna Kumar The pandemic exposed and exacerbated multiple fragilities in the global economy and national economies: supply chain bottlenecks; heavy indebtedness of many economies; expansive monetary response that together with shortages would sow the seeds of high inflation; inequality within countries.

Ryan McBain I see two asymmetric story lines. One is a story of success—that health tech was able to bring a safe and effective set of vaccines to market in record time, and the underlying technology has the potential to transform other areas of health care. The other story is one of failure—about distrust in and devolution of institutions.

Elizabeth D. Steiner The COVID-19 pandemic was a shock to the U.S. public education system and shifted teaching and learning in ways that are likely to linger. For example, many teachers became much more comfortable using technology in their teaching. It also seems likely that some applications of remote instruction (e.g., for snow days or sick days) will continue in some districts.

Carter Price Our supply chains are much more vulnerable than we previously thought. In the early days of the pandemic, there were severe shortages of many essential goods. In some cases, it took months or years for supply chains to come back online. Policymakers should consider how to encourage more-robust supply chains particularly for critical goods.

Marek N. Posard When people are cooped up in their home for long periods of time, afraid, and bored, things in society can get weird quickly. We saw this with the various conspiracy theories that suddenly became mainstream during the height of the pandemic.

How would you rate the U.S. response to the pandemic?

Price As a nation, we did a poor job responding to the pandemic itself, particularly in the early days. Early public health communications were inconsistent and frequently not well grounded in science. The policy response was incoherent and fragmented. These problems led to our per capita death rates being substantially higher than that of peer nations And, by failing to have risk-informed policies, there was substantial learning loss for children taken out of school.

COVID-19 has really highlighted that we, as a society, don't like to do hard things for very long. Meaning, we get tired of making sacrifices, being told what to do, of funding our public health institutions to do their work.

Laura Faherty

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Laura Faherty We overestimated the willingness of the public to take up the stunning scientific advances like the vaccines and overlooked the importance of rigorous social science-based efforts to ensure uptake. COVID-19 has really highlighted that we, as a society, don't like to do hard things for very long. Meaning, we get tired of making sacrifices, being told what to do, of funding our public health institutions to do their work.

Diliberti Although education policymakers and leaders did their best with limited—and often conflicting—information, the pandemic caused major disruptions to both student learning and to their social and emotional development. Educators went to great lengths to continue teaching, but there is increasing evidence that the scattered nature of schooling during this period was bad for both students and educators. The students who learned remotely for longer periods of time lost the most academic ground.

How has the pandemic changed things in the United States and around the world?

Anita Chandra RAND identified two realities. One was that the pandemic raised consciousness about pre-existing health and other structural inequities, but the interest in topics like systemic racism and its influence on health was mostly short-lived. But a second, and perhaps brighter, point for future community action, is that many places in the United States grabbed the devastation of the pandemic as an opportunity to improve health generally and put into place equity action plans.

Jenkins Pandemics, like dragons, have long thrashing tails that devastate economies, fray the fabric of society, intensify prejudices, deepen political divides, profoundly affect attitudes, and leave psychological scars—all of which have political repercussions. American society was already polarized before the pandemic, but the outbreak and the response have resulted in increased distrust of institutions—and of each other.

McBain At first, virtual health care was required because it was risky to get health care in-person. But people came to like this—it saved time and money. I think telehealth is here to stay. Likewise, people worked from home because they couldn't go into work during the pandemic. While some people want to go back into the office, many now prefer to work from home.

Howard Shatz The pandemic upended the global economy, resulting in large losses of gross domestic product worldwide. But by the time the pandemic was well into its second year, an unexpected pattern had emerged. The world's worst pandemic in a century accelerated previous trends but had not changed much about the international economic order.

What improvements might facilitate a more-efficient response when the next pandemic strikes?

Faherty Testing! Without it, we're flying blind. Absolutely key to situational awareness. More-innovative ways to test humans, animals, and the environment.

Abir We need to entirely rethink pandemic planning based on this experience, but also be prepared to respond to unthinkable future scenarios. Some of the key gaps in the pandemic response included an approach that considered public health interventions in a vacuum without considering “collateral” damages to the economy, education, and mental health and many other aspects of society.

