It's not too late.

As the Biden administration took office last January, with the pandemic peaking at more than 130,000 COVID-19 hospitalizations in the United States, there were high hopes for a new plan of "sticking to the science" and expectations that public health policies, communication, and trust would return to levels not seen for many years. That didn't happen. Why?

As the Biden administration took office last January, with the pandemic peaking at more than 130,000 COVID-19 hospitalizations in the United States, there were high hopes for a new plan of “sticking to the science” and expectations that public health policies, communication, and trust would return to levels not seen for many years. That didn’t happen. Why?

For one, managing a public health crisis requires a navigational system based as closely as possible on real-time capture, analytics, and sharing of essential and relevant information. But during the Omicron wave, we haven’t a clue as to whether and to what extent hospitalizations are being prevented by vaccinations and boosters. The president and leading members of public health agencies have made numerous statements and public appearances throughout the pandemic, but not a single word has been uttered about fixing the profoundly deficient data systems. In May 2021, the Centers for Disease Control and Prevention (CDC) declared that there would be close tracking of all hospitalizations and deaths among the vaccinated. That never happened, though not because of the CDC.

The Department of Health and Human Services (HHS), led by Secretary Xavier Becerra, has chosen to avoid mandating that data be collected. Is this unwillingness a reaction to fear of political backlash? Amid an ongoing public health crisis, this inaction is unacceptable.

Mr. Becerra has also shirked other responsibilities. There has been obvious in-fighting between the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the CDC, and the White House COVID-19 Response Team about issues ranging from booster shot recommendations to isolation guidelines that omit any testing for the virus. A leader of HHS should be mediating such conflicts, with the goal of a single, consistent, and unified public message. That, along with data that justify government decisions, would promote clarity and trust.

The CDC, as the primary agency that provides the public with pandemic guidance, is not exempt from responsibility. In August 2021, President Biden, with support of the White House team, NIH, CDC, and FDA, announced that all adults would get booster shots 6 months after their primary vaccination. Six months became 8 months, then 5 months—or perhaps the plan would be limited to certain vaccines or to certain age groups, or was not necessary at all. Is it any wonder that only 23% of Americans have received a booster—in contrast to more than 50% of people in many other countries, including the United Kingdom, Israel, Ireland, and Denmark? Data from Israel’s Ministry of Health, available in late July and August during the Delta wave, made it abundantly clear that boosters would be necessary for preventing symptomatic infections and severe disease, but it took until late November for the CDC to announce that all vaccinated adults should get a booster shot. This inevitably led to preventable hospitalizations and deaths. Now with the Omicron wave, for which booster shots have about 90% effectiveness against hospitalization, the mistakes and delays in communication have become magnified. Millions of Americans would have been far better protected against severe disease from both Delta and Omicron had the FDA and CDC followed the data.

The recent gaffe with the truncated isolation guidance—10 days abruptly cut to 5—was of lesser severity with respect to endangering people, but the lack of any science or evidence to back up the change added to public confusion. Simply acknowledging that despite the uncertainty, it is necessary to take some action to maintain essential workers and the health care workforce in face of the onslaught, would have helped immensely. Furthermore, recognition of best practices for isolation from other countries, using testing for two consecutive days as guidance, would have been helpful. But the unwillingness to do so has been thematic, and particularly ironic given the void of American data or, in many cases, sound practices, like masking. The world was alerted by the South African biomedical community of Omicron’s extreme infectiousness in November, but there has yet to be a recommendation for improved, medical-quality masking.

With the pandemic far from over, public health agencies must take corrective action: gather and share the data, avoid any further infighting, provide consistent, unified communication, and have the Secretary of HHS be an integral part of the pandemic response. It isn’t too late to get all of this on track.