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.
Thank you for your commentary! I totally agree and support the need to separate our health and science from politics. The price to citizens is too high to be pawns in political aversions.
If this crisis only concerned mere physical health, your stance would make sense. However, what about consulting an interdisciplinary panel of experts on a crisis of this magnitude? This crisis is affecting people psychologically, economically, and socially in many areas. My mother-in-law is working in a nursing home, and says the elderly are losing the will the live because of COVID restrictions that prevent them from seeing relatives as much as they like. Are their lives or the lives of those who’ve become suicidal due to economic hardship worth considering? As a schoolteacher of small children, I fear the long term effects of educating children in oversterilized and impersonal ways that limit social interaction and and reduce exposure to healthy bacteria and human touch. This crisis is beyond the expertise of public health officials.
I agree with Michelle and S. Yoder. I find it interesting that most the people who want the government totally in control of the medical system are Democrats and some are on Biden for President teams. How unbiased is their opinion, really?
One more thing to get rid of IMO is this foolish sense of American people for individual and personal liberty! We must comply rigoro
usly to wear PPE masks at all times outside of their homes, to agree to shelter at home, to adhere to quarantine when necessary, stop whining about July 4 Beach closings, and cooperate fully with healthcare authorities for contact tracing, and most importantly to agree to be vaccinated when an effective vaccine becomes available to establish herd immunity.
Chance of all these happening?
I completely agree with this piece. Well said.
First, the US is a republic instead of a true democracy. Second, no one had ever seen this virus before so there was bound to be some conflicting information put out as everyone scrambled to figure it out (of which was only increased due to politics beholden to all but the common people and lack of coordination). What’s allowed this to continue is the fact people aren’t falling over convulsing and bleeding outside of closed rooms – in other words visible enough to the public to instill an appropriate level of fear where scientific and medical reasoning fails. But that scenario would be even worse economically, so we need to fix this issue that has been identified before we run into something like that reaching our shores again.
This proposal would only be accountable to the people if it was like judicial elections at the state district level and less like judicial appointments at the federal level (Supreme Court has long been political). Of course that assumes things like medical degrees are required and those voting have some basic education in real vs pseudo science. The latter assumes those appointing have that as well. The FCC has managed to be political in it’s functions, even prior to current, increasingly over time so not the best example.
With the flaws of being human nothing will be perfect, but sadly only those who care about “next time” will study what went wrong and right with others and try to come up with how to fix it. And, in my opinion, until we the people stand up and clean house of those who didn’t even try something (remember this was new so no one would get it right until more data was gathered) it’s only going to stay the same or get worse. Not to mention how people are going to to feel when long term affects come out (read some autopsy reports, MRI studies, etc about organ damage) and then try to still tell people it’s not as bad as the flu.
Please send me follow up comments.
This is a very non-Democratic approach. People need — and deserve — to feel that THEY have a say. There is much disagreement among health professionals about the right way to proceed (to have proceeded) in response to the coronavirus. To lock down …. not to lock down …. what, specifically, is considered “essential”? To close schools and prevent young people from having any outlet for their energy or the social contact that they absolutely need …. to deliberately put millions of Americans into what will likely be generational poverty …. to prioritize those with comfortable jobs that can be done from home over those whose livelihood depends on businesses deemed “non-essential”. How to treat patients in a health care setting is a medical, scientific question (about which there is little agreement), how to ADVISE the public is a medical, scientific question. Setting the POLICIES relating to lockdown, masks, etc. are 100% purely political questions — and they should be resolved entirely by the body politic. Where I live people are very likely to vote out the mayor after one term (as soon as they can) — because he is blindly following a public health expert who was not elected and does not seem to understand (or care about) the people he is harming with his recommendations. What this article is proposing is that people have NO recourse over the public health personnel that glibly destroy lives and mental health in the name of preventing or slowing the rate of transmission of a virus that seems to be impervious to all of these health personnel’s edicts. That is entirely anti-Democracy.
I served as the director of infection control at two different hospitals in my career prior to retiring and interacted with public health officials frequently. I do not take the author as suggesting these public health officials should be granted absolute power. They should be deferred to in their areas of expertise. President Kennedy didn’t hold a referendum on the design of the Saturn V rocket to launch the Mercury and Apollo programs.
Granted that is an extreme analogy and, yes, this is a novel disease that consequently led to initial disparities in identifying effective containment strategy. Given the lack of safe vaccines, our only options were to identify infection cases, trace contact exposure, and limit spread. As a society, we did none of that effectively at the outset because of small D democratic push-back and inappropriate political interference in science based public health policy. I agree we need to open schools and restart jobs. While doing so, if we do not listen to the actual experts and follow reasoned advice, as opposed to allowing political grandstanding to determine strategy, we face a potentially more severe economic impact that could devastate an already precarious economy.
Which is more important Julie? Public health or personal freedom? Remember what Spock said to Captain Kirk? The needs of the many outweighs the needs of the few!
US, home to the sloppiest, most dickentian response to an epidemic ever
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