“Worried about the pandemics of yesterday”: Health policy experts are concerned that the nation’s health preparedness is eroding

October 15, 2025

Health policy in the United States is set by bodies including U.S. Department of Health and Human Services and Centers for Disease Control and Prevention. Most of the staffers at these organizations are scientists and public health experts. However, political leadership sets the agenda—which can vary widely depending on the administration in power.

We spoke with experts Dawn O'Connell and Rochelle Walensky about health infrastructure in the United States, future of medical research, vaccines, public health preparedness. O’Connell a former assistant secretary of Health and Human Services for Preparedness and Response, and Walensky, former director of the Centers for Disease Control and Prevention, were on campus for a talk hosted by the Kennedy School’s Institute of Politics.

Note: This interview was conducted before the announcement of widespread layoffs impacting the Administration for Strategic Preparedness and Response and the Centers for Disease Control.

Q: Health care has always been a political issue, though much of that debate has focused on fiscal issues or social issues such as family planning, and rarely around the practice of medicine—such as vaccine schedules—until recently. What do you attribute to that shift?

Dawn O'Connell: This is unchartered territory. It’s certainly not a place where most public health practitioners are used to having politics play such a prominent role. I think this shift is a direct response to the COVID pandemic and the experience that some people had with vaccine mandates and social distancing requirements. Those people viewed that guidance as “government overreach.” We’re seeing the flip side of that now. The current administration wants to “underreach” and limit the country’s access to vaccines. Unfortunately, this will result in a country that is sicker and more susceptible to dangerous viruses as we saw with the measles outbreak in Texas.

Rochelle Walensky: One of the real issues is that science is perceived as a definitive answer. Science is actually a stepwise, gradual process, seeking new information, and asking more questions. Science is the pursuit of knowledge. Among the things that were really challenging during COVID was that science moved rapidly. We had new variants. We learned more. We stood on the shoulders of prior giants, who taught us more. Science becomes fact when it’s repeated over and over again. But especially during COVID, it was mostly science and not fact until there were enough studies over time to allow us to say, “This is fact.”

Q: New mRNA vaccines have landed in the middle of this conversation about politics and medicine. How revolutionary are these vaccines?

O’Connell: mRNA vaccines made a significant difference in our ability to respond to COVID very quickly, and it separated itself from other more traditional vaccines in two ways: first, it was extraordinarily flexible and allowed us to target the particular COVID variant that was circulating at the time the vaccine was manufactured; and second, it was manufactured extraordinarily quickly. A traditional vaccine might take six to nine months to manufacture, these mRNA vaccines were manufactured in three months. It provided a very quick tool to protect the American people. And when talking about mRNA vaccines, I think it’s always important to emphasize that the FDA continues to deem them safe and effective.

Q: What happens if we walk away from these investments in vaccine technologies such as mRNA vaccines?

O’Connell: If we walk away, we lose this tool against any other pandemic pathogen. We currently only have COVID- and RSV-licensed mRNA vaccines. One of the things that I did as I was leaving the government was make investments in the development of a pandemic flu mRNA vaccine. At the time, we were watching H5N1 spread in dairy cows, and it was important for us to be able to have a tool that could be very flexible and very quick to manufacture if we were to see the virus begin to spread among humans. The investments would have also allowed us to prove that technology, if it were to be successful in a pandemic flu scenario, against other pathogens of pandemic potential. It can be an extraordinarily important tool, but we need to have it beyond COVID and RSV.

Walensky: We have seen in prior pandemics—whether in1918, where we didn't have a vaccine, or ’57 or ’68, or H1N1 in 2009—that how quickly you have a vaccine versus how quickly it spreads wildly through your population matters the most. When it has already spread wildly before you have a vaccine, that is when you see the most deaths. Time is so critically important.

Many people have said, “Well, if the United States is not picking up the slack and continuing the science of mRNA vaccines, other countries will.” Most of this investment has, in fact, been in the United States. While we might rely on other countries to do some of the work, if we abandon it, we can’t expect that other countries are going to entirely fill the gap.