Chandra Two areas deserve our focus going forward. First, is the essential reimagining and recapturing of what public health does, how it is understood by the American public, and how the field grabs hold of its original social impact mission. Second, public health needs to modernize in many ways, not the least of which is in the data systems that support decisionmaking.

Gerstein The United States should establish a national commission for COVID-19 as it did following 9/11. Such a focused effort would allow for collecting and assessing shortfalls and developing coordinated approaches to preparing for, responding to, and mitigating future pandemics.

Steiner For K–12 schools, planning and consistent guidance—particularly around quarantines and remote instruction—would help facilitate a more-organized response when the next pandemic strikes. Federal and state policymakers should help schools develop emergency response plans, including clear policies, communications plans, and resources for families.

Christopher Whaley Our research suggests that risk mitigation strategies that rely on changing behavior, whether shelter-in-place or other policies, are likely to have limited impact. Instead, investing in vaccines and technology so that vaccines can be quickly administered is critical for pandemic preparation.

Gidengil We should take this time as things have settled down to learn from the last three years and be prepared to apply those lessons to the next threat that emerges. We don't know when that will happen, but we do know it will happen again. We need to keep the pilot light burning in between threats so that we don't lose our collective knowledge and experience.

Andrew Parker First and foremost, prioritize the social and behavioral sciences alongside of the biomedical sciences. Invest in social and behavioral science infrastructure, because the public and their response is fully half of the equation.

McBain We do not have the robust decisionmaking systems or trust in public health institutions to operate more effectively, efficiently, and equitably next time. To get unstuck, it would require bridging political parties and engaging in significant institutional reforms. If this happens, it will be over the timescale of years, or decades, not months.

Douglas Yeung Improving vaccination rates among minority and lower income groups will require addressing longstanding concerns—like those that influence both individual beliefs about vaccination and structural barriers, including vaccine access. As one path to improving uptake, trusted health care providers may be well suited to share accurate information about vaccines, including their benefits and risks.

Why was it so difficult to combat disinformation around the pandemic and what can be done to improve the dissemination of accurate information and data to the public?

Parker The logic of public health—that measurable good can be done for the general public, even though a specific action doesn't move the needle for an individual—is tough to grasp. Add on top of that the psychological trickiness of adding a small risk of commission to protect from a larger act of omission—it's just a tough message to sell.

Block It is tough to combat misinformation and disinformation because facts and falsehoods about COVID-19 have become tightly attached to our social and political identities. For example, believing conspiracy theories regarding where COVID-19 originated, how it spreads, or if vaccines are effective signals not only whether people are “correct” or “incorrect” but also what communities people belong to.

It is tough to combat misinformation and disinformation because facts and falsehoods about COVID-19 have become tightly attached to our social and political identities.

Ray Block

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Yeung Conspiracy theories about the COVID-19 vaccines were widely believed. Dispelling them is difficult, but could involve providing counternarratives with accurate information about vaccines, or seeking to dampen anger by promoting civil discourse around science and public health.

Abir Misinformation adversely impacted the pandemic response on many levels, including resulting in preventable spread of the disease and related hospitalizations and deaths and vaccination refusal, just to name a few. Lack of consistent and coordinated messaging from public health officials at the federal, state, and local levels also fed into public distrust and lack of compliance with public health interventions.

Posard Conspiracy theories and disinformation can be exciting to people, making it attractive for some to go down rabbit holes of falsehoods they otherwise would not even consider entertaining in any other context.

Are there response strategies implemented in other countries that could serve as models?

Abir In one RAND study, we evaluated pandemic response in a sample of nations in the Middle East. In some with much less resources, creative interventions were implemented to prevent the spread of disease within hospitals—for example, by dedicating entire facilities for COVID-19 patients only—and by implementing a national control center for distributing patients to different hospitals as a strategy for load-balancing.

Bouey I am fully convinced that very early alert, preparation, and use of non-pharmaceutical interventions such as isolation and masking can save millions of lives before vaccines and treatments are available. Some countries made it happen—South Korea, Singapore, Taiwan—and they have had much less loss in terms of lives and as well as economically.