Despite troubling reports of harassment and threats targeted at public health officials over the past few months, public confidence in the science community has remained strong for several decades. In a recent Pew Research Center survey, 79% of Americans said they had a great deal or a fair amount of confidence in scientists to act in the best interests of the public, while only 25% said the same about elected officials.
If we respect and trust scientists, why do we give politicians more power for decision-making about issues that directly affect our health?
As the U.S. approaches 130,000 deaths from Covid-19, we should be able to look to the Centers for Disease Control and Prevention (CDC), arguably the world’s leading public health institution, for unfiltered and unbiased analysis and guidance. Yet instead of leading the response, the CDC’s repeated early warnings of Covid-19’s potential for devastating impact were ignored; the White House prevented it from sharing comprehensive, science-based messaging the public desperately needed; and its guidelines for safe economic reopening were softened by the White House.
Unfortunately, this is not the only example of presidential interference with the CDC’s response to a pandemic. In the past 40 years, two global pandemics were each made worse by political interference that sidelined and muzzled CDC’s public health leaders and scientists.
By the time President Reagan delivered his first major speech on the AIDS crisis in 1987 — six years after the disease was first reported in the United States — more than 25,000 Americans had died of the disease. Much more could have been done in those six years had public health experts led the charge. We are seeing much the same thing with Covid-19 as we live through a worst-case scenario with deaths and illnesses that could have been curbed with sound public health leadership unencumbered by political interests.
Political interference with public health is not unique to the federal level. An analysis by Kaiser Health News and the Associated Press found that at least 34 state and local public health leaders across 17 states have announced their resignations, retired, or been fired since April. Some were forced out because of policy disagreements; others stepped down after being harassed, even receiving death threats, from community members.
When public health leaders are driven from their jobs because elected officials grow weary of their evidence-based resistance to more aggressive economic reopening, required mask-wearing, or relaxed social distancing requirements, the consequences affect everyone. The number of new COVID-19 cases are increasing in many states and cities where elected officials have either ignored or silenced public health officials with whom they disagree.
We are seeing firsthand what happens when partisanship is prioritized over the public’s health and well-being. We need structural change to ensure this doesn’t happen again. We must ensure that public health leaders working in federal, state, and local governments cannot be easily sidelined or forced out during the next public health crisis. Fortunately, there are existing solutions at each level of government.
At the federal level, the CDC’s responsibility to the executive branch is problematic. Remarkably, no statute sets the minimum qualifications of the CDC director. It’s not an exaggeration to say that the president could appoint a friend or a family member to lead the agency. What limits would an anti-vaccine president, for example, put on vaccinations and other medical and public health issues?
In areas that Congress has determined should be conducted with some degree of autonomy from presidential, and arguably partisan, control, it has created independent agencies such as the Federal Communications Commission, the Securities and Exchange Commission, and the National Labor Relations Board. To ensure science-based responses to our nation’s most challenging public health crises, it is time to release the CDC from the grasp of the executive branch. If Covid-19 has taught us anything, it should be that the nation’s health should never again be susceptible to partisan control.
At the state and local levels, part of the answer may lie in boards of health. To empower state and local health officials to provide factual, unbiased information to the public with limited partisan influence, they should report to local boards of health instead of to single elected or appointed officials. State and local boards of health in the United States have been around since the late 18th century. Their responsibilities differ substantially, but they are an existing infrastructure that, if empowered to do so, could help to insulate state and local public health officials from partisan interference. Research has shown that when a state health official reports to a board of health rather than a secretary of health or governor, the length of their tenure doubles, suggesting that those health officials are less susceptible to partisan dictates.
Of course, none of this is foolproof. While executive control can be limited, political influence is harder to regulate. Yet by shifting the oversight of federal, state, and local public health agencies from single, elected officials to boards or commissions with staggered terms; ensuring a balance in the party affiliations of commissioners; guaranteeing seats for community members, public health practitioners, and medical professionals; and requiring legislative confirmation, we can encourage greater autonomy and preserve the evidence-based, scientific voice even in times of extreme political polarization.
If Americans wouldn’t consult their mayors or congressional representatives about personal health issues, then it reasons that decisions about responding to a historic pandemic should be driven by health experts and scientists, not politicians. We can’t simply survive this current crisis and then continue to accept a system that puts partisan politics ahead of health. In this moment, when public health professionals have never been more essential yet have never been more silenced and threatened, we must confront the dangers of partisan influences on scientific decision-making and restructure these outdated systems of leadership.
Brian C. Castrucci is the president and chief executive officer of the de Beaumont Foundation.