OPINION: Here's what we need to do to prevent another pandemic from devastating the vulnerable

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Editor's note: Richard E. Besser, a physician, is president and chief executive of the Robert Wood Johnson Foundation in Princeton, N.J. He was the former acting director of the US Centers for Disease Control and Prevention from January to July 2009. Follow him on Twitter @DrRichBesser. The views expressed in this commentary belong to the author. View more opinion at CNN.

(CNN) — Six months after Hurricane Katrina devastated New Orleans and a swath of the Gulf Coast, the House of Representatives Select Bipartisan Committee issued a report to assess the preparation and response to that historic storm, which killed more than 1,800 people.

"Four and a half years after 9/11, America is still not ready for prime time," it bluntly stated. "Government failed because it did not learn from past experiences, or because lessons thought to be learned were somehow not implemented."

That report and others like it called for dramatic changes in how the United States prepares for and responds to national emergencies. It recognized that our nation's failures during this crisis required deeper examination. "There was little question that Katrina had sparked renewed debate about race, class, and institutional approaches to vulnerable population groups in the United States," the report said.

But little has changed in the last 15 years. The pandemic has disproportionately affected Black and brown Americans, who are more likely than White people to be infected, hospitalized and killed as a result of Covid-19. We must identify and address the underlying causes that allow public health emergencies to impact some people more than others simply because of the color of their skin, what they earn and where they live. Dismantling structural racism must become America's ultimate public health intervention.

Although we are still in the throes of the pandemic, post-mortems are already being written. However, the thoughtful and insightful reports that have assessed America's failures and offered prescriptions for change -- including one I contributed to and one that the foundation I lead helped fund -- still fall short of adequately addressing the historic and ongoing neglect that continues to harm communities of color.

As the Biden administration and the 117th Congress set their sights on fixing what has gone wrong with the US response to Covid-19, health equity must be the central focus. We have a chance to get this right if we recognize that public health preparedness requires changes that go far beyond our existing health care system and address our society's fundamental failures.

America's social safety net has gaping holes. The wealthiest nation in the history of the world continues to deny millions of its people the means and ability to live the healthiest lives possible. A more equitable approach must begin with some core needs:

Universal health insurance. In the first half of 2020, 30 million people in the US had no health insurance, according to an estimate from the National Health Interview Survey. Pandemic-related job losses have exacerbated this.

Paid sick and family leave, and affordable childcare. Millions of workers with high risk jobs have been forced to continue going to work, even if they become ill or are exposed to someone who is because they have no paid time off. Childcare -- if available -- is often out of reach financially.

Increased nutrition assistance. More than 35 million people already lived in food-insecure households in 2019, according to the US Department of Agriculture. Between March and September 2020, an additional six million people joined the Supplemental Nutrition Assistance program (SNAP), reflecting increased levels of food insecurity fueled by job loss and wage reductions. Permanent increases in SNAP benefits could improve children's health, reduce poverty, lower food insecurity and help jumpstart the economy.

A living wage. Congress has not approved an increase in the federal minimum wage since 2007, a failure that is particularly galling considering the rise in wage inequality in the US over the past 40 years.

Affordable housing. Quality, stable housing has a strong connection to health. The US housing crisis showed up loud and clear during this pandemic, particularly for people of color who tend to spend a greater share of their income on housing. Federal policies must be enacted so that housing becomes a fundamental right.

School funding. Children of color have been hit hardest by learning loss resulting from pandemic-related school shutdowns, and too many schools in underserved communities are at an inherent disadvantage when it comes to having the resources and equipment to reopen safely. These inequities will further widen educational disparities.

One could predict, even a year ago, how the structural vulnerabilities and frayed social safety net would hurt us as Covid-19 began to spread. It was clear that communities of color, people in nursing homes and jails, and frontline workers would suffer most. The script played out just as we knew it would, and the US life expectancy numbers released last month provide sobering and succinct clarity: Black Americans lost 2.7 years, Latinos 1.9 years and Whites 0.8 years.

A lesson I learned both as acting director of the US Centers for Disease Control and Prevention in the early days of the H1N1 pandemic in 2009, and before that as head of the agency's Terrorism Preparedness and Emergency Response work (a position I began just a few hours before Hurricane Katrina came ashore) is that our elected officials have a brief and limited window of time to enact policies to address such structural deficiencies. They rally to support pressing needs during a public health emergency and its aftermath, then turn their attention elsewhere.

We see this play out starkly with respect to public health funding in the US -- to wit, the CDC's budget for public health preparedness and response programs has been cut in half over the past decade, even as our needs have grown. We've seen a similar erosion at the state and local level, with funding cut by nearly one-third since 2003.

When the lessons of the previous crisis are left behind, neglected systems remain our status quo. We tend to focus on the immediate and visible deficits but rarely stop to thoughtfully consider what it would take to make sure that everyone in America has the means and ability to weather the next storm, whether it be a hurricane or a pandemic.

We've reached a cautiously optimistic point in the Covid-19 crisis. Caseloads and deaths are trending downward across the US, more Americans are being vaccinated and schools are beginning to reopen. If we continue to follow public health guidance in the days ahead and Congress comes through with additional relief, we can feel hopeful that this is the beginning of the end of this pandemic. But as good as that sounds, we cannot rest until we are ready for the next public health crisis.

The outrage from the injustices of Hurricane Katrina was not enough to drive real change in America. A question from that House Select Bipartisan Committee Report haunts us, even today: "With Katrina, we have had the catastrophe, and we are racing inexorably toward the next. Americans want to know: what have we learned?"

We have seen this pandemic's devastation. The question is, what will we do so that this never happens again?

This story was first published on CNN.com 'Here's what we need to do to prevent another pandemic from devastating the vulnerable'