Could the U.S. Face a Post-Soviet Style Collapse of Public Health?

What happens when you cut public health funding for prevention and treatment?

All of us who work in health have been quietly asking ourselves the same uncomfortable question: What happens if the U.S. keeps cutting public health funding, loses more experienced staff, and the public’s trust in health authorities keeps eroding?

What Happened After the Soviet Union Collapsed?

The nightmare scenario isn’t theoretical. We’ve seen it before: after the collapse of the Soviet Union in the early 1990s. When the newly independent states suddenly lost public health funding, staffing, and medical supplies, the consequences were catastrophic. Measles and diphtheria spread widely. Tuberculosis resurged, and even today, many of those countries continue to struggle with multidrug-resistant TB (MDR-TB).

Public health systems can fall apart faster than we like to believe, and rebuilding them is slow, expensive, and often incomplete. Imagine what happens when a bridge does not get repaired over decades. Small cracks appear, but the bridge still functions. Until one final crack is too much, and the entire bridge collapses. That’s what happens in public health. The damage is slow and not obvious to most people – until finally it isn’t.

New JAMA Study Quantifies the Risks for the U.S.

A new study in JAMA puts some numbers around what risks the U.S. might face if we continue down this path. The researchers modeled future outbreaks of vaccine-preventable diseases under different scenarios of vaccination coverage and public health investment. Their findings should be a wake-up call.

Which Diseases Are the Greatest Threats?

The highest risks were for two diseases we often think of as relics of the past, but that I have been trying to sound the alarm on: measles and polio. Declining vaccination coverage, combined with a high attack rate, could easily lead to more illness, hospitalizations, and deaths from both. Unlike COVID-19, which initially spread asymptomatically, these diseases hit young children fast and hard, overwhelming hospitals and causing lifelong complications or death.

Why Diphtheria May Be Less of a Concern

Perhaps the only somewhat reassuring finding was that, even under dire scenarios, the U.S. is not likely to experience widespread, deadly outbreaks of diphtheria like the post-Soviet states did. But that’s little comfort when we’re talking about losing ground on diseases we know how to prevent.

Public Health Systems Must Be Protected

The lesson is clear: public health is not self-sustaining. It requires constant investment, vigilance, and public trust. Funding for surveillance systems, outbreak investigations, and emergency preparedness and response must be continuous. Once it starts to fray, the damage can spread faster — and last longer — than we want to imagine.