5 years of COVID-19 underscore value of coordinated efforts to manage disease – while CDC, NIH and WHO face threats to their ability to respond to a crisis

As the pandemic accelerated in 2020, U.S. hospitals — including this one in New York City — set up tents to diagnose patients with COVID-19. Misha Friedman via Getty Images

Five years ago, on March 11, 2020, the World Health Organization declared the outbreak of COVID-19 a global pandemic. The novel coronavirus, dubbed SARS-CoV-2, began as a “cluster of severe pneumonia cases of unknown cause” reported in Wuhan, China, in December 2019. It had spread to 118,000 cases reported in 114 countries by March 11.

Dr. Tedros Adhanom Ghebreyesus, WHO director-general at the time, said in a media briefing that day that “the WHO is deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction.” He urged leaders to move quickly to scale up their emergency responses, saying that “all countries can still change the course of this pandemic.”

Public health agencies like the WHO and the U.S. Centers for Disease Control and Prevention played critical roles throughout the pandemic in coordinating with local health departments to detect, trace and test for the virus. The WHO and CDC websites received unprecedented traffic as they became invaluable go-to sources for the most up-to-date resources on means of prevention, case numbers, hospitalizations and deaths. The National Institutes of Health was instrumental in its development of COVID-19 treatments and contributions to vaccine research.

Now, five years later, the Trump administration has cut more than 5,000 employees at the NIH and the CDC combined, and is withdrawing the U.S. from the WHO.

At the same time, the U.S. is facing outbreaks of tuberculosis, a resurgence of measles among unvaccinated communities, and the worst flu season in 15 years.

Much of the work of the WHO, CDC and other public health agencies occurs behind the scenes, only occasionally drawing public attention. To put these roles into perspective, it can be helpful to examine public health before these unifying entities existed.

In February 2025, the Trump administration laid off nearly 1,300 CDC workers, or 10% of its workforce. Some of those firings have since been rescinded.

A spreading epidemic, slow communications

As the author of the 2020 book “Constructing the Outbreak: Epidemics in Media and Collective Memory” and “Capturing COVID: Media & the Pandemic in the Digital Era,” published in 2025, I have extensively studied how public health crises have unfolded. And through my research as a health communication scholar, I have analyzed the integral role of nonprofits and public agencies in protecting public health.

Both the WHO and the CDC were set up in the 1940s. Before an international or even national network of public health agencies existed, there were no coordinated communication means, external investigations or formalized ways of recording data across geographic areas. Without a means of sharing information, it was much more difficult for outbreaks and epidemics to be linked between regions.

One notable example was the 1918 influenza pandemic, a deadly combination of influenza and pneumonia that first emerged in a Kansas army base in the spring of 1918. From there, the epidemic moved overseas, spreading throughout Asia and Europe by late summer. When it returned to the U.S. in August, the disease had been mislabeled the “Spanish flu.” The lack of media coverage of the spring outbreak, paired with the lack of disease tracking, meant that most people believed the lethal strains had begun in Europe.

No one formally tracked these outbreaks until the disease returned with American troops in August 1918. In September, the U.S. Surgeon General and the U.S. Public Health Service attempted to gauge the magnitude and transmission of influenza by sending telegrams to state health officers.

The Sept. 27, 1918, issue of the official publication of the U.S. Surgeon General’s Office, one of the first reports to focus on the growing influenza epidemic.
Public Health Reports

By that point, it was much too late for mass preparation. The few stories of the spring outbreaks had been buried in a flood of competing news stories about the world war. Therefore, people knew almost nothing about the raging disease until it infected their own town. Short on resources and caregivers, communities struggled to create makeshift hospitals and find healthy residents to nurse the ill.

For example, at the University of Kansas during the influenza pandemic, female professors cared for sick students, faculty and staff, washed linens and prepared food. Since agencies like the WHO and CDC didn’t yet exist and the world war further impeded communication, little information was documented and shared across geographic regions, such as the sharing of information on how to prevent the disease from spreading, possible treatments or even the number of cases and deaths.

The influenza pandemic quickly faded in the public’s collective memory, due in part to an absence of personal narratives and follow-up stories after cases subsided – at least until COVID-19 sparked renewed public interest in the 100-year-old crisis.

In 1918, at a Massachusetts hospital, many flu patients were treated outside in tents so they could get fresh air.
Hulton Archive via Getty Images

Polio epidemic saw a more coordinated response

Starting in the 1930s, public health responses to polio outbreaks demonstrated the advantages of nationally coordinated efforts. The National Foundation for Infantile Paralysis helped battle polio through fundraising, running extensive campaigns to educate the public, supporting scientific research and helping victims from the acute hospital stage through rehabilitation. This effort was especially apparent in the 1952 polio epidemic.

In the summer of 1952, U.S. polio cases escalated, eventually totaling 57,628 – more than one-third of which included various stages of paralysis. Throughout the epidemic, the National Foundation for Infantile Paralysis coordinated with local chapters of its organization. Together, the foundation kept people informed of the growing epidemic, created emergency polio-focused hospital wings, recruited nurses and other health professionals, and shared resources to the areas with outbreaks.

Widespread vaccination efforts led to a deep reduction in polio cases in the U.S. by the 1960s, prompting the National Foundation for Infantile Paralysis to change its name and mission to the March of Dimes. The organization served as a model for nonprofits and public health agencies for communicating and coordinating between local and national entities.

Polio patients in iron lung machines at a Boston hospital in 1955.
Bettmann via Getty Images

The critical role of public health agencies

The CDC opened in 1946 as a small organization based in Atlanta, aimed at fighting malaria in the U.S. Two years later, representatives from 53 countries ratified the constitution of the WHO. This global entity brought countries together across continents to tackle disease surveillance, prevention, treatment and research.

As these agencies expanded into new areas of public health over the 1950s and 1960s, they mirrored many of the approaches and strategies utilized by the National Foundation for Infantile Paralysis: tracking and recording data public, educating the public, investigating threats, aiding in moments of crisis and supporting scientific research. Together, the CDC and the WHO greatly improved public health, from the global eradication of smallpox and the decline of vaccine-preventable diseases to the development and implementation of HIV/AIDS treatments.

Prior to the COVID-19 pandemic, the roles of these agencies often didn’t garner much attention, as field agents traveled to examine something as routine as salmonella or as frightening as hemorrhagic fever cases.

COVID-19 patients await entrance to a New York City hospital in April 2020, shortly after the start of the pandemic.
John Moore via Getty Images

While public opinions of the CDC and the WHO shifted throughout the COVID-19 pandemic, recent survey results indicate that the majority of Americans trust public health agencies at least to some degree. A 2024 survey found that nearly 60% of American adults believe that the U.S. benefited from its WHO membership.

Unfortunately, when infectious diseases move out of the spotlight and are seen as less urgent, the critical roles of these public health agencies fade into the distant collective memory, much like the 1918 and COVID-19 pandemics. People soon enough forget the need for ongoing scientific research, educational programs and teams that can quickly respond to local, national and international levels.

Disease continues to be a threat, as the outbreaks of measles, tuberculosis, influenza and other pathogens remind us. People are still sick or dying of COVID-19: As of March 1, 6,725 people had died in the U.S. from COVID-19 just in 2025, and nearly 7.1 million have died worldwide since January 2020.

Without strong, coordinated efforts between public health agencies, even small health calamities can escalate into full-blown epidemics or even pandemics, which the world will be far less prepared to handle.

Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.