Five years after the arrival of COVID-19 forced New Jersey to shift from pandemic planning to pandemic response, the state is in some ways better prepared for the next public health emergency.
The state now has a detailed vaccine plan that could be useful in the future, an interagency task force of state officials focused on emergency response and government, not to mention clinical and public health leaders with valuable first-hand experience, according to experts involved with New Jersey’s COVID-19 response.
But gaps in the defenses still loom large. The health care workforce is shrinking and stretched thin, especially among bedside caregivers, experts note, and New Jersey’s public health system – responsible for mass testing, vaccination and disease tracking during an epidemic – is overburdened and under-resourced. Vulnerable populations that suffered an outsized burden then remain at higher risk today.
“Many of the vulnerabilities that existed before COVID still exist,” said Cathy Bennett, president and CEO of the New Jersey Hospital Association, which represents the state’s 72 acute care hospitals and shared critical data during the pandemic that helped guide state policy decisions. “Viruses don’t stop at borders, and infectious disease remains the leading cause of death worldwide. Just like COVID, the next public health emergency can emerge anywhere, anytime,” Bennett said in email to NJ Spotlight News.
New Jersey’s challenges are compounded by instability within the federal government, these experts said. President Donald Trump’s administration has suspended or delayed the collection and publication of key public health data, halted relevant research and fired scores of federal workers assigned to monitoring and preventing disease outbreaks.At Trump’s request, Republicans in Congress are seeking massive spending cuts that could slash as much as $4 billion in federal funding New Jersey planned to use for hospital aide in fiscal year that starts July 1, one of several potential spending reductions under review in Washington, D.C. that could be devastating to health care, state officials said.
“Much of what is happening at the national level now is the wrong direction for public health, in terms of having access to critical data and medical advice to track outbreaks and prepare us for the next pandemic,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, a non-profit research and advocacy organization that has examined the state’s COVID-19 response in a series of reports.
“In some, in New Jersey, we are in a better place than we were” pre-pandemic, Schwimmer told NJ Spotlight News, such as work the state has done to grow mental health care capacity and expand infection-control training. “But, we have a lot more to do.”
The politicization of public health in general – and recommendations from key government agencies like the federal. Centers for Disease Control and Prevention – is also a big concern for Schwimmer and others. The Centers are under the umbrella of the U.S. Department of Health and Human Services, now run by vaccine-skeptic Robert F. Kennedy Jr.
Dr. Denise Rodgers, a vice chancellor at Rutgers University and director of the school’s Urban Health and Wellness Institute, agreed. “Actually, in some ways we are worse off today than before COVID-19 – we are less prepared for a pandemic – because of the political divide,” she said, noting she encounters a growing number of people who are shunning vaccines. Without trustworthy information from sources like the CDC, navigating these decisions becomes even harder for members of the public, she added.
These anti-vaccine sentiments are especially concerning following an outbreak of measles in Texas, which killed one child, and cases reported elsewhere, including New Jersey, Rodgers said. In addition, dozens of human cases of avian flu, or H5N1, have now been identified nationwide and the virus has been found in wild birds, poultry and now cats in New Jersey – another concern for Rodgers.
“The public health infrastructure, in my opinion, is insufficiently robust to really be able to follow what’s going on with avian flu,” Rodgers warned, explaining that it may be hard to identify human cases that aren’t severe, and therefor nearly impossible to control potential spread.
Dr. Eddy Bresnitz, an epidemiologist and vaccine expert who advised the state for two years during the COVID-19 pandemic, counts as advances the coronavirus vaccination plan the state Health Department developed in the fall of 2020, which he said could be easily adapted to address future threats. The state also paid an attorney to conduct a detailed after-action assessment released in March 2024, something Bresnitz said is important, and has formed an inter-agency pandemic prep task force that continues to meet, a coordinated approach he said can help with threats like H5N1.
“All this is informed by past experiences,” Bresnitz told NJ Spotlight News. “One of the most important things that happens with preparedness activities, whether you’re in the planning stage or in the response stage or in the mitigation stage – or all three at the same time, because things are moving so quickly, and they’re very dynamic – is you’re developing relationships with people in the organizations that you have to work with. In terms of COVID 19, it was everybody – it was truly a One Health approach,” Bresnitz said.
“That’s a very positive thing.”
But these gains are somewhat overshadowed by national and global concerns, Bresnitz conceded, including the nomination of RFK Jr., who he warned in an op-ed could increase vaccine skepticism. Trump’s decision to withdraw from the World Health Organization – an intergovernmental agency dedicated to reducing disease – also increased the risk for an outbreak here, Bresnitz said.
