Deborah Klein Walker, EdD
Adjunct Professor at Boston University School of Public Health and Tufts University School of Medicine
Former President AMCHP, President APHA, and Title V Director in Massachusetts Department of Public Health
Over the past three decades, maternal and child health (MCH) agencies and staff have participated in larger team efforts to prepare for and respond to a wide spectrum of emergency situations. These include:
Naturally occurring weather events, such as hurricanes, wildfires, floods, and tornados
Disease outbreaks and epidemics, including HIV/AIDS, severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), Ebola, H1N1, Zika, and others
Domestic and foreign terrorist attacks, including the 9/11 attack, the Oklahoma bombing, the anthrax attack, and massive gun shootings.).
The COVID-19 pandemic, however, is different from any emergency the MCH field has encountered in the last 50 years. What distinguishes this public health crisis from others is that it requires all local and public health departments across the country to simultaneously step up to provide risk communication to key constituency groups, conduct testing and contact tracing, and assist people in gaining access to needed medical and other support services. All MCH programs, which include home visiting; Women, Infants and Children (WIC); early intervention; and school health, have been transformed in some way because of COVID-19. In some locations, MCH staff are providing individual health care services from screening and contact tracing to patient care. Remarkably, many MCH staff are providing these supports while working from home with their children out of school. Another distinguishing feature of this crisis is that the timeline for the end of the pandemic is undetermined, and there are no current treatments or FDA-approved vaccines to fight the coronavirus.
MCH agencies’ role in other crises
MCH agencies were involved in many past disasters and disease outbreaks; their leaders were the “experts” for several vulnerable populations―including pregnant women, infants, children, and adolescents, as well as those with special health care needs—who are served by public health plans MCH program staff also have the expertise required to plan for, respond to, and advocate for the vulnerable MCH groups. MCH networks of programs, providers, parents, and related stakeholders are activated in an emergency response and in the recovery, period following a crisis.
MCH involvement through the history of the HIV/AIDS epidemic
Since the 1980s, MCH staff also provided input into crafting the messages, guidance, and programs related to the HIV/AIDS epidemic because this disease had an impact on pregnant women and children.
MCH programs were among the first to communicate proactively about AIDS risks to children with hemophilia when it was discovered that some of these children had contracted AIDS through blood transfusions. Risk communications about AIDS was a challenging task during the early years of the epidemic for a variety of reasons:
There was no treatment
Those with the virus were stigmatized
People did not understand how the virus was spread.
At a later point, MCH staff at the state and federal levels spearheaded efforts to establish programs for pregnant women and mothers with HIV/AIDS.
9/11 and anthrax scare provided the impetus for comprehensive new emergency preparedness measures to combat threats and natural disasters
The terrorist attack on 9/11 (in 2001), which was followed a week later by the anthrax scare, ushered in new attention on preparedness that involved all parts of public health departments. Federal resources became available to all sectors to plan, train, and conduct exercises for a variety of threats from biological, chemical, and nuclear releases to natural disasters. Each state’s public health plan became one of 15 “emergency support functions” (ESF) in the National Response Framework coordinated by the Federal Emergency Management Agency (FEMA) in the Department of Homeland Security. This framework gives the state Department of Health and Human Services the lead coordination role for ESF #8, which relates to public health and medical services, including mental health and addiction services. In coordination with the Centers for Disease Control and Prevention (CDC), all states, four major cities, and eight territories began to receive Public Health Emergency Preparedness (PHEP) cooperative agreements to plan and prepare for emergencies of all kinds. In addition, a dedicated office (called the Children’s Preparedness Unit) was established in the CDC Division of Human Development and Disability to assist in planning and responding to children during an emergency.
Natural disasters that occur with weather changes—hurricanes, tornados, floods, and forest fires—have grown in frequency over the past decades. The nation’s response to major hurricanes from Andrew in Florida and Iniki in Hawaii in the early 1990s to Hurricane Katrina in New Orleans in 2005 and the more recent hurricanes that impacted Puerto Rico, Florida, and other parts of the Southeast have demonstrated how vital it is to prepare adequately for special populations, especially for individuals with disabilities who are dependent on technology for survival, for residents in nursing homes and in other congregate living situations. The lack of planning and quick responses to the disaster results in preventable deaths.
MCH engagement in stemming recent infectious disease epidemics
During the last decade, several infectious disease epidemics have circulated around the globe, including Ebola, MERS-CoV, Zika virus, H1N1. Although very few individuals contracted MERS and Ebola in the United States, both H1N1 and Zika outbreaks occurred in many states and had a major impact on both pregnant women and children. As a result of the emergence of H1N1 and other flu viruses, MCH programs are actively engaged today in recommending and ensuring that all pregnant women and children receive the flu vaccine each year. The CDC continually monitors both MERS and Ebola as they occur in other parts of the world.
Finally, MCH programs in 2016 during the Zika outbreak (spread via mosquitos) provided significant outreach and guidance e to all women of reproductive age living in states affected by Zika, especially targeting those living in circumstances where environmental prevention solutions were difficult. The distinguishing aspect of Zika was the impact of the virus on infants who were exposed prenatally; this meant that a primary control measure for stopping the spread of the disease was through reproductive planning. MCH epidemiologists were actively involved in setting up surveillance systems to track the epidemic and the outcomes of children born to pregnant women with the Zika virus. The MCH response team units that provided services for children with special needs also assisted the families with children who developed delays as a result of the virus. To summarize, MCH programs engaged in the full spectrum of prevention, intervention, follow-up, and supportive care.
Insights and Hope We May Draw from the Collective Experience of COVID-19
This COVID-19 pandemic is illuminating what MCH staff already know about the social determinants of health and the significant inequities in health for individuals from different racial groups and those with disabilities and chronic conditions. Because infectious disease, terrorist attack, or major weather event of this scale has never occurred in this country, every MCH provider and program is experiencing this pandemic in real time together. The guidelines and principles for emergency preparedness used to address disasters and epidemics faced in the past are still relevant and important for today—although on a much bigger scale.
Hopefully, many “silver linings” and positive outcomes will emerge from this experience. One outcome could be that maternal and child health, as part of the larger public health system, is fully appreciated and funded. In any case, it is certainly not a time to be complacent. It is the perfect time to work together to demonstrate the strength and impact of maternal and child health programs. It is also the time to advocate for an increase in Title V and other MCH funding to enable a critical part of the public health infrastructure to operate as needed for emergency preparedness now and in the future. Significant increases in Title V funding are needed so that all local and state public health agencies can adequately staff and fund MCH programs. Who else will attend to the unique needs of mothers, fathers, children, and youth during epidemics if we in the MCH community do not?v