# Making US public health a good idea again

## TL;DR

The paper argues that the US public health system failed during the pandemic due to a lack of shared values and trust, and suggests rebuilding a social contract to improve future responses.

## Contribution

The paper introduces a cultural-historical perspective on public health failures during the pandemic, emphasizing the need for a renewed social contract.

## Key findings

- The pandemic exposed fault lines in the US public health system due to a limited sense of common good.
- Public health efforts were weakened by perceptions that scientific innovations did not benefit everyone equally.
- Renegotiating the social contract is essential for improving public trust and pandemic preparedness.

## Abstract

The stress test the COVID-19 pandemic imposed on the US public health system illuminated predictable yet surprisingly unplanned for fault lines. A perceived lack of choice associated with nonpharmaceutical and pharmaceutical interventions led many Americans to question both measures and processes for mitigating disease consequences, such as masking and mass vaccination. A cultural-historical examination shows that a central impediment for US efforts to control the pandemic was the limited sense of common good. Many factors and beliefs, including also that the scientific-biotechnological innovation system did not serve the interests of all people equally, and the public health community's equating disease with how people perceived illness, weakened vaccination acceptance and disease control efforts. We conclude that US public health must renegotiate the social contract with the American people to recover a shared understanding of its relevance and to effectively respond to future health challenges and pandemics.