The Critical Need for Public Health Engagement

F. DuBois Bowman, dean of the University of Michigan School of Public Health, believes public engagement is a critical piece of academic public health. We spoke with Dean Bowman to learn more about public engagement and how the School of Public Health has been committed to supporting the State of Michigan.

What is public engagement? 

In the context of public health, we think of public engagement as a broad term that encompasses and recognizes the myriad ways in which faculty, staff, and students at the University of Michigan share their expertise, research, and work to benefit communities within Michigan and around the world. Public engagement is foundational to our core beliefs around service and the pursuit of a healthier and more equitable world for all. Engagement takes many forms, including faculty, staff, and students discussing their research on the news; sharing educational information; providing training to local groups; offering volunteer or pro-bono services; working with communities to design research projects that meet their needs; meeting with state lawmakers to advocate for policy change; supporting government efforts to improve public health; and creating equitable partnerships with individuals, communities, and practitioners. At Michigan Public Health, we participate in all of these forms and more of public engagement in service of our state, our country, and the world. We view public health engagement as foundational to our lifetime commitment to creating a healthier world.

How did the pandemic highlight the importance of public engagement? 

When the COVID-19 pandemic started, our commitment to public engagement became more important than ever. We were all faced with a novel situation in which everything about the virus was still largely unknown. Faculty, staff, and students at Michigan Public Health stepped up in countless ways to lend their expertise to pandemic response efforts and help keep Michiganders safe. I remain in awe of their resilience, compassion, and selflessness to keep serving despite exhaustion and personal hardship. 

The collective effort of public health professionals across the globe has saved lives. Much of this work has been focused on building trust and understanding challenges within communities. It is impossible to ignore the role and impact of health misinformation and propaganda circulating during the pandemic. Public health experts remained focused on sharing clear, accurate data and guidance to ensure that people had the information they needed to keep themselves and their families safe. The fight against health disinformation continues, but Michigan Public Health remains committed to engaging with the public through every avenue to continue to provide accurate evidence-based guidance and advice. We are constantly seeking new opportunities and methods to share information and resources.

What are some of the ways the School of Public Health served Michiganders early in the pandemic?
In early 2020, Michigan Public Health faculty began using data to model projected case counts in our state. Cases in Michigan were rising faster than other states in the Midwest, and it became clear to us that this novel virus was incredibly serious. An aggressive response would be needed if there was any hope of curbing the accelerating spread. 

We immediately began collaborating with the Michigan Department of Health and Human Services and the Governor Gretchen Whitmer’s office. Our team shared data, modeled projections, and outlined the potential devastation of COVID, if quick action was not taken. While we were one of many resources that the state government was working with at the time to better understand the scope of the pandemic, we were eager to support their work in any way we could. State policymakers considered the guidance from our school and ultimately decided to take proactive measures to mitigate the spread of the virus. 

  • Preparing for the Next Pandemic: The University of Michigan remains focused on supporting the mitigation of the current COVID-19 pandemic while looking to the future to prepare for new and emerging infectious diseases. As part of this work, the University of Michigan has established the Michigan Center for Infectious Disease Threats to focus on issues key to infectious disease preparedness and response, including public health workforce development, increasing lab capacity, expanding protein production for disease-testing capacity, and adding testing of zoonotic pathogens through interdisciplinary research. The center, led by Dr. Aubree Gordon, an infectious disease expert in the School of Public Health, will bring together researchers from public health, engineering, medicine, evolutionary biology, and social sciences to better prepare Michigan locally and globally for ongoing COVID-19 response and future pandemic preparedness through a community of experts focused on infectious disease. 
  • Vaccine Development: Dr. Arnold Monto, professor emeritus in the School of Public Health and chair of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) is leading the committee’s review of safety, effectiveness, and appropriate use of vaccines and related products. The committee is currently having discussions on whether a variant-specific booster should be made available for the fall. During a recent FDA panel, Dr. Monto noted the need for annual vaccination similar to influenza but shared in the concerns expressed by other panelists around the difficulty of predicting viral evolution with COVID-19. Flu strains often take years to evolve whereas the COVID-19 virus evolves at the much faster rate of changes within the span of a few months.
  • Impact of Long-Term Post-Covid Health Issues: Looking ahead at the long-term impact of COVID-19 infections on the population, a recent report from the Michigan COVID-19 Recovery Surveillance Study details the potential ongoing health harm after illness. Dr. Nancy Fleisher, associate professor of epidemiology in the School of Public Health, has raised concern around the level of disability after infection and the potential impact on healthcare systems at large. Of note, nearly 1 in 3 Black respondents reported mobility disability post-COVID-19 illness. The report found that Michigan residents who had a COVID-19 infection in 2020 were twice as likely to experience disability following their illness. Key findings included that 27% of respondents reported disability after infection which was up significantly from 15% before infection. While we are no longer in the early days of the pandemic, the work to study and understand the long-term impact of COVID-19 infections is just beginning.

