FAIRFIELD COUNTY, CONNECTICUT  —  With COVID-19 still an ever-present threat and monkeypox cases rising alongside existing chronic epidemics, building strong, responsive public-health systems has never been more important. In addition to improving data management (which I addressed in a previous commentary), we also need sustained investment and training in the public-health workforce.

Public health has always suffered from chronic underfunding, partly because the social and economic benefits of investing in preventive care are difficult to quantify or invisible to the untrained eye. Successes in containing disease outbreaks or reducing mortality rates often go unnoticed. Unfortunately, it often takes a massive failure of prevention to get policymakers and the public to recognise the need for greater preparedness.

Americans spend significantly more on medical costs than do people in other similar wealthy countries, yet still have lower life expectancy, higher rates of chronic disease and maternal mortality, and fewer doctors per capita. America’s underinvestment in public health is a major reason. Researchers developing cancer treatments have far greater access to funding than those working on cancer prevention.

You know you have a flawed system when you can’t mobilise investments that will pay for themselves, which is precisely what most outlays for public health will do. According to a systematic review of 52 interventions published in 2017 in the Journal of Epidemiology and Community Health, health-protection programmes (including vaccinations) saved an average of $34 for every $1 spent on them.