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In early March 2020, , a bodybuilding competition that draws thousands of athletes from around the world, not to mention millions of dollars, was slated to take place in Columbus, Ohio.

At that point, coronavirus cases had been found in 77 countries, 120 infections had been spotted in the U.S., and about nine people had died stateside. And that was the moment, just 2 days before the festival was to start, that Mysheika Roberts, MD, MPH, the commissioner for Columbus Public Health, followed the data and "my gut," she said, and .

But Ohio Gov. Mike DeWine (R) "quickly called into question" Roberts' decision, she said.

After several conversations with DeWine, the state health commissioner, the mayor, the event organizers, and Arnold Schwarzenegger himself -- the event's namesake -- Roberts said, they chose to cancel every event except for one, and no spectators were allowed at the festival.

"It was a tough decision, and I received a lot of negative pushback, but ultimately it was the right decision to make," she said during hosted by the American Public Health Association, the Alliance for Disease Prevention and Response, and the COVID Collaborative.

Just days after the festival would have taken place, the .

In the beginning, public health officials in Columbus collaborated with local and state government leaders to help keep the city safe, Roberts said. Soon afterwards, however, the state legislature began passing laws aimed at restricting the same powers that had helped protect communities from COVID-19.

Now, Roberts said, she and other health commissioners must look to their elected officials -- in her case, the mayor of Columbus and the city council -- before any public health measures can be enacted. And that includes mask and vaccine mandates.

Roberts said she is lucky to have a supportive mayor and city council, but other Ohio officials and communities aren't as fortunate.

"Their hands -- public health hands -- have been tied," she said. And while some are "sitting back," believing themselves to be powerless in the face of these pressures, others are doing their best to use the resources they have. For example, issuing "mask advisories" instead of mandates, Roberts said.

In June 2020, the National Association of County and City Health Officials issued a report citing laws that were passed or being considered in over a dozen state legislatures that the association argued could threaten public health. These include a law a law that under any circumstance, and an Ohio law that would allow the legislature to revoke any action by the state health department or director of health. (DeWine attempted to veto the law, but his veto was overridden by the legislature.)

Kansas is another example of a state attempting to curb the authority of public health officials.

Former Kansas Gov. Kathleen Sebelius (D), an HHS secretary during the Obama administration, said the legislature there is "busily drafting laws" that not only oppose mandates for COVID-19 but are also opposed to any vaccines, including measles, mumps, or rubella, being a requirement for children to attend school.

"That would be a terrifying step back in our public health future," Sebelius said.

Hemi Tewarson, JD, MPH, executive director of the National Academy for State Health Policy, agreed that many of the recently passed laws aimed at public health are a response to "cultural tensions" and "public concerns" born out of COVID fatigue. Many of those laws "limited or reallocated" state and local health officials' authority related to masking, vaccination, quarantines, and school closures -- "core public health authorities" that need to be leveraged in a pandemic, she said.

But states have also passed laws aimed at improving public health, based on lessons learned from the pandemic, Tewarson said. These are laws focused on "collective decision-making," actually strengthening local public health powers, increasing transparency, and laws around the best way to invest federal health dollars to increase public health capacity.

Examples include laws aimed at creating commissions to study a state's public health response, to establish advisory boards that provide feedback related to a state's public health infrastructure, and laws to expand scope of practice for emergency medical technicians, dentists, optometrists, podiatrists, pharmacists, and pharmacy technicians to be allowed to administer vaccines.

"[W]hen you really dig into the laws themselves, nothing is simple and straightforward," Tewarson said.

One state law gives the legislature expanded authority, but also calls for public health emergencies to be subject to the State Emergency Management Act, which Tewarson said could help by improving planning and coordination across state agencies.

In addition, Tewarson stressed the need to improve "antiquated" public health data systems to make them interoperable, and to "rebuild public trust in public health ... because that will then be reflected in the laws that are passed and the actions that are taken by elected leaders."

Sebelius agreed, echoing the focus on improving data systems and trust, and also highlighted President Biden's proposal to establish a "major health corps" of hundreds of thousands of trained health workers or "" as they are called in border communities. These workers can go door-to-door, making sure that pregnant women know how to get prenatal care, for example, or that neighbors know how to get help during an outbreak, Sebelius explained.

"I think that kind of neighbor-to-neighbor, person-to-person effort, particularly in our most vulnerable communities, could be a huge step forward in building a public health infrastructure back in the United States," she said.

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