How did your work with the state government change as the pandemic evolved?

In late March, Governor Whitmer issued an executive order called “Stay Home, Stay Safe,” which outlined protective measures for businesses and activities across the state. We continued to track and analyze COVID-19 cases across the state after the order was in place. The measures led to a steady decrease in cases, ultimately helping to save lives and mitigate spread throughout Michigan. 

  • Supporting the Economic Reopening: After the “Stay Home, Stay Safe” order was in place, the natural next question became, when can we begin to safely reopen businesses and the economy? To answer this, our school began working with the Michigan Economic Recovery Council, which included CEOs of major companies and hospital systems in Michigan, presidents of major universities in the state, and colleagues from the Michigan Department of Labor and Economic Opportunity. The economy cannot simply be turned back on like a light switch. Our approach had to be more like a gradual turning of a faucet. We worked to start slowly opening up activity, and if the data showed us that we were trending in a positive direction, we could continue. If not, we had to pull back. We helped the state establish what data points we would need to reach to move to each subsequent step toward more in-person activity. In addition, we broke the state into eight geographic regions so reopening plans could be tailored based on the virus spread and case counts within each area as well as the regional hospital and public health capacity. We also tailored the plan by job type. Our framework became known as the Michigan Safe Start Plan, which helped our state gradually and safely reopen the economy and resume in-person activity. 
  • Data Development: School of Public health associate professor of epidemiology, Dr. Marisa Eisenberg, led the project to develop a dashboard that shows COVID-19 cases and hospitalizations by race, ethnicity, and gender. The dashboard expands the capabilities of the MI Safe Start dashboard by providing more data to Michigan residents and by enabling experts to identify trends early and make informed decisions about public health measures. Dr. Eisenberg is also a member of a team of School of Public Health faculty who are conducting COVID-19 wastewater surveillance as part of the Michigan Department of Health and Human Services statewide dashboard efforts. The data will allow researchers and leaders at the local and state levels to better understand community spread and the impact of public health protections. 
  • COVID-19 Genomic Sequencing: Earlier this year, four Michigan universities, including the University of Michigan, received $18.5 million in federal funding to expand sequencing for COVID-19 and other infectious diseases. The funding will support two years of work to collect and analyze genomic data to address and enhance the state’s ability to respond to infectious disease threats. Dr. Emily Martin, an infectious disease expert at the School of Public Health, will co-lead the project to better track and understand infectious diseases with the threat for broad community spread. 

The School of Public Health’s work continues in partnership with the State of Michigan. As the pandemic remains a dynamic and rapidly evolving situation, we continue to seek innovative ways to support the state’s efforts and to provide up-to-date data and modeling forecasts to assist in their response and plans to mitigate spread.

What have you learned about effective communication over the last two years?

During the pandemic, we witnessed the profound and devastating impact that false information could have. It is easy for anyone to post something on social media and share their personal opinions, but that content can quickly spread to a wide audience and cause confusion and concern. Prolific disinformation campaigns sewed distrust toward public health officials and made the work of mitigating COVID far more challenging. Confusion and discord around masking and vaccinations has resulted in illness and the loss of life for too many Americans. 

  • Educational Materials: At Michigan Public Health, we created videos to break down complex topics and share accurate, concise, and accessible information. For example, we produced a video stressing the importance and the benefits of multiple safety protocols such as wearing a mask, social distancing, washing hands, etc. The video compared each of these protocols to one slice of swiss cheese. Although each slice has holes, as you stack them on top of each other, those holes become covered and the risk of the virus making its way through them is reduced. We also heard from many people who were having trouble explaining the pandemic to their children. We produced a short video, narrated by a child, to explain the virus and new safety protocols in a way that was appropriate for elementary-aged kids. We shared both of these videos widely and received a lot of positive feedback, particularly around the video for children, which had an accompanying guide for families that was translated into 10 languages. At a time when so many families were facing challenges, I am proud that our school could serve as a trusted resource and provide a small bit of clarity and reassurance. 
  • Vaccine Hesitancy: Dr. Abram Wagner, a research assistant professor in epidemiology in the School of Public Health has focused his expertise on ongoing vaccine challenges. His research has found that vaccine hesitancy contributes to lower numbers in many states, but vaccine access remains a major issue. Michigan mostly administered vaccines through large mass centers which were quickly booked well in advance of vaccine availability in local pharmacies and grocery stores. For many people who are not vaccinated, it was an issue of convenience. His work focuses on the need to find trusted partners (such as primary care physicians or community leaders) to help hesitant residents to get vaccinated. Specifically, he notes the number of people who are vaccine “fence sitters” who need to be identified and quickly contacted whenever a new vaccine is introduced into the population.

In a public health crisis, messaging must be clear, consistent, and compelling. It is evident that much more work must be done to fight against general misinformation, disinformation, and harmful health advice. The public health community will need to be better prepared in the future to overcome the challenges of widespread and easily distributed misinformation.