Weakened public health powers raise outbreak risks

Demonstrators at a rally with truckers protest against COVID-19 vaccine and mask mandates in Adelanto, Calif., in February 2022. PATRICK T. FALLON/AFP via Getty Images hide caption

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As Americans worry about the risks from hantavirus and Ebola, many state and local health officials now have less power to protect the public from all kinds of disease outbreaks than during the COVID-19 pandemic.

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That's because some jurisdictions weakened their public health authorities in response to criticism of lockdowns, school closures, mask mandates, vaccine requirements and other COVID-era restrictions.

"There's been such an enormous backlash from the COVID-19 pandemic right across America, particularly in red states," says Lawrence Gostin , a professor of public health law at Georgetown University. "It's become part of our national lore of overreaching government."

The Trump administration has reined in the Centers the Centers for Disease Control and Prevention with budget cuts, staff reductions and tighter oversight by political appointees.

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But most public health powers reside with the states, and more than half have made changes to their own state, city and local powers , according to the Network for Public Health Law. The changes affect their ability to respond to public health emergencies. Many watered down those authorities.

"Taken all together, we're in a much weaker position post-COVID in handling a health emergency," Gostin says.

At least 15 laws in 11 states, including Alabama, Virginia and Louisiana, imposed new restrictions on declaring public health emergencies — declarations necessary to do things such as muster disease fighters and clear away red tape.

State lawmakers have a bigger say

"There have been examples where they have said, 'Well, if you want to do this, you now need to come to the legislature to get it.' Or the legislature has the authority now to reverse it," says Dr. Georges Benjamin , who heads the American Public Health Association. "I'm worried that many public health officials will now have their hands tied."

Some localities, such as Kansas and Utah, have hamstrung use of traditional public health tools such as quarantining people who might have been infected with a dangerous pathogen or isolating people who are already sick.

"In some states where there has been a lot of activity around public health power, it's going to create confusion," says Elizabeth Platt , director of research and operations at the Center for Public Health Law Research at Temple University. "And so just understanding if your public health entity has these authorities is going to take time. And as we learned during the pandemic, time is of the essence."

Backlash over COVID mandates

Some states, such as Florida, Oklahoma and Texas, pulled back the authority to impose mask mandates. Others limited vaccination requirements. Some curtailed the power to restrict gatherings.

"If you think about what that really means, it's like telling the police department that you can't arrest people, that you can't protect people when you know there's extreme weather happening," Benjamin says.

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At the same time, some state and local health departments have lost staff and funding . And some state and local health officials have gotten more skittish about pulling the levers they have left. Some were harassed and threatened over COVID. And some who objected to the pandemic response are now in charge.

"There are a lot of public health commissioners now who are not traditional public health people and who are much more MAHA or MAGA," Gostin says. "And so I think all in all you've got weakened authority, you've got weakened political backing and you don't have traditional public health scientists at the head of public health agencies."

Still, there is support for some of the changes as a way to build trust and as an understandable response to criticism of some COVID measures.

"You're building a level of accountability into how we utilize some of the most restrictive public health measures in the United States," says James Hodge , director of the Center for Public Health Law and Policy at Arizona State University. "I'm fine with that."