American Medical Association (AMA) President Gerald Harmon on Thursday detailed six "well-documented missteps" that led to a "profound loss of trust" in U.S. health care professionals—and offered five recommendations to fix the health care system.

Covid-19 tested national health systems—and they responded largely as designed

6 reasons trust has decreased during the pandemic

Harmon in his comments said the United States has endured a second pandemic alongside the Covid-19 pandemic—one that stemmed from an erosion in the trust of health care professionals—which he said has been almost as damaging as the Covid-19 pandemic itself.

According to Harmon, "[t]his pandemic of mistrust was probably beginning before Covid-19, but the extreme polarization during this crisis has profoundly hampered our nation's ability to respond. It is a major reason why the U.S. has a far higher death rate from Covid-19 compared to other well-resourced countries."

Harmon outlined six "well-documented missteps prior to and since the start of the pandemic that have understandably contributed to this environment of distrust," including:

1. Insufficient funding for pandemic preparedness and public health agencies 
2. Undefined lines of responsibility
3. Inconsistent use of federal authority to produce personal protective equipment (PPE), as well as testing and supplies
4. Mixed messages on masking, social distancing, isolation guidelines, and quarantine requirements
5. Political—and sometimes even personal—attacks that targeted scientists and physicians
6. Insufficient response to the omicron surge as well as a shortage of Covid-19 tests

AMA recommends 5 ways to fix the U.S. health care system

To restore this damaged trust, fix the health care system, and more effectively respond to the next public health emergency, Harmon recommended:

1. Boost federal and state stockpiles of medical supplies while improving the systems that acquire and distribute them

"We're calling on Congress to work with federal agencies to build our domestic manufacturing capacity, utilizing public/private relationships and partnerships to quickly accelerate production [of PPE]," Harmon said. "We urge that the nation create a transparent plan for obtaining and distributing [PPE] and other needed supplies with clear delineation of federal and state roles. We call for increasing funding and improving planning for the Strategic National Stockpile."

2. Allocate more funds to boost the nation's depleted public health infrastructure

"State public health spending has dropped 16% over the last decade, resulting in the loss of nearly 40,000 jobs at state public health agencies" and exacerbating the "lack of widespread [Covid-19] testing," Harmon said.

He added, "It's critical that we invest what is necessary to increase staffing, upgrade essential functions, such as public health surveillance, which would make it easier to respond to emerging threats and to better educate the public on how to protect themselves in a crisis."

3. Learn from the processes that led to the rapid development of the Covid-19 vaccines

Calling Operation Warp Speed "one of the greatest scientific achievements of our lifetime," Harmon said, "We believe the public/private partnership and operational structure of this plan should be preserved in some form for future pandemics, or any time vaccines and therapeutics are needed in such an emergency."

4. Expand telehealth

Citing the benefits of telehealth expansion amid the pandemic, Harmon said the AMA "strongly supports the Telehealth Modernization Act and applauds the inclusion of it in the second [21st Century] Cures Act for the rest of the pandemic and beyond."

5. Mitigate physician burnout

"We owe physicians and health care workers a whole lot more than just our love and appreciation," Harmon noted. "We owe them our sincere efforts to fix the problems that have plagued our response to Covid-19, and [we need] to work with them to solve common frustrations that are driving so many out of the profession."

Harmon praised Congress for passing the Health Care Provider Protection Act and noted that it "will help raise public awareness of the mental health needs of physicians, and dedicate federal resources to create evidence-based programs to better support physicians and other health care workers."

"These types of actions are long overdue," Harmon said. (Cheney, Health Leaders Media, 2/24; Frieden, MedPage Today, 2/24)