Q: Are the public current administration’s public health decisions being guided by science?

Walensky: I believe in the statements from the administration that we should have a healthy America, that we should have transparent policies and that we should have gold standard science. Where I see challenges is that a decision will be made, and the data behind it are not obvious—that decisions are made from a podium by nonmedical or subject matter experts, that there is not a study or a collection of studies that they can refer to that says, “We made this decision based on this body of evidence, on these data,” or that they might point to one very small, poorly designed or unpublished paper or a handful of small, poorly designed unpublished papers. There is a wealth of data that is published in the highest-tier journals, with the best possible study designs, that have been through peer review, and they sometimes refute the evidence that is being put forward. That’s the real disconnect that has so many experts today baffled.

Q: Is there precedent for the political intrusion into this medical and health decision making?

O’Connell: Science has always been the foundation from which we make public health policy decisions at HHS. The established science, the science that everyone agreed to, was longstanding and understood. Certainly, different administrations will take that science and interpret it in different ways, but what we’re seeing now that is so unusual is the denial of science that has been long established.

Q: With any large public agency or organization, there are avenues for reform, areas to introduce new ideas and ways of thinking and doing business. For the agencies you oversaw, can you spotlight those areas for reform?

Walensky: It was helpful for me to step back and recognize the challenge that any subject matter expert or civil servant has every four years or eight years with the direction of the new administration. These experts are there for their careers, and they have to add activities that are priorities of a new administration. That happens over and over in somebody’s 20- or 30-year career in an agency. They have to pivot to the priorities of a new administration or the line item of a new authorization or a new appropriation. Those things are then very hard to stop when a new administration with new priorities arrives. That leads to decades of potential vestigial remnants of things that were once a priority and not anymore, but they’re very hard to stop doing. They might be written into some congressional budget.

So if you think about that as how we operate—our government and those priorities—it’s also the case that if you are a political appointee, then there are many people who’ve been there much longer than you have, and their job, in their mind, is to wait you out and to keep their head down and keep doing what they're doing.

Both of those things make it very hard to think innovatively, to transform, to update. That’s where DOGE could have been particularly helpful if they had been thoughtful and strategic about it. And unfortunately, they weren’t. We did a huge amount of work on lab reform at the agency while I was there because of the challenges that had happened with the COVID test when it rolled out. But we had some people disinterested in change, “I don't want to change my current way, and you’re going to be gone after this administration.” It's very hard to run an agency like that, and it’s certainly very hard to have reform when that’s the backdrop.

Q: From a public health perspective, what keeps you up at night?

O’Connell: My role at HHS required me to be prepared for the unexpected. I needed to be sure that the country had the tools to respond to whatever pathogen might land in an airport and whatever hurricane might come to our sure. Being prepared for the unexpected was my job, which meant there was a lot that kept me up at night.

Now that I am out of government, I am getting a bit more sleep, but I do worry, when I look at the current budget plans and the prioritization of the current administration, that they are taking some of the tools that we built away. There were lots of disadvantages to COVID. It was a terrible time in our country. However, we were able to strengthen the public health infrastructure with the additional COVID response funds we received from Congress. We were able to improve our ability to respond. The current administration is no longer prioritizing preparedness, and I worry that our country will be less prepared to respond. Which is concerning now that we are seeing climate change increase the frequency and intensity of natural disasters and infectious disease outbreaks.

Walensky: If you had asked me when I left CDC, I would’ve said, “I’m worried about the pandemics of tomorrow.” I’m worried about our public health infrastructure, the personnel—do we have a workforce? Do we have modern data systems? Do we have a laboratory infrastructure that is ready to respond in a cohesive way? I used to say, “I’m worried about the pandemics of tomorrow,” and now I say, “I’m worried about the pandemics of yesterday,” because we are swiftly losing the infrastructure.

Banner image: A pharmacy advertises COVID-19 testing and a vaccine in New York City five years after the emergence of the COVID-19 pandemic in the U.S. Photo by Spencer Platt/Getty Images 

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