The majority of scientists agree the development of COVID-19 vaccines – which arrived in New Jersey mid-December 2020 – marked a turning point in the pandemic. By September 2021, unvaccinated people in New Jersey were nearly six times more likely to be hospitalized with the novel virus compared to people who had their full compliments of shots, data from the hospital association showed at the time. Globally, the COVID-19 vaccines saved at least 14 million – and likely closer to 20 million lives – in one year, a study funded by the National Institutes of Health showed.
New Jersey was one of the first states in the nation to confront the novel coronavirus in March 2020 and within weeks COVID-19 was spreading quickly. Gov. Phil Murphy ordered a cascade of closures in an effort to control transmission, months-long measures that triggered growing criticism, and the state established mass testing sites to better understand the extent of the disease.
Hospitals filled up quickly that spring as doctors and nurses struggled to identify effective treatments and avoid infection. Too often these attempts fell short. Once the virus entered nursing homes, fatalities soared among vulnerable residents, and staffing challenges increased as more caregivers got sick.
By late 2020, the promise of a vaccine offered some relief, although glitches in the rollout cased delays. Viral mutations led to Omicron a year later, which overwhelmed levels of existing immunity and sent hospitalizations sky high in New Jersey. Since then, COVID-19 peaks have largely been seasonal and less intense; at the start of February influenza patients outnumbered those with a coronavirus by nearly eight to one in emergency rooms here.
Since the start of the pandemic, more than 37,000 people have likely died of COVID-19 in New Jersey and more than 193,000 were hospitalized with the disease, state data shows. Black and Hispanic residents were several times more likely to become infected, seriously ill or die from the virus, when compared to white residents here. More than 20 million doses of a COVID-19 vaccine were administered in the state. (Information on current COVID-19 vaccines is on the state Department of Health website here.)
Bennett, with the state hospital association, said the data the group collected from its members from the start provided a “consistent and reliable source of critical information” that Murphy’s administration used to make decisions and keep people informed about the evolving COVID-19 threat. It also enabled hospitals to assess staffing needs, allocate resources like gloves and protective gowns and even the ventilators that were essential early on in helping patients to breath.
“What stands out to me is the power of data in ensuring continuity of care and access to care in crisis times,” Bennett said. “When time was of the essence, data helped our state focus, prioritize and save lives.”
While hospital figures are no longer publicly available in the same format, the state health department monitors the threat of COVID-19, influenza and other infectious diseases using data it gathers on acute care admissions and emergency room visits. A similar surveillance system exists at the federal level, although some of the details have been delayed or inaccessible in recent weeks, according to public health professionals who fear the nation’s pandemic early-warning system is in danger under Trump.
New Jersey has launched a public health institute since the pandemic, a non-profit that seeks to bridge gaps in the health care system, provide additional resources for the patchwork network of public health offices and address racial health disparities. But some public health officials are concerned the entity, known as the Center for Health Equity and Wellbeing, is not focused enough on securing more funding for its frontline work.
In addition, emergency funding provided these local public health offices during the pandemic has since dried up and with limited state money available, the work is heavily reliant on local taxpayers.
“New Jersey remains one of the few states without dedicated funding for local health, leaving departments vulnerable to financial instability, especially during crises like the COVID-19 pandemic. Without unrestricted funding, local health departments struggle to respond effectively to unexpected challenges, jeopardizing the health of entire communities,” Dr. Sreelekha Prakash, associate professor of health science at Stockton University and president of the New Jersey Public Health Association, wrote in a recent op-ed.
The state’s inter-agency pandemic preparation task force continues to meet regularly, according to the governor’s office; the group’s creation was one of several recommendations New Jersey has implemented based on the COVID-19 after action report. The task force is now updating New Jersey’s pandemic influenza plan, officials said, and had developed guidance on immunization and other prevention strategies in the past.
In an email to NJ Spotlight News, Murphy’s deputy press secretary Maggie Garbarino said the task force “is leading efforts to bolster preparedness across government agencies to ensure that future administrations are set up for success in preventing and quickly combatting future public health crises.”Bresnitz, the epidemiologist, hopes the group’s work is impactful. “The task force is supposed to come up with concrete recommendations,” he said. If that hasn’t happened, “they’ve lost an opportunity,” Bresnitz said, especially given the changes at the federal level and limited revenue at the state level heading into the next budget cycle.
Murphy’s team did not respond to repeated questions about the existing influenza plan or how agencies are working together to prepare for future pandemics, other than through the task force. And staff declined to say what will happen with a second COVID-19 report created by a state task force on racial disparities, which offered dozens of recommendations in October on how to improve health equity.
“The COVID-19 pandemic was unprecedented and devastating in its impact,” Garbarino said. “It also reinforced many hard-learned truths about our State and nation’s level of preparedness for large-scale public health crises. Based on our experience, our first-in-the-nation independent after-action report, and other reflective Task Force efforts since the end of the public health emergency, Governor Murphy has prioritized integrating best practices into our prevention and response to future health challenges.”