Earlier this month, around the four -year anniversary of the first reported case of COVID-19 in New Jersey and Gov. Phil Murphy’s declaration of state and public health emergencies, the “Independent Review of New Jersey’s Response to the COVID-19 Pandemic” (the Zoubek report) was released, a year-and-a -half after it was commissioned by the governor. It may be the only COVID-19 after-action report released publicly by any state to date.

This comprehensive, well-written, bible-sized report documents the course of events of the pandemic in New Jersey and nationally, as well as the strengths and challenges of the response by the government, community-based organizations and the private sector. The overall tone of the report reflects an assessment that the state performed reasonably well during this unprecedented crisis, in the face of initial unpreparedness and continuously evolving science, knowledge, experience and resources.

Although the strengths clearly outweigh, or are matched by, the challenges in many (but not all) of the 14 key elements of the response that were assessed, the 33 recommendations in the final chapter of the report — with many more in a separate chapter that are agency-specific for congregate settings — clearly support the conclusion that there is much room for improvement.

Many of the recommendations echo those made in earlier reports in the wake of the pandemic. A few, such as those pertaining to long-term care facilities, are already being addressed through legislative actions.

The recommendations are detailed and will require intensive analysis and debate on feasibility. In response to the release of the Zoubek report, Gov. Murphy has pledged to create a whole-of-government implementation task force to evaluate the recommendations over the remainder of his term in office, which ends in January 2025. The remit of the task force will be to propose reforms that would help to prevent, respond to, and mitigate the next public health crisis.

Political will, time and money

The governor stated in a recent interview that “It will take a while to chop through” the recommendations and to “cement,” i.e., codify, corresponding policies and procedures through legislative initiatives. It will take political will, time and money to effect many changes.

This approach is necessary, but can the state wait that long for significant improvements in its public health infrastructure to address the next potential widespread infectious disease outbreak or public health crisis? The state and country were unprepared for COVID-19 in 2020 and without additional resources in the next budget cycle, not two years from now, the state will be unprepared again for the next pandemic.

In an earlier Op-Ed, I highlighted the annual roller coaster of funding that impacts the ability of states to prepare for public health emergencies. The roller coaster is now, once again, on the way down.

I concluded the article with the following: “We can only hope that our policymakers will consider the many recommendations outlined in … federal and state-specific after-action reports, and act accordingly to continue to build and sustain our defenses before our inevitable next infectious disease or other public health crisis.”

A recent report by the Government Accountability Office emphasizes the difficulty that all states have in sustaining public health infrastructure and preparedness in the face of cyclical funding.

Inadequate public health funding

Last month, Gov. Murphy released his proposed budget for the 2025 fiscal year. While the document contains many laudable and appropriate goals and proposals, addressing many critical needs in the state, what is missing is significant state funding (exclusive of federal funding) for enhancing public health infrastructure for emergency preparedness at the state and local levels.

Local health departments are funded mostly through local taxes and have experienced reductions in workforce and attendant services over the last few years. It’s difficult to figure out how much is awarded to these departments annually for infrastructure capacity building and preparedness, but roughly less than 2% will come from state funding in FY 2025. The vast majority is from the federal government and is distributed through the state Health Department. Only about $1.6 million in state dollars will be available through DOH for reimbursement of allowable expenses, unchanged from FY 2024.

Federal funding for strengthening this infrastructure is also declining, partially due to the expenditure of emergency funding awarded during the pandemic and partially through inflationary costs. President Biden’s FY 2025 budget proposes level funding to the Centers for Disease Control and Prevention compared to FY2023.

One historical state funding source for local health departments was Public Health Priority Funding, which was discontinued by the Christie administration in 2011. Last year, Sen. Vin Gopal (D-Monmouth) and others co-sponsored a bipartisan bill restoring that funding, at a minimum of $10 million annually. It was overwhelmingly approved by the Senate Health Committee, but the Assembly Health Committee failed to discuss the bill, which was reintroduced as S-2010 and A-1854 earlier this year.

Three near-term actions

What can the Legislature and executive branch do now as the state waits for a task force to be appointed, convene, digest a meaty report, deliberate, and act? I can propose three near-term actions that would accelerate the timeline.

First, every agency in the state, including the governor’s office, does not need to wait for a task force report. Much can be done without the need for legislation or additional funding. The governor should direct every government agency to review the recommendations that pertain to their scope of operations and present a plan within a few months on what can be done sooner than later.

Second, to begin to address the recommendations to provide needed and renewed state investment in public health infrastructure and emergency preparedness, the Legislature can restore the Public Health Priority Funding for local health departments in the FY 2025 budget process to the minimum amount as proposed in S-2010 and A-1854. There should be clear provisions in the legislation for these departments on how the dollars must be used only for all hazards preparedness and no other services. Public Health Priority Funding should not be used to offset local tax support to these departments. Think of this as a down payment on future improvements and additional resources.

Finally, there are hundreds of funded vacancies in the state Health Department and local health departments that must be filled without bureaucratic delay to return the public health infrastructure to a baseline level of functioning, let alone to a level of preparedness, for a future public health crisis. This will require investment in workforce development as well.

The COVID-19 pandemic taught us all a lot, and the state now has several sets of robust recommendations to ensure that it is prepared for the next novel pandemic and statewide public health emergency. There is no time to waste: there will be no excuses if we are not as ready as we can be.